Hearings to examine how the Older Americans Act uplifts families living with aging-related diseases.

1[Senate Hearing 119-261]2[From the U.S. Government Publishing Office]34                                                        S. Hrg. 119-26156                    RENEWING OUR COMMITMENT: HOW THE7                  OLDER AMERICANS ACT UPLIFTS FAMILIES8                   LIVING WITH AGING-RELATED DISEASES9=======================================================================1011                                HEARING1213                               BEFORE THE1415                       SPECIAL COMMITTEE ON AGING1617                          UNITED STATES SENATE1819                    ONE HUNDRED NINETEENTH CONGRESS2021                             FIRST SESSION2223                               __________2425                             WASHINGTON, DC2627                               __________2829                            NOVEMBER 5, 20253031                               __________3233                           Serial No. 119-173435         Printed for the use of the Special Committee on Aging3637[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]3839        Available via the World Wide Web: http://www.govinfo.gov40                                __________4142                   U.S. GOVERNMENT PUBLISHING OFFICE4362-490 PDF                  WASHINGTON : 202644-----------------------------------------------------------------------------------4546                       SPECIAL COMMITTEE ON AGING4748                     RICK SCOTT, Florida, Chairman4950DAVE McCORMICK, Pennsylvania         KIRSTEN E. GILLIBRAND, New York51JIM JUSTICE, West Virginia           ELIZABETH WARREN, Massachusetts52TOMMY TUBERVILLE, Alabama            MARK KELLY, Arizona53RON JOHNSON, Wisconsin               RAPHAEL WARNOCK, Georgia54ASHLEY MOODY, Florida                ANDY KIM, New Jersey55JON HUSTED, Ohio                     ANGELA ALSOBROOKS, Maryland56                              ----------57                McKinley Lewis, Majority Staff Director58                Claire Descamps, Minority Staff Director5960                         C  O  N  T  E  N  T  S6162                              ----------6364                                                                   Page6566Opening Statement of Senator Rick Scott, Chairman................     167Opening Statement of Senator Kirsten E. Gillibrand, Ranking68  Member.........................................................     26970                           PANEL OF WITNESSES7172Erick Montealegre, Family Caregiver, Broward County, Florida.....     473Stephen Sappington, Patient Advocate, Harford County, Maryland...     674Duana Patton, USAging President, CEO, Ohio District 5 AAA,75  Ontario, Ohio..................................................     87677                                APPENDIX78                      Prepared Witness Statements7980Erick Montealegre, Family Caregiver, Broward County, Florida.....    2681Stephen Sappington, Patient Advocate, Harford County, Maryland...    2882Duana Patton, USAging President, CEO, Ohio District 5 AAA,83  Ontario, Ohio..................................................    308485                        Questions for the Record8687Erick Montealegre, Family Caregiver, Broward County, Florida.....    3588Duana Patton, USAging President, CEO, Ohio District 5 AAA,89  Ontario, Ohio..................................................    369091                       Statements for the Record9293AARP Statement...................................................    3994American Foundation for the Blind (AFB) Statement................    4295Alzheimer's Association and Alzheimer's Impact Movement Statement    4496Defeat Malnutrition Today Statement..............................    4797National Academy of Elder Law Attorneys Statement................    5098National Association of Nutrition and Aging Services Programs99  Statement......................................................    52100National Rural Health Association Statement......................    54101VISIONS/Services for the Blind and Visually Impaired Statement...    58102103                    RENEWING OUR COMMITMENT: HOW THE104                  OLDER AMERICANS ACT UPLIFTS FAMILIES105                   LIVING WITH AGING-RELATED DISEASES106107                              ----------108109                      Wednesday, November 5, 2025110111                                        U.S. Senate112                                 Special Committee on Aging113                                                    Washington, DC.114    The Committee met, pursuant to notice, at 3:30 p.m., Room115216, Hart Senate Office Building, Hon. Rick Scott, Chairman of116the Committee, presiding.117    Present: Senator Scott, McCormick, Moody, Husted,118Gillibrand, Warnock, Kim, and Alsobrooks.119120                 OPENING STATEMENT OF SENATOR121                      RICK SCOTT, CHAIRMAN122123    The Chairman. The U.S. Senate Special Committee on Aging124will now come to order. Today, we are once again talking about125an incredibly important issue that affects millions of American126seniors and their families, the reauthorization of the Older127Americans Act, OAA, and its impact on seniors with age related128conditions like Alzheimer's and Parkinson's.129    The OAA is one of the most quietly impactful laws this130country has ever passed. It is the reason a senior in Naples131gets a warm home-delivered meal through Meals on Wheels. It is132the reason a daughter in Pennsylvania can take a few hours of133respite after spending the night caring for her father with134Alzheimer's.135    It is the reason a man in West Virginia with Parkinson can136still get to a physical therapy appointment using137transportation services. It is the reason senior centers across138the country, including New York, can help coordinate with all139of these things to support older Americans and their families.140    These are just a few examples of the faces of this law.141When we talk about reauthorization, we are talking about142protecting the people who raised us, served our country, built143our communities, and now simply need a bit of our support.144Across the United States, more than seven million older145Americans are living with Alzheimer's, including more than146580,000 in my home State of Florida.147    Alzheimer's steals memories and independence, often turning148spouses and children into full-time caregivers overnight.149Nearly one million Americans live with Parkinson's disease,150which slowly robs people of movement, balance, and speech, but151not of their determination or dignity. Each year about 90,000152new cases are diagnosed, and behind each one is a family153learning to adjust, adapt, and to persevere.154    Behind each of these numbers is a caregiver, a husband, a155wife, a son, or a daughter providing care around the clock.156More than 11 million Americans provide unpaid care for people157living with Alzheimer's or another Dementia. Together, they158give 19.2 billion hours of informal assistance valued at $413159billion, and that doesn't even include caregivers for160Parkinson's, ALS, or other chronic diseases of aging.161    These are people holding down jobs, raising children, and162still finding time to feed, bathe, and comfort a loved one who163depends on them. They do it out of love, and they deserve our164support. That is why the Older Americans Act is so vital. It165works because it is not a big Government approach. It is166directing resources to local communities. It is neighbors167helping neighbors.168    In Florida, I have seen the impact firsthand through our169Area Agencies on Aging, our senior centers, and the volunteers170who deliver meals, install ramps, and check on seniors who live171alone. For families living with Alzheimer's, Parkinson's, and172other age-related diseases, these programs are not luxuries,173they are lifelines. They meet a hot meal, a safe home, a few174hours of rest for a caregiver, or a ride that keeps someone175connected to their community.176    When we talk about reauthorizing the Older Americans Act,177we are not just debating policy. We are renewing our commitment178to America's seniors. A commitment that in the United States,179we will stand by our parents and grandparents as they age, and180that when disease or disability strikes, families will not have181to face it alone.182    Every service made possible by this law represents183compassion made real. That is what governments should do,184empower communities to care for one another and let them direct185resources to meet their local needs because they understand186their communities far better than anyone in Washington, D.C.187does.188    I have said it before and I will say it again, our seniors189have spent their lives building and serving this country, and190this bill is one way we ensure they continue to be supported,191respected, and valued. I am proud to be leading the192reauthorization of the Older Americans Act this year with193Ranking Member Gillibrand, helping committee Chairman Cassidy194and Ranking Member Sanders.195    I urge all my colleagues to support this important196legislation so we can continue to honor, protect, and care for197America's seniors and the families who stand beside them each198and every day, and now I would like to recognize Ranking Member199Gillibrand for her opening statement.200201                 OPENING STATEMENT OF SENATOR202             KIRSTEN E. GILLIBRAND, RANKING MEMBER203204    Senator Gillibrand. Chairman Scott, thank you for calling205today's hearing, and thank you to our witnesses for being here.206    I am greatly looking forward to our discussion on how our207Older Americans Act provides vital life sustaining supports to208older adults and people with disabilities that allow them to209live with dignity and independence in the community of their210choice.211    Many Americans don't realize that the OAA even exists, even212though an estimated one in six older adults and millions213nationwide are helped by OAA funding and programs that it runs214each year. In 2024 alone, the OAA allowed older Americans to215receive over 240 million meals at home or in a community216setting, over 14 million trips to a doctor, the supermarket, or217community events, and over 10 million hours of help with218everyday tasks like dressing or bathing.219    The OAA is a bipartisan workhorse program that flies below220the radar. It helps fill the gaps and serves as connective221tissue that improves the efficiency of federal programs like222Medicaid, Medicare, Social Security, SNAP, and LIHEAP. Older223adults and people with disabilities want to live and thrive in224their communities, and the essential supports administered225under the OAA allows them to do just that.226    It's just a bonus that it's also cost efficient. Providing227services to the community saves taxpayers billions of dollars228every single year that would otherwise pay for extended stays229in the hospital or institutional care, like nursing homes,230which are far, far, more expensive. In 2024, OAA funding231generated 3.39 times the return on that investment. This means232that every dollar invested in OAA aging services generated233$3.39 in community value and taxpayer savings. Furthermore,234because of the efficient service delivery, older adults avoided2351.9 million days of long-term hospital stays and institutional236care but now is not the time to take our foot off the gas.237    Authorization of the Older Americans Act expired last year.238Even though so far there have been limited interruptions in OAA239service delivery because of this lapse, it is vital to pass a240reauthorization this fall to modernize the statute and be241reflective of the evolving needs of older adults.242    In June, I was proud to join Chairman Scott and our243colleagues in introducing a bipartisan Older Americans Act244Reauthorization of 2025. This bill reflects our bipartisan,245bicameral agreement that was included in last December's final246appropriations package, which unfortunately ultimately fell247apart.248    Particularly as the aging population is growing at the249fastest rate in our Nation's history and more Americans are250being diagnosed with aging related diseases each day, it is251crucial to reauthorize this legislation that allows for greater252flexibility and increased capacity under the law to meet the253need.254    In today's hearing, our witnesses will highlight how the255OAA helps families living with aging related diseases by256providing them with a variety of supportive and nutritional257services, health promotion programs, and support for family258caregivers. However, OAA services are just one essential piece259of this puzzle. It helps these families live well in their260communities now.261    Other bipartisan landmark laws, like the National Plan to262End Parkinson's Disease, and the National Alzheimer's Project263Act, which are currently being implemented by HHS, help to264chart the path for the future. They represent a federal265commitment to changing the trajectory of neurodegenerative266diseases that impact millions of American lives.267    As we continue this work, it is my top priority to ensure268that the voices and the needs of older adults and people with269disabilities are elevated in federal policy discussions,270particularly about the implementation of key statutes that271impact their lives today and for years to come.272    I look forward to doing this in my role as ranking member273of the Aging Committee and the Senate co-chair of the274bipartisan congressional Parkinson's Caucus, and the soon to be275formed Americans with Disabilities Caucus. I will always fight276to make sure that older adults and people with disabilities can277age with health, dignity, and independence in their homes, in278their communities, and in the setting of their choice.279    I look forward to hearing from our witnesses today about280how we can strengthen and administer the OAA to do exactly281that.282    The Chairman. I want to thank Ranking Member Gillibrand for283all of her hard work on all these issues, and I would like to284welcome our witnesses. Our first witness is Eric Montealegre.285Mr. Montealegre is a resident of Broward County in my home286State of Florida.287    Along with his sister, he is a caregiver for his father who288was diagnosed with mild cognitive impairment four years ago. He289also serves as a trained volunteer Alzheimer's Association290community educator and previously served as a long-term care291ombudsman. Thank you for being here. You may begin your292testimony.293294            STATEMENT OF ERICK MONTEALEGRE, FAMILY295               CAREGIVER, BROWARD COUNTY, FLORIDA296297    Mr. Montealegre. Thank you, Chairman Scott, Ranking Member298Gillibrand, and members of the Committee. Thank you for the299opportunity to testify today. My name is Eric Montealegre, and300I live in Broward County, Florida.301    I am a family caregiver, a volunteer with the Alzheimer's302Association, and a small business owner in the senior care303field. I have only been in the field for a short time, about a304year and a half, but every day reminds me of just how vital305programs supporting older adults are not just for families like306mine in Florida, but for the nearly 12 million family307caregivers nationwide who are caring for someone living with308Alzheimer's.309    Today, I speak to you first and foremost as a son, one of310four adult children doing our best to care for our father,311Alberto, who is living with stage three mild cognitive312impairment. I am proud to have him here today with me. As313November is National Family Caregiver's Month, it makes today's314hearing especially meaningful.315    Dad was diagnosed with mild cognitive impairment five years316ago, when we first noticed changes in 2019. Initially he lived317on his own, proud of his independence, but over time it became318clear that he needed more support, and he moved in with my319sister.320    We soon found ourselves learning, often through trial and321error, how to balance his independence with his safety, and how322to find resources that would help him stay connected both to323his community and to his family.324    Caregiving, as many of us here know, is emotionally taxing,325physically demanding, financially challenging, and it is a326full-time responsibility. With the help of our local Area327Agency on Aging, we accessed services under the Older Americans328Act, which have made a world of difference to his quality of329life.330    At first, Dad received home delivered meals, which ensured331he had healthy food and provided the reassurance of a daily332check-in. He then began attending a local adult day center,333which has become the heart of his day-to-day life, and in many334ways the heart is my story. Dad now participates in many335activities that keep him engaged and happy. Like he is learning336to play the piano and he does lots of art.337    He is able to exercise regularly and safely at the gym that338they have onsite. He gets to play chess daily, which is339something that he has enjoyed throughout his entire life and340allows him to remain socially and mentally engaged. He is 84341years old, and since attending the center, he started taking up342dancing, which has been a surprise to all of us. It is343encouraging to see him enjoying something new at this stage of344his life and it gives us hope and the ability to hold back the345progression of the disease.346    The center provides much more than just recreation. It347gives him cognitive stimulation, physical activity, social348connection, and dignity, and for my siblings and me, it gives349us respite and peace of mind. Knowing that he is in a safe,350engaging environment allows us to focus on our own families,351our own careers, and without constantly having to worry.352    I truly believe that the structure, consistency, and353connection that the center provides are key reasons why my354father is doing as well as he is today. It has allowed me to355step back from being his care manager and allows me to spend356time with him just being his son. Dad immigrated to the United357States from Columbia back in the 1970's.358    Over the course of the disease, he has lost some of his359English and now speaks primarily Spanish. This can make it360difficult for us to communicate with him on complicated topics361such as retirement benefits and planning. The center employs362bilingual trained staff who can speak to him in his native363language, helping him and us understand the complicated issues364that we need to know to make decisions around his care.365    It is hard to overstate what a relief it is to have366caregivers who truly understand him and speak his language.367They can often pick up on like nuances in his speech that even368sometimes I miss. Hispanics are one and a half times more369likely to develop Alzheimer's disease, making it all the more370important to prioritize high quality, culturally, and371linguistically appropriate programs.372    Programs funded through the Older Americans Act are doing373exactly that. They are meeting people where they are and374honoring their story. In my culture, caring for our elders is375part of who we are, and I hope that my children see that376example and carry it forward. Reauthorizing and strengthening377the Old Americans Act is an investment in our families, our378dignity, and the community.379    Its programs provide families like ours with structure,380valuable resources, support, and hope. I Hope that my siblings381and I can give dad the best care possible, and hope that as our382country ages, no family will have to walk this journey alone.383Thank you again for the opportunity to testify, and I look384forward to your questions.385    The Chairman. I think we all hope our kids are going to386take care of us. I hope so. All right, now we are going to387recognize Senator Alsobrooks to introduce our next witness.388    Senator Alsobrooks. All right. Thank you so much to389Chairman Scott and Ranking Member Gillibrand. I am really390pleased to introduce our next witness, Steve Sappington, who is391a constituent of mine from Harford County, Maryland.392    Mr. Sappington is a patient advocate who was diagnosed with393Parkinson's disease in 2015. Shortly after his diagnosis, Mr.394Sappington became involved with Rock Steady Boxing, which395provides boxing classes for Parkinson's patients that are396specifically designed to help mitigate symptoms.397    When funding provided through the Older Americans Act for398Rock Steady Boxing was in jeopardy, Mr. Sappington became a399driving force behind the creation of Rally Against Parkinson's,400a non-profit organization dedicated to protecting this vital401exercise, education, and wellness resources for people living402with Parkinson's.403    Mr. Sappington continues to advocate for the404reauthorization of the Older Americans Act and the405implementation of the National Plan To End Parkinson's Act to406better support Marylanders living with Parkinson's disease.407    Mr. Sappington, thank you so much for joining us today to408share your story. You may begin your testimony--actually we are409going to go to introduce one more witness--okay, and you can410actually begin your testimony now.411412            STATEMENT OF STEPHEN SAPPINGTON, PATIENT413               ADVOCATE, HARFORD COUNTY, MARYLAND414415    Mr. Sappington. Thank you so much. Hello, Chairman Scott,416Ranking Member Gillibrand, and members of the Committee. Thank417you for the invitation to join you today. My name is Steve418Sappington, and I am 73 years old. I am married to my wife Dee419for 51 years, and I was diagnosed with Parkinson's disease in4202015.421    We have five sons and nine grandchildren who keep us busy422and motivated. For over three years before my diagnosis, my423wife and I noticed a number of changes in my behavior. I was424taking tiny steps instead of long strides. My once clear425handwriting became illegible. We went to Longwood Gardens, and426I suddenly couldn't smell the thousands of blooming flowers. My427hands began to shake.428    My balance was deteriorating. I had no idea what429Parkinson's disease was. Dee urged me to see her family430physician who referred me to a neurologist. That is when I was431diagnosed in 2015. I was upset and frankly in denial. No one in432my family had ever had Parkinson's disease.433    At that time, Dee and a close friend who also had434Parkinson's--and she and a friend were attending a class called435Rock Steady Boxing, and these classes, they kept telling me for436weeks how great they were. I wanted nothing to do with it at437the time, why would I want to go to a boxing class? I was still438angry and ignoring the obvious, and I guess going to a class439would mean I had to recognize I did indeed have PD. Eventually,440I gave in, mostly to get them off my back.441    I went to observe a class secretly determined to hate it.442Instead, I found it interesting and even fun. Everyone was443friendly and welcoming. All had Parkinson's, had different444progressions, and they were doing exercise specifically445designed to counter the symptoms of the disease.446    I started going to three-hour long classes, four to six447times a week--I am sorry, three-hour long classes, four to six448time a week and noticed small but immediate results. I449faithfully went for 18 months, and then I heard that the450funding for these classes was in jeopardy. After talking with451the gym owner and certified trainers, I realized I couldn't let452the classes stop due to lack of funding.453    More than over 200 older adults with Parkinson's, people454like me, were benefiting from these free classes. I decided to455start a nonprofit to raise money to keep them going. In 2018, I456launched a nonprofit called Rally Against Parkinson's, or RAP,457to make that happen. We were all volunteers, mostly seniors458living with Parkinson's and some friends, learning as we went.459    With help from community grants as in the Older Americans460Act and our own fundraising, we were able to secure enough461funds to cover costs and keep every class free. That support462made it possible for hundreds of people with Parkinson's to463keep exercising, connecting and improving their health.464    Today, our program offers 10 free hour long classes each465week. It has been life-changing for so many. Programs like this466need secure, long-term funding. My neurologist tells me that my467Parkinson's symptoms have remained unusually steady, saying it468has never happened before in decades of her practice and469dubbing it a miracle.470    I went eight years without needing to increase my471medication, something very rare in a progressive472neurodegenerative disease like Parkinson's. I believe the473exercise and community programs like Rock Steady Boxing are a474big reason why. When I first heard my diagnosis, it rocked my475world. I didn't know what my future would hold. My balance and476energy were fading.477    I was skeptical of the boxing class originally, but I went.478That single decision changed my life. That is why the Old479Americans Act matters. Programs that provide transportation,480home delivered meals, caregiver support, and community services481make it possible for people like me to get to classes that482improve mobility, reduce isolation, and help caregivers483continue their vital work.484    I and many from Rock Steady Boxing class attend monthly485Parkinson's support group meetings, and caregivers attend the486caregiver support group monthly meetings, all funded by the487OAA. Thank you. These services don't cure Parkinson's. There488still is no cure, but they keep us moving, participating, and489connected while these researchers work toward better490treatments.491    My ask is simple, please reauthorize and fund the Older492Americans Act this year with strong support for Title III493services, nutrition programs, transportation, and caregiver494support. These investments help people with Parkinson's and495millions of other older adults stay in their homes, and496communities keep moving and stay connected.497    I also ask on behalf of the Parkinson's community that you498support robust federal funding for PD research and ensure the499implementation of the National Parkinson's Project Act and a500seated advisory council. These efforts are important pathways501to a cure. Thank you for the opportunity to share my story.502    I will be submitting a full written statement and look503forward to any questions that you may have. Thank you so much.504    The Chairman. Thanks for being here. I look forward to505hearing about the boxing. Okay, Senator Husted, if you will do506our next witness.507    Senator Husted. Thank you, Mr. Chairman. I would like to508introduce in Ohioan, Duana Patton. Welcome to the Committee.509Ms. Patton serves as the President of USAging, a national510organization representing the Nation's 600 plus Area Agencies511on Aging.512    In this role, she leads efforts to strengthen and modernize513the Older Americans Act and ensure that community-based514programs like home delivered meals, transportation, caregiver515support, and in-home assistance remain accessible to older516adults and their families.517    Additionally, Ms. Patton serves as the CEO of Ohio District5185 Area Agency on Aging, where she has worked to expand access519to dementia friendly services, improving workforce training,520and promoting partnerships across health and aging sectors. Ms.521Patton, thank you for joining us today, and please begin your522testimony.523524         STATEMENT OF DUANA PATTON, USAGING PRESIDENT,525            CEO, OHIO DISTRICT 5 AAA, ONTARIO, OHIO526527    Ms. Patton. [Technical problems]--sorry. Chairman Scott,528Ranking Member Gillibrand, and members of the Committee, thank529you for the opportunity to speak before you today. My name is530Duana Patton, and I am honored to serve as the CEO of Ohio531District 5 Area Agency on Aging, where I have worked for nearly53231 years.533    Our agency located in Ontario, Richland County, Ohio, is534one of 613 Area Agencies on Aging, or AAAs, located across the535Nation that helps older adults remain independent and supported536in their communities. I am also the board President of USAging,537the National Association of AAAs.538    On behalf of these agencies, and the millions of older539adults and family caregivers we serve, I want to express my540gratitude for your continued commitment to improving and541prioritizing the Older Americans Act. As the older adult542population in the United States continues to rise rapidly, AAAs543have seen increased demand for OAA programs and services across544the country.545    Strengthening the OAA, which is administered by the546Administration for Community Living, over the next decade will547be critical as it is the cornerstone of the Nation's non-548Medicaid home and community-based services, serving nearly 11549million older Americans per year. The Aging Network carries out550these services and includes state units on aging, Title VI551Native American aging programs, and tens of thousands of local552service providers.553    The OAA enables the local delivery of home and community-554based services, which are almost always less expensive than555institutional care provided in nursing homes or assisted living556facilities. The longer older adults can successfully age at557home, the better it is financially for families and the Federal558Government.559    For over 50 years, AAAs have served as the local leaders on560aging. We are social care experts and often the front door to561aging services, receiving referrals from caregivers,562physicians, and community partners, usually at a time when a563person is facing a new or increasing risk related to aging.564    The core services we provide include nutrition, supportive565services, caregiver support, health and wellness, and elder566rights. Our person centered approach recognizes the health of567the person and focuses on interventions that will foster better568outcomes. A good example of that is Ms. Gray.569    Ms. Gray was referred to our AAA following a hospital stay570for a chronic health condition. She was not complying with her571medication regimen and had poor eating habits. By providing572personal care in her home weekly and home delivered meals, Ms.573Gray has improved health both physically and mentally and has574not been admitted to the hospital since she started receiving575these services.576    This is a powerful impact of the Older Americans Act. There577are several OAA programs that provide critical support to older578adults with age-relating diseases. First is the Older Americans579Act Title III-B, Supportive Services, the bedrock of the Act,580and a lifeline for older adults needing in-home support.581    Then we have OAA Title III Nutrition Services Program, the582largest program in the country that provides nutrition services583to older adults in need. Additionally, OAA Title III-D,584Evidence Based Health Promotion and Disease Prevention Programs585support falls prevention and health management for older586adults.587    Title III-E, the National Family Caregiver Support Program,588supports the family caregivers of older adults. Last,589authorization of the OAA expired last year, and since the last590reauthorization in 2020, AAAs have identified new opportunities591to be even more responsive to the evolving needs of older592adults.593    In closing, the lessons we learned during the pandemic594underscore the importance of allowing AAAs to continue using595innovative practices that have proven effective. The timing of596this reauthorization is ideal. It gives us the opportunity to597strengthen what works, modernize where needed, and ensure the598Act continues to meet the needs of older adults, caregivers,599and communities across the Nation.600    Chairman Scott, Ranking Member Gillibrand, and members of601the Committee, thank you for the privilege to share my passion602and stories from the field. This day for me is particularly603meaningful, not only because it marks my mother's 82nd604birthday, but also because this opportunity stands as a605cornerstone moment in my career dedicated to serving older606adults like my mom.607    The Chairman. I thank each of you. You have great stories608about the importance of the OAA. Now we are going to go to609questions. Senator McCormick, would you like to go first?610    Senator McCormick. Thank you. Thank you all--thank you, Mr.611Chairman. Thank you, Ranking Member. Thank you all for taking612time to speak with us today. You bring such important613perspectives, and this is something that we are very focused on614in Pennsylvania with our aging population.615    Mr. Sappington, you have a unique perspective as both a616patient and an advocate for Parkinson's disease patients and617caregivers. How does the support you get from your community618volunteers compliment federally supported programs like those619covered under the Older Americans Act?620    Mr. Sappington. Volunteerism is the center of everything.621We wouldn't have anything if it weren't for volunteers and622people that we are working on. I hope I am answering your623question properly, but I think it works in concert with those624benefits provided by the OAA because the OAA provides many625services such as transportation, nutrition, and well, many626other services.627    I think without the people, the caregivers, and the628volunteers who support them, you wouldn't be able to have all629that. In other words, it wouldn't happen without--they are630synergistic, I guess.631    From my vantage point, all of these have been very632beneficial for all of us. We would not be able to sustain the633program that we have at all without that being the case,634without the OAA providing transportation, without providing635some of the programs that they have.636    I know that the support group meetings that I go to were637funded by the OAA. That is something that has been vital for us638to get information and get the word out to other people that--639through our volunteers, we are able to get large people640gathered for these meetings and get the word out about our641programs that we offer, so again, they kind of go hand in hand.642I hope that helps.643    Senator McCormick. Yes, it does. Thank you. You know, we644have more than 300,000 Pennsylvanians that suffer from645Alzheimer's, and nearly 50,000 Parkinson's patients live in our646Commonwealth. These numbers don't capture the hundreds of647thousands of caregivers who volunteer their time and resources648to support their loved ones.649    Mr. Montealegre--I hope I got that right--you know, your650firsthand experience, you know, with your father and so many651others in your community is extremely valuable. You have652touched on several services supported by the Older Americans653Act.654    What do you think is missing in the programs covered under655the OAA that would go a long way toward supporting Americans656with these neurodegenerative diseases?657    Mr. Montealegre. Thank you for the question. I think one of658the most important things is time. The sooner that the family659caregivers can learn what services there are at the diagnosis660point--a lot of families get diagnosed, they get told, and then661they get appointments with social workers who can give them a662multitude of options.663    The family needs to understand that the sooner they can get664their loved ones into treatment and therapy, the sooner they665can start pushing back on these diseases that do not have666cures.667    I think a lot of times there is a slight delay between668diagnosis and the start of community resource interventions. If669there is anything we could do to shorten that time or limit670that time, it would make an impact in everybody's lives.671    Senator McCormick. Thank you very much. Thank you, Mr.672Chairman.673    The Chairman. Thank you. Senator Alsobrooks.674    Senator Alsobrooks. Thank you so much to Mr. Chair and675Ranking Member Gillibrand. You know, like so many of my676colleagues, I am a part of what they call the sandwich677generation, which means that I am caring for a 20-year-old678daughter, and also I am really privileged to balance that with679the caregiving of my parents.680    I also hear daily from Marylanders who are caring for their681own family members, and I know how important the responsibility682can be. I share it with each of you in having a mother who is683suffering from dementia. My father was her caregiver, and he684has most recently turned ill himself.685    It is the case that so many adult children who are686balancing work, childcare, and caregiving, it can be a really687awesome responsibility. We know that a shutdown causes so much688fear and turmoil for so many people who are just wondering what689tomorrow will look like.690    Now, the Older Americans Act exists to bridge the gap for691caregivers, to ensure that older adults can live independently692and with dignity, and to support the families who care for693them. Last year, Congress got to the five-yard line on a694bipartisan reauthorization of this critical law before a tweet695by Elon Musk undermined the progress.696    At the very same time, the families are being requested to697do more with less, we know that this Administration has moved698to dissolve the Administration for Community Living, weakening699the agency responsible for coordinating the support nationwide.700Our responsibility is clear.701    We must reauthorize and strengthen the Older Americans Act702and ensure the programs and agencies that carry it out have the703staffing and stability needed to meet rising need, especially704during a shutdown that, in my opinion, has gone on too long. I705look forward to hearing from each of you today in discussing706how we can protect and strengthen the systems that our seniors707depend on so that they and their caregivers are supported and708not left behind.709    The first question for Ms. Patton or Mr. Montealegre, is710about the ACL cuts and shutdown. The Administration for711Community Living is the backbone of the Older Americans Act. It712keeps the Nation Aging Network coordinated and functioning, but713over the past year we have sweeping staffing reductions along714with a proposal to dissolve the agency altogether and fold its715functions into a larger, less specialized division at the716Department of Health and Human Services.717    Now, layered on top of these cuts, we are 36 days into a718shutdown that has frozen or delayed essential work across the719agency. Ms. Patton, what does it mean for families and720caregivers when the ACL loses staff, loses structure, and is721unable to operate its Older Americans Act programs?722    Ms. Patton. Thank you for the question. You know, I think723that is where the Older Americans Act, where we see its724greatest strength, is because it does start at the federal725level through state units on aging, all the way down to the726local level.727    You know, during the pandemic, the AAAs, we were required728to be very nimble and to come up with ways in which, during729trying times or challenging times, whatever the reason, to make730sure that individuals and families have the services and731supports that they need.732    When we think about the Older Americans Act and the way it733is designed, and the importance of the reauthorization, it is734making sure that no matter what is happening around us, that we735have the ability to serve the people in our communities, to736take care of the individuals in a timely way, and to think737about caregivers.738    You know, that is the value of the Older Americans Act is739because there is this federal perspective and the authority to740administer the Old Americans Act, but then it works its way all741the way down to the local level where we can be innovative and742responsive to the needs of individuals.743    Senator Alsobrooks. Thank you. Now, Mr. Sappington, first744of all, I want to thank you for being here today and for the745work that you have done in Maryland in keeping our community746exercised and moving in programs like the one that you have747been involved in.748    Your testimony, I think, underscores something really749important about the Older Americans Act, and it is how it helps750people to live well today and also helps people to have hope751for tomorrow. As someone who is living with Parkinson's, you752know personally what it means to rely on the day-to-day support753for long-term search for better treatments.754    I want to ask you, how do the services that the Older755Americans Act supports, like transportation, caregiver756resources, and community exercise programs, help people with757Parkinson's maintain functions, stay connected, and live well758day to day?759    Mr. Sappington. Thank you for the question. I will try to760do my best to answer that. The OAA provides vital support in761terms of the transportation and the caregiver support that762people with Parkinson's desperately need.763    The fact that it is a federal program and obviously needs764to be supported and reauthorized to prevent any disruptions and765access to critical support like home care, transportation, or766caregiver assistance.767    I am also going to say that the National Plan To End768Parkinson's Act would be something that would go hand in hand769with the OAA, because the OAA provides what people need now,770the services they need to get from point A to point B to be771connected and to continue to stay active, and as well as the772nutrition and the caregiver supports.773    The OAA is vital to people with Parkinson's and those that774have neurodegenerative diseases in the older population. They775both go hand in hand with the National Plan To End Parkinson's776Act.777    One is basically providing people what they need now to778live with their--older Americans to live their779neurodegenerative diseases, and the other looks for a permanent780end to those diseases, so they kind of work hand in. One is the781now cause. One is the future cure for it. I can't say enough782about the need for both, so thank you very much for that783question.784    Senator Alsobrooks. Thank you so much.785    The Chairman. Ranking Member Gillibrand and I would love it786if everybody on the Committee would co-sponsor the re-787authorization of the OAA. Let me turn it over to Senator Moody.788    Senator Moody. Thank you so much, Chairman Scott and789Ranking Member Gillibrand. Thank you for holding this important790hearing on a very important topic. Let me welcome my fellow791Floridian from Broward County, Eric Montealegre. I Appreciate792you being here.793    Thank you so much, and to all of our witnesses today. This794is so important, and these hearings help us not only highlight795how certain policies help Americans--the challenges that we796might face in getting policies pushed through Congress. This is797all part of that process and such an important part, and we798appreciate you taking part in today's hearing.799    I was raised by a mom who dedicated her entire career to800helping seniors, aging Americans, working with the groups that801are supported through the Older Americans Act. It is probably802no surprise when I became Florida's Attorney General, one of803the first things I did was set up a senior protection team,804which was an interagency team to focus on how we can better805serve aging Americans.806    As you know, we are the Sunshine State in Florida, but we807are also the Silver State, I like to say. It was so important.808I want to thank the attorneys that worked with me and the809investigators that worked with me.810    They did so much to protect seniors in our state, but I811think one of the things that gets lost in this piece of812legislation is that it authorizes grants for long-term care813ombudsman program, and specifically the Elder Abuse Neglect and814Exploitation Prevention Programs.815    I know that we have people here, a volunteer now with816Alzheimer's Association, but previously, I believe, sir, you817served as a long-term care ombudsman. I know, Ms. Patton, you818as well.819    I would just like to talk to you because so many of these820programs, and not just those that are specifically designed to821prevent or hold people accountable for abuse and exploitation,822but also the programs like Meals on Wheels and other programs823where we have interaction with our aging population so that we824can better identify those seniors that may be in need--I would825just like to hear from you how important those programs are to826our aging population based on your own personal experience.827    We will start with you, Mr. Montealegre.828    Mr. Montealegre. Thank you, Senator Moody. I like to think829of the ombudsman program less of a compliance program and more830of like a cooperation program. Residents oftentimes have needs831that they can have trouble expressing or maybe don't know who832to express those needs to.833    The ombudsman would uncover those needs through asking,834through developing relationships, and then bring those needs to835the management of a facility to try to resolve or to maybe just836bring that to awareness.837    Most of the time, when I was in the program, that was838exactly the case. It was a need that was not being addressed839because there was no awareness, and that was some of the best840work that I could do.841    Senator Moody. Are there any tweaks that you think need to842be made to the legislation--probably in many instances, once843you made them aware, that was remedied, and we were providing844better care, but do you think there need to be any tweaks in845the legislation to provide better coordination with law846enforcement when these instances might be identified?847    Mr. Montealegre. Well, the ombudsman are required848reporters, and there is a process in place--at least in849Florida, there is a process in place to report that to the850correct authorities when needed--immediately if needed so.851    I am not sure about legislation, but I would say that I852think there's an education piece that needs to be done at the853community level so that the residents are aware of their rights854and aware of what we can do to benefit them.855    Many times, I would tell somebody, hi, I am your ombudsman,856and they are like, what? Once they understand what my857responsibility was and my role was in supporting them, they858would open up. I think that is just a lack of clarity to the859population.860    Senator Moody. I will ask you, Ms. Patton, the same861questions.862    Ms. Patton. Thank you. Great question, and from our863perspective, in Ohio, at our AAA, we actually administer and864sponsor the Ombudsman Program, so I am very familiar with that,865and also, in parts of our region, we administer the Adult866Protective Service Program.867    I think one of the amazing things is that the Older868Americans Act allows AAAs to be the front door. A lot of times,869people are coming into a AAA at the front door needing870information and assistance, or a referral somewhere, and871through the process of, you know, talking with them and872building this trust, we often learn about things that are going873on in their lives that maybe they might not open up to that are874very appropriate for a referral to an ombudsman program or to875an adult protective services program.876    A lot of times people do find themselves in situations and877they don't even realize that they have rights or that they878might be exploited. The fact that the Older Americans Act879exists--and Area Agencies are across the country working with880ombudsman programs, whether they sponsor it, or it is somewhere881else in their community, or adult protective services, or law882enforcement.883    The fact the AAAs are boots on the ground in their884communities, we like to think that those collaborations happen,885and, you know, I think when we think about the reauthorization886of the Older Americans Act, and the fact that we want to embark887more flexibilities, that there can be more of that, more888collaboration at the local level to protect individuals.889    Senator Moody. Thank you, Mr. Chairman.890    The Chairman. Thank you, Senator Moody. Senator Kim.891    Senator Kim. Thank you, Chairman. Ms. Patton, I actually892just wanted to build off of what you were just talking about893there. You noted that Area Agencies on Aging are often front894doors for families navigating aging related challenges. I guess895I wanted to ask you, how can we strengthen coordination across896the local, the state, and the federal levels to make it easier897for older adults and caregivers to access the full range of898support that they need?899    Ms. Patton. I think that part of that comes with, you know,900awareness of what AAAs can do and do in their communities--901talking about it. I love the stories that the gentlemen have902shared here with me today, is that when there is this awareness903and there is conversations about things that are sometimes a904little difficult to talk about, it builds that collaboration.905    When the Aging Network, AAAs, other partner agencies can be906at the table and talk about policies, talk about funding, talk907about challenges that exist, then great programs and innovative908ideas come to be.909    Senator Kim. Because you are saying that they are where the910rubber hits the road, and as a result, you know, the insights911so they can be able to provide--can just really encourage that912kind of creative, innovative thinking?913    Ms. Patton. Absolutely. I think AAAs, you know, throughout914many, many years have been innovators. The Act has allowed us915to do that.916    Senator Kim. Yes. When we kind of zoom out a little bit, I917guess I just wanted to get a sense of your kind of overarching918priorities. You know, do you have ideas of what are some of the919most critical priorities that Congress should consider as we920are working to reauthorize the OAA, you know, to be able to921ensure that the programs are meeting the needs of today?922    Ms. Patton. I think it would be real easy for folks to talk923about funding. When we talk about the Older Americans Act, and924the way that it exists--and its purpose is to make sure that925there is this local perspective.926    That local organizations can work together to determine927what the needs are in their local communities, and that there928is flexibility to ensure that maybe the way that somebody needs929a home delivered meal in one part of the region or country is930not necessarily the same way somebody needs it in another part931of the country.932    Senator Kim. Yes. I appreciate that. Mr. Montealegre, I933guess there is something there that I felt like kind of934connected with things that you have talked about when you have935highlighted the importance of you know, culturally and936linguistically appropriate care. How can the OAA programs937better ensure that caregivers and older adults from diverse938communities have equitable access to this kind of support?939    Mr. Montealegre. Well, I think it is important to940understand that as people progress through the disease, very941often they start losing languages but then revert to original942native languages.943    It is important to us to understand, you know, where our944community came from so that we can train and bring in the right945people with the right skill set to support those people who946have for one reason, or another lost the ability to speak947English.948    That would keep them engaged with therapies and with949community resources that will help them stave off the950progression of disease.951    Senator Kim. Yes. I appreciate that. It is something that I952have been grappling with myself. My father is somebody who has953been declining quite rapidly over the last year, and actually954just a couple weeks ago we got the formal diagnosis of955Alzheimer's for him.956    He is somebody that has lost the faculty to speak English,957has reverted back to Korean. He doesn't actually realize he is958not speaking English. He thinks he is, but it has been very959difficult. There are very few places where we can get care--960caregivers and get that kind of support in Korean.961    It has been just very challenging to be able to do so in a962way that I feel like he is taken care of while I am here at the963Capitol, so, you know, I agree with you wholeheartedly on that964front, that we need to be pushing on that. I mean, look, just965as we are talking through this, you know, Chairman, I am966grateful that you brought this up because again, I really do967think and we have talked about this before, you know, this is a968unifying issue.969    You know, this is something that all of us understand as970part of the human condition in terms of what our families are971going through, and at a time when we are certainly having972deadlocks and challenges and other types of policy debates, I973do hope that our ability to draw upon just the struggles that974so many families are facing when it comes to aging related975challenges--I know, as I said, you know, we have kind of976plunged into the deep end as a family and it has been977overwhelming for us. It has been a very difficult last year.978    Things that I never realized that we would have to979confront, and to do so while I am also raising an eight year980old and a 10 year old has been a lot, and so, you know, this981isn't just academic to me or theoretical to me, and I am982grateful for you all coming on out here, talking to us about983this.984    You have my word that we will do everything we can here to985try to push forward on the reauthorization and do it in a way986that can provide help to so many Americans, so with that, I987will yield back, Chairman.988    The Chairman. Thank you, Senator Kim. Senator Husted.989    Senator Husted. Thank you, Mr. Chairman. Thanks to the990Ranking Member and you for hosting this hearing today. In991preparation for this hearing, I was doing a little research,992and I saw that this problem of isolation and loneliness is993getting worse. It did hit a--perhaps a peak during the COVID994pandemic, but as a trend, it is getting worse.995    I saw the report that said people between the ages of 15996and 80 reported feeling lonely and isolated--one in three997people found themselves in that situation, and that loneliness998and isolation is associated with an additional $6.7 billion in999Medicare spending.1000    If we can do better at eliminating the loneliness and the1001isolation, we get better health outcomes, people's cognitive1002decline is maintained for a longer period in their life, and1003better--higher quality of life, which is also important.1004Longevity, but also quality of life is a big deal, and I know1005that in doing some of the research, you see that, look, it is--1006I know my parents are 86 and 87.1007    They have each other and they have my brother and sister1008who live very near them, so they have that family structure1009that helps a lot. It helps a lot, but I know a lot of people1010don't have that. Our society, for a variety of reasons, in1011terms of family formation, the number of children, people1012having the mobility, and people living all around the country1013or all around the world--children, meaning their adult1014children--makes it harder on them.1015    I will start with my Ohioan, Ms. Patton. What have you seen1016over the years in these trends? Not just as a matter of policy,1017but as a society, how can we do better?1018    Ms. Patton. Well, I think certainly through the pandemic,1019social isolation really came, you know, to be. We started1020talking about it.1021    A lot of those statistics, we are very aware of those. I1022think that what we need to make sure that we are doing is not1023just saying that someone is socially isolated but meeting them1024where they are, and I think the gentleman over here talked1025about the fact that he was able to go to a senior center and1026didn't realize the value that that would bring. I like to tell1027the story real quickly, if I could.1028    We had a gentleman during the pandemic that could not go to1029the grocery store, was afraid to go out in public, but we had1030grab and go meals, and so, he came to the agency, picked up a1031grab and go meal, and you know, had nutrition--you know, better1032nutrition. He was diabetic. He was living on pop tarts and hot1033dogs. That is what he was eating because that is what he could1034fix.1035    After he began getting the grab and go meals, he lost1036weight, and his diabetic medication was reduced. In addition,1037he made friends because we made the grab and go meal experience1038something in which the individuals engaged with our staff and1039engaged with each other.1040    Today, that very same gentleman is coming to the congregate1041meal site and is healthier, happier, and certainly more engaged1042with the community. I think what we have to do is we have to be1043creative, and we have to think about what makes someone1044socially isolated and what would help them become more engaged1045in their community. It might not be going to a senior center or1046a meal program.1047    It might be that they become one of those volunteers in an1048innovative program that AAA has created where they pick up the1049phone and they are calling somebody else. It can be that1050simple.1051    Senator Husted. Yes. How is it? I mean, I know that every1052Agency on Aging is different. They are run by different--you1053know, this isn't administration. It is innovation. What are1054some of the examples or best practices that you have seen used1055to create that engagement?1056    Ms. Patton. One of the great examples is the phone a friend1057where seniors are engaged in telephone calls back and forth1058with each other. We have leveraged schools in our communities1059where we invite them to participate with us to have1060intergenerational programs where we can provide the1061transportation for a senior to get to the school and maybe read1062to a student.1063    In addition, you know, a lot of the Older Americans Act1064programs bring people into the home because people are1065remaining in the community versus in an institutional setting,1066and so, by working with meal providers, personal care1067providers, and people that are in the home, making sure that1068they are building a relationship with the individual.1069    Maybe sometimes they are bringing puzzles, or books, or1070things for people to do so that they can be more engaged,1071whether they are at home or in the community.1072    Senator Husted. Great. Thank you. Thank you, Mr. Chairman.1073    The Chairman. Ranking Member Gillibrand.1074    Senator Gillibrand. Thank you, Mr. Chairman. I wanted to1075ask a little bit about how the OAA connects older adults to1076multiple social services. Sort of a general experience from1077you, Eric, and Stephen, and maybe from you, Ms. Patton, you1078could tell me how it actually fits together.1079    Things like Medicaid, SNAP, LIHEAP, that our older1080Americans rely on, and how does this serve as an umbrella for1081organizational structure for delivery of critical services? In1082particular, how does it affect rural Americans, because one in1083five of our older adults are in rural America? Ms. Patton?1084    Ms. Patton. Thank you for the question. The Older Americans1085Act as the umbrella of many services allows us to connect1086people to the services that you had mentioned, Medicaid and1087SNAP.1088    A lot of times, we will work with individuals in our1089agencies that come to the front door or that are participating1090in a program, and we want to make sure that they are connected1091to the resources that are available to them, whether it is SNAP1092or Medicaid, but one of the things that we also do is we are,1093in many cases, a Medicaid diversion.1094    Trying to use the lowest cost intervention that is1095possible, the funding sources or programs that exist, and then1096connecting them to these services at the right time when they1097need them.1098    A really good example of SNAP is an individual that gets1099SNAP but doesn't have transportation is not going to be able to1100leverage those, so we have actually, in our network, been able1101to leverage the Older Americans Act services, and help people1102connect and use the services that they may be eligible for.1103    Senator Gillibrand. Understood. Stephen or Eric, do you1104have any anecdotes about how it has worked for you?1105    Mr. Montealegre. I will go next, so here in Broward, the1106agency serves as, like she mentioned, an umbrella organization,1107but they also are an experimental organization as well, where1108they are reaching out to technology companies, for example,1109like robot puppies or robot cats, to help people deal with1110isolation and feelings of loneliness, and as well as like radar1111for alert monitoring devices, things like that.1112    These are things that I wasn't even aware of that existed1113or were even needed, and I think the agency is constantly1114looking for other things that could help, and while--and then1115they vet those programs or products or resources.1116    Going to the agency gives us a sense of confidence that1117there is all these different things, and maybe these things1118work for us or not, but what we feel is they are safe to try,1119and they are safe to go talk to without possibly having our1120family members fall into some kind of bad situation or some1121kind of trap, and that certainty makes it easy for us to reach1122out to them and say, hey, you are a safe source, so the other1123organizations also funnel themselves automatically to the Area1124Agencies on Aging because they know that if they can get the1125agencies buy in and support, that the population, the community1126will reach out to them for help as well.1127    Senator Gillibrand. Understood. Stephen.1128    Mr. Sappington. Yes, I would like to say that grassroots1129programs are often the closest to the need and they see1130firsthand what helps older adults and people living with these1131cognitive diseases stay healthy and engaged. Increasing the1132funding for the Area Agencies on Aging so that they can partner1133with and support innovative community-based nonprofits.1134    Area Agencies on Aging can also offer technical support and1135guidance to older adults who want to start local programs but1136may lack the experience or resources, and transportation is1137also--on the OAA, transportation is often the biggest barrier1138for keeping older adults and people with Parkinson's and other1139neurodegenerative diseases----1140    Senator Gillibrand. Have you used any of those1141transportation services?1142    Mr. Sappington. Yes, I have.1143    Senator Gillibrand. Give us an example of where it made a1144difference for you.1145    Mr. Sappington. We have had--well, personally speaking, we1146have--I got a call from a gentleman that had just been1147diagnosed with Parkinson's.1148    He thought it was the end of the world. His parents had1149died. His girlfriend had just broken up with him. He went to1150the doctor and was diagnosed, and he came back in--ironically1151enough an infomercial was on, and I had reached out to some1152people in the media and was doing a thing on Parkinson's and1153how to fight back against that, and he thought his world was1154coming to an end and saw me giving my phone number, and I got a1155call from him. I spent the next two and a half hours walking1156him off the edge.1157    I ended up meeting with him halfway. He was 20--he was in1158Baltimore City. I was up around the Pennsylvania line, and1159anyway, we ended up meeting halfway and I hooked him up with a1160way to get from down 20 miles away from where he was to a Rock1161Steady Boxing class that he would be able to----1162    Senator Gillibrand. Oh, that is great.1163    Mr. Sappington [continuing]. be able to take advantage of1164that. That worked out very well. Thank you for that.1165    Senator Gillibrand. Thank you--thank you.1166    The Chairman. Mr. Sappington, tell me about your boxing.1167What do you do?1168    Mr. Sappington. It is fun. Well, first of all, I want to go1169back and say I did tell all the gals that were trying to get me1170to go that they were right.1171    The Chairman. It is always better.1172    Mr. Sappington. Yes, yes it is. You recognize that sooner1173is always better later, but they play music, and everything1174they do is designed to combat the symptom of Parkinson's, and1175Parkinson's is one of those things where you have--you know,1176your brain and interferes with your muscles' ability to respond1177and your body. That is why they get the dyskinesia and the1178shakes, and your body not behaving the way that it should.1179    First of all, they play rock music of our generation, which1180gets you involved with it. You know, so you are there from a1181musical standpoint. That is wonderful, and then they give you1182short commands where you have to use your brain and your mind1183to stay active. Like, you are going to throw x amount of1184combinations of punches into heavy bags, or you are going to--1185they have ladders painted on the floor, and you have to step in1186and step out of them in much the way you see football players1187do between tires.1188    Ours are not between tires because we would be falling all1189over the place, so these are just painted on a floor, and you1190would have to use your footwork, and you have to have strength1191in your brain to tell your muscles what to do, and if you keep1192doing that, the muscle memory becomes very strong, and it can1193override some of the symptoms, and that is wonderful.1194Parkinson's even takes away your voice, and my voice used to1195not very often be this soft, but even with the commands that1196they give you, you have to use your voice to holler back, so1197you get you to--the more you exercise it, the more can1198strengthen your voice, so it works out very well.1199    The Chairman. You don't have to box a person.1200    Mr. Sappington. No. That was one of the things that I1201harbored under when I first heard it. Why would I want to go1202boxing, you know, but----1203    The Chairman. I already have a problem. I don't need1204another one.1205    Mr. Sappington. Right. No, but I appreciate the question.1206That is exactly where I was, at least from my standpoint, so,1207thank you.1208    The Chairman. Mr. Montealegre, how would you find these1209services? How did you even find out about them?1210    Mr. Montealegre. Not fast enough, to be perfectly honest.1211We started, you know, using internet searches to try to find1212and see what options there were. I think that is where we1213started getting confused. I think if you put in, you know,1214dementia, any of those kind of searches, tons of things come1215up.1216    After having gone through several rounds of talking to the1217wrong people, I found the right people, and they were able to1218get us in to take classes for us so that we could understand1219what was going on, so we could learn about what dementia1220progression looks like. What some symptoms are that might1221happen.1222    What adaptations we can make to help our family members. It1223is that kind of education that really gave us the confidence to1224keep looking. At that point, we don't even know what we don't1225know, so when you don't know what you don't know, you don't1226know what to look for.1227    Being in those classes, it tells you this is what you need1228to look for, this is what you need to look for, and it is1229really developing like a new vocabulary for things that we had1230never heard of before.1231    The Chairman. Ms. Patton, can you tell me--do you have any1232other stories you want to tell us about how you have changed1233people's lives?1234    Ms. Patton. Thank you for asking, so, I have been very1235inspired by both of the other witnesses here today and the1236questions that have come from the Committee. I think that, you1237know, what I would really like to just share is the things that1238we have just talked about here, this discussion has inspired me1239to think about, you know, the value of the Older Americans Act,1240the value of conversations like this with people that can tell1241stories and that can make a difference in policy and in1242practices.1243    It saddens me when Eric says that he didn't get the1244information fast enough, and, you know, I think that, you know,1245through the Older Americans Act and the innovative approaches1246for AAAs, and when we think about the programs that we have--1247you know, I am thinking about 3(d) and the evidence-based1248programs--is where we are touching individuals and how1249invaluable it is that we are meeting people before they are in1250crisis. That we are leveraging the funds and the programs under1251the Older Americans Act to get to families, caregivers, and1252individuals before the crisis.1253    The Chairman. Do you think you both help people and you1254save money?1255    Ms. Patton. Absolutely. We help people and we save money,1256and the sooner that we do that, and the more innovative we can1257be, yes.1258    The Chairman. Have you helped people either stay active in1259their job or stay active in their volunteering?1260    Ms. Patton. Yes, through the Area Agency and through the1261Older Americans Act transportation services, through the1262ability to work collaboratively with other organizations. We1263have many individuals that come and volunteer in our meal sites1264that might not otherwise get out.1265    The Chairman. For any of you, is there any reason at all1266you think we shouldn't reauthorize the OAA? Is there any--in1267your wildest imaginations, can you imagine why we wouldn't do1268that?1269    Ms. Patton. [No response.]1270    The Chairman. No, it is pretty simple isn't it. Well, on1271behalf of the Ranking Member, I just want to thank you guys for1272coming here. I want to thank you for your testimony. I think1273that having a hearing like this gives us an opportunity to1274give--you know, hopefully inspire all of our colleagues to1275focus on this and get this done as quickly as possible.1276    I would like to thank everyone for being here today and1277participating. I look forward to working with members across1278the aisle and down the dais. If any Senator has additional1279questions for the witnesses or statements to be added, the1280hearing record will be open until next Wednesday at 5:00 p.m.1281Thank you guys for coming.1282    [Whereupon, at 4:36 p.m., the hearing was adjourned.]12831284?12851286=======================================================================12871288                                APPENDIX12891290=======================================================================12911292?12931294=======================================================================12951296                      Prepared Witness Statements12971298=======================================================================12991300?13011302                 U.S. Senate Special Committee on Aging13031304         "Renewing Our Commitment: How The Older Americans Act1305          Uplifts Families Living With Aging-Related Diseases"13061307                            November 5, 202513081309                       Prepared Witness Statement13101311                           Erick Montealegre13121313    Chairman Scott, Ranking Member Gillibrand, and members of1314the Committee - thank you for the opportunity to testify today.1315    My name is Erick Montealegre, and I live in Broward County,1316Florida. I'm a family caregiver, a volunteer with the1317Alzheimer's Association, and a small business owner in the1318senior care field. I've only been in this field for a short1319time - about a year and a half - but every day reminds me just1320how vital programs supporting older adults are, not just for1321families like mine in Florida, but for the nearly 12 million1322family caregivers nationwide who are caring for someone living1323with Alzheimer's.1324    Today, I speak to you first and foremost as a son - one of1325four adult children doing our best to care for our father,1326Alberto, who is living with stage three mild cognitive1327impairment. I am proud to have him here with me today. As1328November is National Family Caregivers Month, it makes today's1329hearing especially meaningful.1330    Dad was diagnosed with mild cognitive impairment five years1331ago, after we first began noticing changes in 2019. Initially,1332he lived on his own, proud of his independence, but over time,1333it became clear he needed more support and moved in with my1334sister. We soon found ourselves learning, often by trial and1335error, how to balance his independence with safety - and how to1336find resources that would help him stay connected to his family1337and his community.1338    Caregiving, as many of us here know, is emotionally taxing,1339physically demanding, financially challenging and a full-time1340responsibility. With the help of our local Area Agency on1341Aging, we accessed services under the Older Americans Act,1342which have made a world of difference to his quality of life.1343At first, Dad received home-delivered meals, which ensured he1344had healthy food and provided the reassurance of a daily check-1345in. He then began attending a local adult day center, which has1346become the heart of his day-to-day life - and, in many ways,1347the heart of my story. Dad now participates in many activities1348that keep him engaged and happy, like piano and art. He is able1349to exercise regularly and safely at the gym they have on-site.1350He also gets to play chess daily, which is something he has1351enjoyed throughout his life and allows him to remain socially1352and mentally engaged. He's 84 years old and, since attending1353the center, he has taken up dancing - which has been a surprise1354to all of us. It's encouraging to see him enjoying something1355new at this stage of life and it gives us hope in his ability1356to hold back the progression of the disease.1357    The center provides much more than just recreation. It1358gives him cognitive stimulation, physical activity, social1359connection, and dignity, and for my siblings and me, it gives1360us respite and peace of mind. Knowing he's in a safe, engaging1361environment allows us to focus on our own families and careers1362without constant worry. I truly believe that the structure,1363consistency, and connection that the center provides are key1364reasons why my father is still doing as well as he is today. It1365has allowed me to step back from being a "care manager" and1366freed me to spend time with him as his son.1367    Dad immigrated to the United States from Colombia back in1368the 1970s. Over the course of his disease, he's lost some of1369his English and now speaks primarily Spanish. This can make it1370difficult for us to communicate with him on complicated topics,1371such as retirement benefits and planning. The center employs1372bilingual staff who can speak with him in his native language,1373helping him and us understand complicated issues around1374decisions that need to be made. It's hard to overstate what a1375relief it is to have caregivers who truly understand him and1376speak his language. They can pick up on nuances in his speech1377that even I sometimes miss.1378    Hispanics are one and a half times more likely to develop1379Alzheimer's disease, making it all the more important to1380prioritize high-quality, culturally and linguistically1381appropriate programs. Programs funded through the Older1382Americans Act are doing exactly that - meeting people where1383they are and honoring their story. In my culture, caring for1384our elders is part of who we are, and I hope my children see1385that example and carry it forward.1386    Reauthorizing and strengthening the Older Americans Act is1387an investment in families, dignity, and community. Its programs1388provide families like ours with structure, valuable resources,1389support, and hope. Hope that my siblings and I can give Dad the1390best care possible while balancing our own lives, and hope1391that, as our country ages, no family will have to walk this1392journey alone.1393    Thank you again for the opportunity to testify, and I look1394forward to your questions.13951396                 U.S. Senate Special Committee on Aging13971398         "Renewing Our Commitment: How The Older Americans Act1399          Uplifts Families Living With Aging-Related Diseases"14001401                            November 5, 202514021403                       Prepared Witness Statement14041405                           Stephen Sappington14061407    Hello Chairman Scott, Ranking Member Gillibrand, and1408members of the Committee. My name is Steve Sappington. I'm 731409years old, married to my wife Dee for 51 years, and I was1410diagnosed with Parkinson's disease in 2015. We have five sons1411and nine grandchildren who keep us busy and motivated.1412    For about three years before my diagnosis, Dee and I1413noticed strange changes in my health. I was taking tiny steps1414instead of my usual long strides. My once-clear handwriting1415became illegible. We went to Longwood Gardens and I suddenly1416couldn't smell the thousands of blooming flowers. My hands1417began to shake, and my balance started to deteriorate. We had1418no idea what Parkinson's disease was. Dee urged me to see our1419family doctor, who referred me to a neurologist. When I was1420diagnosed, I was upset - and frankly, in denial.1421    A friend of Dee's who also had Parkinson's kept telling me1422about a local boxing program called Rock Steady Boxing. She1423said it was life-changing. I wanted nothing to do with it. Why1424would I want to go to a boxing class? I was angry and ignoring1425the obvious.ut eventually, I gave in and went to observe a1426class, finding it interesting and fun. Everyone there had1427Parkinson's, each at different stages, and the exercises were1428designed specifically to combat symptoms of the disease.1429Everyone was friendly and welcoming. I started going to the1430free, hour-long classes four to six times a week. The results1431came slowly but surely: better balance, improved strength, and1432a huge boost in mood. I went religiously for 18 months. Then I1433learned the funding for the classes was in jeopardy.1434    After talking with the gym owner and certified trainers, I1435realized I couldn't let the classes stop. More than 200 older1436adults with Parkinson's were benefiting from these free1437classes. I decided to start a nonprofit in late 2017 to raise1438money to keep them going.n April 2018, I helped create Rally1439Against Parkinson's (RAP) to keep the classes going. Getting it1440started took a lot of work. We were a group of unpaid1441volunteers - all seniors, most living with Parkinson's - who1442had no experience running fundraisers. We learned on the job1443because we knew what these classes meant to us.1444    We applied for a Community Grant-in-Aid through the1445Community Outreach Office. We were denied the first year, but1446the next year we received half of what we requested - about1447$10,000. The full cost to run the program was more than $30,0001448a year, so we organized several fundraisers annually to make up1449the difference. RAP has always been a no-cost program, using1450100 percent of every dollar raised to pay for the classes.1451    When COVID hit and gyms closed, we didn't stop. We quickly1452adapted by holding socially distanced classes in the gym's1453parking lot and launching Zoom sessions for those who couldn't1454or preferred not to leave home. As the program grew, we1455expanded to our local YMCA and secured a county grant to1456purchase equipment. Today, our program includes four in-person1457classes each week, two livestream classes added during the1458pandemic, and two additional sessions hosted at the YMCA.1459    At 71, I decided it was time to step back and was fortunate1460to find another volunteer - a young 65-year-old - to take over1461as president. My neurologist calls me "a miracle." He says it's1462rare to see someone with Parkinson's remain at the same1463medication level for eight years. I credit that to consistent1464exercise and the community built through programs like RAP.1465    Programs like ours are possible because of the foundation1466created by the Older Americans Act (OAA). Local OAA-funded1467services, including transportation, congregate and home-1468delivered meals, caregiver support, adult day services, and1469other supportive programs, make it possible for older adults1470like me to stay active and connected.14711472These services work together:14731474      
Transportation helps participants get to classes and1475support groups.1476      
Nutrition programs provide meals that support health and1477energy.1478      
Caregiver support allows family members to continue1479their vital role.1480      
Title III supportive services give local agencies the1481flexibility to meet community needs.14821483Without this infrastructure, many older adults wouldn't be able1484to participate in programs that improve their health and well-1485being.1486    Despite progress, several challenges remain. Many older1487adults are unaware of available services, underscoring the need1488for culturally competent outreach - particularly to low-income,1489rural, and minority communities. Even when programs are1490accessible, transportation barriers often prevent1491participation; funding through the OAA helps address these1492gaps. Additionally, sustaining free or low-cost programs is1493difficult due to limited unrestricted funding. These1494initiatives rely heavily on consistent public investment and1495strong local partnerships to remain viable.1496    To ensure that older adults with Parkinson's and other age-1497related diseases can thrive, I respectfully recommend that1498Congress:1499      1. Reauthorize the Older Americans Act this year and1500maintain or increase funding for:1501        
Title III nutrition programs1502        
Title III B supportive services (including1503transportation and in-home supports)Caregiver support programs1504      2. Provide dedicated outreach and capacity-building1505funding so local agencies can reach underserved seniors,1506including those in rural and minority communities.1507      3. Support flexibility for virtual and hybrid1508programming, such as livestreamed exercise classes, so1509homebound seniors can stay active and connected.1510      4. Sustain funding for transportation and meal programs,1511which are foundational to participation in community exercise1512and wellness programs.1513    As a patient advocate, I'm encouraged by Congress's1514bipartisan passage of the National Plan to End Parkinson's Act,1515now being implemented by the federal government. This law1516creates the first-ever whole-of-government strategy to prevent,1517diagnose, treat, and ultimately cure Parkinson's disease. It1518also establishes a federal advisory council to coordinate1519research and services across agencies and address the needs of1520caregivers and families.1521    From my perspective, this effort complements the Older1522Americans Act. The OAA ensures that people like me can live1523well today, while the National Plan builds the roadmap for1524tomorrow. Together, they represent hope: hope for better1525quality of life now, and hope for a future without Parkinson's1526disease.1527    We don't yet have a cure for Parkinson's and we need strong1528federal investment in research to get there. While researchers1529work every day toward that goal, I'm proud to do my part1530through studies like the Parkinson's Progression Markers1531Initiative (PPMI) to help advance our understanding of1532Parkinson's Disease. Programs funded and authorized under the1533Older Americans Act keep people like me moving, connected, and1534cared for. They make the difference between being isolated at1535home and living a full life with community, purpose, and1536dignity.1537    Thank you for considering these requests. I welcome follow-1538up questions and will gladly help the Committee understand how1539OAA services directly improve outcomes for people living with1540Parkinson's and their caregivers.15411542                 U.S. Senate Special Committee on Aging15431544         "Renewing Our Commitment: How The Older Americans Act1545          Uplifts Families Living With Aging-Related Diseases"15461547                            November 5, 202515481549                       Prepared Witness Statement15501551                              Duana Patton15521553    Chairman Scott, Ranking Member Gillibrand and members of1554the Committee, thank you for the opportunity to speak before1555you today. My name is Duana Patton, and I am honored to serve1556as the Chief Executive Officer of the Ohio District 5 Area1557Agency on Aging, Inc., where I have worked for nearly 31 years.1558Our Agency, located in Ontario, Richland County, Ohio, is one1559of 613 Area Agencies on Aging (AAAs) across the nation that1560helps older adults remain independent and supported in their1561communities. I am also the current Board President of USAging,1562the national association of AAAs. On behalf of these agencies-1563and the millions of older adults and family caregivers we1564serve-I want to express my gratitude for your continued1565commitment to meeting the needs of individuals, families, and1566caregivers through the Older Americans Act (OAA). As the older1567adult population in the United States continues to rise1568rapidly, AAAs have seen increased demand for OAA programs and1569services across the country. In 2022, older adults numbered157057.8 million, representing 17.3 percent of the population and1571the number of older adults has increased by 34 percent since15722012 compared to an increase of two percent in the population1573under age 65. The older adult population is expected to1574continue to grow significantly in the future and is projected1575to reach 88.8 million in 2060.i1576    Strengthening the OAA, which is administered by the1577Administration for Community Living (ACL), over the next decade1578will be critical as it is the cornerstone of the nation's non-1579Medicaid home and community-based services (HCBS) system1580serving nearly 11 million older Americans per year across the1581country. The Aging Network carries out these services and1582includes State Units on Aging (SUAs), AAAs, Title VI Native1583American Aging Programs (Title VI programs) and tens of1584thousands of local service providers.15851586Older Americans Act Overview and Background on Area Agencies on1587Aging15881589    Signed into law in 1965, the OAA has connected older adults1590and their caregivers to services that help older adults age1591with health, dignity and independence in their homes and1592communities-where they want to be. The OAA enables the local1593delivery of home and community-based services, which are almost1594always less expensive than institutional care provided in1595nursing homes or assisted living facilities. The longer older1596adults can successfully age at home, the better it is1597financially for families and the federal government. OAA1598programs and services also support healthy aging and address1599upstream drivers of health.ii1600    AAAs were formally established in the 1973 OAA as the "on-1601the-ground" organizations charged with helping vulnerable older1602adults live with independence and dignity in their homes and1603communities. For 50 years, AAAs have served as the local1604leaders on aging and the OAA was intentionally designed to give1605AAAs the flexibility to ensure that the local needs and1606preferences of older adults are considered and reflected in the1607design and implementation of local service delivery systems.iii1608Across the country, AAAs play a vital role in supporting both1609individuals living with aging-related diseases and their1610caregivers, thanks to the foundation provided by the OAA. As an1611AAA, our mission is to plan, fund and deliver a broad range of1612programs and services rooted in the demonstrated needs of the1613communities we serve. We are often the "front door" to aging1614services, receiving referrals from individuals, caregivers,1615physicians and community partners-often at a time when a person1616is facing a new or increasing risk related to aging. Once AAAs1617receive input from consumers, service providers and other1618stakeholders, we develop Area Plans, which outline local needs1619and propose recommendations for programs and services for older1620adults and caregivers. Through comprehensive assessments, we1621determine what supports and interventions will best promote1622their health, safety and independence. When an individual comes1623to the AAA, they are not coming for health care, they are1624coming to seek support in navigating challenges and risks1625associated with their health condition.1626    AAAs are social care experts and we know that social needs1627often drive health outcomes. The core services we provide1628include nutrition, supportive services, caregiver support,1629health and wellness and elder rights. Our person-centered1630approach and assessment expertise recognizes the health of the1631person and focuses on interventions that will foster better1632outcomes. A good example is that of Ms. Gray. Ms. Gray was1633referred to our AAA following a hospital stay for a chronic1634health condition. She was not complying with her medication1635regimen and had poor eating habits. By providing two hours a1636week of personal care in her home as well as home-delivered1637meals, Ms. Gray has improved health, both physically and1638mentally, and has not been admitted to the hospital since1639receiving these services. This is the powerful impact of the1640OAA.16411642Key OAA Programs Supporting Older Adults with Aging-Related1643Diseases16441645OAA Title III B Supportive Services16461647    OAA Title III B Supportive Services is the bedrock of the1648Act and provides states and local agencies with flexible1649funding to provide a wide range of supportive services to older1650Americans like Ms. Mary. These services include in-home1651services for frail older adults, senior transportation1652programs, Information and Referral/Assistance Services (e.g.,1653hotlines to help people find local services, resources), case1654management, home modification and repair, chore services, legal1655services, social engagement activities, emergency/disaster1656response efforts and other person-centered approaches to1657helping older adults age well at home. Services provided1658through Title III B are a lifeline for older adults and are1659heavily based on assessed local needs and the desires of older1660adults in that community.iv These services are especially1661critical for older adults with aging-related diseases such as1662Alzheimer's and Parkinson's disease. As their diseases progress1663and their needs change, the AAA can adjust the type or1664intensity of services provided to meet the client where they1665are.16661667OAA Title III C Nutrition Services Program16681669    To meet the nutrition needs of older adults, all AAAs1670provide nutrition services through the OAA Title III C1671Nutrition Services Program. OAA Title III C is the largest1672program in the United States that provides nutrition services1673to older adults in need and provides older adults with1674opportunities for optimal health and well-being, reduced food1675insecurity and chances for social interaction with peers. AAAs,1676working with contracted community-based partners, provide both1677congregate and home-delivered meals to older adults in their1678service areas. Congregate meals sites can include senior/1679community centers, senior cafes, schools, churches, farmers1680markets and other places where older adults gather. Home-1681delivered meals are available to older adults who are homebound1682or otherwise have difficulty getting to congregate sites. The1683OAA also allows AAAs to provide nutrition education, risk1684screening and counseling to older adults. Like under Title III1685B, AAAs have some flexibility under Title III C and can adjust1686services as a client's needs change. For example, an older1687adult newly living with Parkinson's or dementia may at first1688benefit from attending a congregate meal program in their1689community. However, should their disease progress, and they1690experience increased difficulty leaving their home, the AAA may1691offer transportation to the congregate site or, if needed,1692switch to providing home-delivered meals.16931694OAA Title III D Evidence-Based Health Promotion and Disease1695Prevention Programs16961697    In addition to nutritional needs, the OAA also supports1698healthy aging for older adults through Title III D Evidence-1699Based Health Promotion and Disease Prevention. OAA Title III D1700was established in 1987 to provide formula grants to State1701Units on Aging to support healthy lifestyles and behaviors1702among adults age 60 and older with priority given to those in1703greatest economic need and living in medically underserved1704areas of the state.v Decades later, Congress required the1705programs to be evidence-based. Of the formally recognized by1706ACL evidence-based programs, AAAs are most likely to deliver1707the following: A Matter of Balance, Chronic Disease Self-1708Management Program, Diabetes Self-Management Program, Tai Chi1709for Arthritis and Powerful Tools for Caregivers. The impact of1710the OAA-and the Aging Network that brings it to life-is deeply1711personal and person-centered. For example, one older gentleman1712in our region who was living with Parkinson's disease enrolled1713in a Title III D falls prevention class at the recommendation1714of his physician after experiencing a fall. The program1715provided him with exercises and education to reduce his fall1716risk, improving both his confidence and his quality of life.17171718OAA Title III E National Family Caregiver Support Program17191720    Lastly, the OAA provides critical support to the family1721caregivers of older adults living with aging-related diseases1722through the Title III E National Family Caregiver Support1723Program (NFCSP). The NFCSP funds local AAAs to assist older1724caregivers and family members caring for older loved ones by1725offering a range of in-demand supports to family caregivers in1726every community. An estimated 63 million Americans provide care1727for an older adult, or someone living with illness or1728disability, nearly a 50 percent increase since 2015. Nearly1729half of care recipients are age 75 or older and face multiple1730chronic health conditions with the most common primary1731conditions including age-related decline, Alzheimer's or other1732dementias, mobility limitations, cancer and postsurgical1733recovery.vi Family caregivers provide a wide range of services,1734such as transportation, food preparation, housekeeping and1735personal care, enabling care recipients to live at home or in1736the setting of their choice with dignity and independence. OAA1737Title III E services include respite care; individual1738counseling and support groups; caregiver education classes/1739training; and emergency assistance. AAAs also play a crucial1740role in information and referral and caregiver navigation,1741ensuring families are connected with local providers who can1742help them create a caregiving plan, address specific challenges1743and ensure they receive the right services at the right time.1744    Caregivers supporting older adults are not only family1745members but can also be paid professional caregivers. However,1746the nation is experiencing grave direct care workforce1747shortages which have contributed to greater strain on already1748stressed family caregivers and puts the health and safety of1749millions of older adults without other caregivers at risk. The1750direct care workforce includes professionals such as personal1751care attendants, home health aides, residential workers and1752more. The United States does not currently have the caregiving1753workforce it needs to support the rising number of older adults1754who need personal, in-home care or institutional support. The1755pay is low (median earnings of $23,688 annually) and the work1756is physically and mentally demanding with very limited1757opportunities for career advancement.vi While not directly1758supported by OAA Title III E, the direct care workforce1759provides critical support to family caregivers and should not1760be ignored. Without professional caregivers, older adults have1761an increased chance of receiving low quality care, which1762threatens their lives and health.17631764OAA Reauthorization17651766    Authorization of the OAA expired last year and since the1767last reauthorization of the OAA in 2020, AAAs have identified1768new opportunities to be even more responsive to the evolving1769needs of older adults. During the pandemic, we were challenged1770to adapt-and that adaptation sparked innovation. When1771congregate meal sites had to close, AAAs were permitted to1772provide "grab-and-go" meals, allowing older adults to maintain1773access to nutritious food and social connection in a safe way.1774One participant, a man with diabetes, began using the program1775because he wanted to avoid grocery stores during the pandemic.1776He later shared that the meals helped him lose weight and1777reduce his medications. Today, he continues to attend1778congregate meal sites and actively manages his condition. To1779reflect the needs of today's older adults and preserve OAA's1780inherent flexibility and locally driven structure, it is1781critical for the OAA to be reauthorized, and I urge Congress to1782swiftly pass the bipartisan, bicameral reauthorization bill1783that fell out of last December's final spending package.17841785Conclusion17861787    The lessons we learned during the pandemic underscore the1788importance of allowing AAAs to continue using innovative1789practices that have proven effective. The timing of this1790reauthorization is ideal-it gives us the opportunity to1791strengthen what works, modernize where needed and ensure the1792Act continues to meet the needs of older adults, caregivers and1793communities across the nation. Chairman Scott, Ranking Member1794Gillibrand and members of the Committee, thank you for the1795privilege to share my passion and stories from the field. This1796day is particularly meaningful; not only because it marks my1797Mother's 82nd birthday, but also because this opportunity1798stands as a cornerstone moment in my career dedicated to1799serving older adults like my Mom.1800------------------------------------1801(i) Administration for Community Living, 2023 Profile of Older1802Americans (2024)1803(ii) USAging, Older Americans Act: Get the Facts (2025)1804(iii) USAging, Area Agencies on Aging: Local Leaders in Aging1805Well at Home (2023)1806(iv) USAging, Policy Priorities 2025: Promote the Health,1807Security and Well-Being of Older Adults (2025)1808(v) Administration for Community Living, Health Promotion1809(2025)1810(vi) AARP and the National Alliance for Caregiving, Caregiving1811in the US Research Report (2025)18121813?18141815=======================================================================18161817                        Questions for the Record18181819=======================================================================18201821?18221823                 U.S. Senate Special Committee on Aging18241825         "Renewing Our Commitment: How The Older Americans Act1826          Uplifts Families Living With Aging-Related Diseases"18271828                            November 5, 202518291830                        Questions for the Record18311832                           Erick Montealegre18331834                        Senator Raphael Warnock18351836    Question:18371838    There are nearly 188,300 individuals in Georgia living with1839Alzheimer's disease and over 384,000 caregivers.1840    What advice would you give families who are just starting1841this journey after a dementia or mild cognitive impairment1842diagnosis on how to advocate for needed services and how to1843engage community resources to supplement formal programs?18441845    Response:18461847    The first thing I would want families to know is that they1848are not alone. A new diagnosis of dementia can feel1849overwhelming, but there are clear steps they can take to1850advocate for their loved ones and start building a strong1851support network.1852    I would tell them to start with educating themselves by1853taking advantage of the educational programs provided through1854the Older American's Act and the Area Agencies on Aging.1855Understanding the diagnosis empowers families to make informed1856decisions. They should ask specific questions such as:18571858    
What changes should we expect?1859    
What services should we put in place early?1860    
When should we request a referral to a neurologist,1861geriatrician, or memory-care specialist?18621863    Then, document everything. Keep a binder or digital folder1864with medical notes, test results, medication lists, and any1865observed changes in memory or behavior. Having clear1866documentation also helps families advocate for the level of1867care their loved ones truly need.18681869    Third, they should build their teams earlier than they1870think they will `need' them. Dementia care is strongest when it1871combines formal services with community support. Families1872should explore:18731874    
Local Aging & Disability Resource Centers (ADRCs) for1875benefits screening and case management1876    
Area Agency on Aging for low-cost or free programs1877    
Senior centers and adult day programs to reduce isolation1878    
Faith-based and community organizations for social1879engagement and respite1880    
In-home care providers who offer companionship, personal1881care, and safety oversight1882    
Support groups for both caregivers and those living with1883early-stage dementia18841885    The biggest advice I can give is to start early, any delays1886in receiving treatment or therapy can be devastating. Unlike1887many diseases which can be recovered from, once function is1888lost to dementia it's gone for good. There simply is no time to1889delay treatments and therapies.18901891                 U.S. Senate Special Committee on Aging18921893         "Renewing Our Commitment: How The Older Americans Act1894          Uplifts Families Living With Aging-Related Diseases"18951896                            November 5, 202518971898                        Questions for the Record18991900                              Duana Patton19011902                        Senator Raphael Warnock19031904    Question:19051906    Area Agencies on Aging (AAAs) offer critical services for1907seniors across the country. Georgia's 12 AAAs do exceptional1908work providing resources and care to older Georgians. However,1909the aging population is growing rapidly, and AAAs across the1910country need increased funding to meet the real and urgent1911needs of their community.1912    How would the reauthorization of the Older Americans Act1913(OAA) help AAAs connect older adults with aging-related1914diseases to the services they need?19151916    Response:19171918    The number of older adults living with one or more chronic1919conditions is rapidly increasing and many require long-term1920supports that go far beyond traditional medical care. Without1921adequate community services, caregiver resources, and1922coordinated care, older adults face greater risk of1923malnutrition, falls, hospital readmissions, caregiver burnout,1924and premature institutionalization.1925    Reauthorizing the Older Americans Act (OAA) will modernize1926and strengthen funding for community-based services that1927support chronic disease prevention and self-management, care1928coordination, in-home services, and caregiver assistance. It1929provides Area Agencies on Aging (AAAs) with greater flexibility1930to continue their pandemic-era nutrition services innovations1931and to build stronger partnerships with health care systems in1932order to reach more adults with these life-changing1933interventions. Importantly, OAA reauthorization increases the1934ability of AAAs to reach older adults at the right time, in the1935right place-often before a crisis occurs.19361937    Question:19381939    According to the American Association of Retired Persons1940(AARP), nearly one in three adults in Georgia is an unpaid1941caregiver for family members or friends with health conditions1942or disabilities. The number of caregivers is expected to1943increase over the next few years, as Georgia's older adult1944population grows.1945    How do services authorized by the Older Americans Act (OAA)1946support unpaid caregivers, and what steps can Congress take to1947further alleviate the financial and social burden of caregivers1948in states like Georgia?19491950    Response:19511952    The Older Americans Act (OAA) plays a vital role in1953supporting the millions of unpaid family caregivers who form1954the backbone of our long-term care system. Through services1955such as respite care, caregiver training, counseling, and care1956coordination, OAA-funded programs help caregivers manage the1957physical, emotional, and financial strain that comes with1958caring for an older adult with complex health needs. These1959supports allow caregivers to remain in the workforce, protect1960their own health, and continue providing care safely at home-1961delaying costly hospitalizations and institutional placements.1962    Yet, the demand for caregiver support far exceeds current1963capacity. Reauthorizing the OAA presents a critical opportunity1964for Congress to support funding for the OAA Title III E1965National Family Caregiver Support Program, increase access to1966respite services, and provide Area Agencies on Aging with1967greater flexibility to use funds for evidence-based programs,1968supportive services, and partnerships with health care systems.1969These steps would allow AAAs to reach caregivers earlier-often1970before they are in crisis-and deliver the assistance they need1971to sustain care over time.1972=======================================================================19731974                       Statements for the Record19751976=======================================================================19771978                 U.S. Senate Special Committee on Aging19791980         "Renewing Our Commitment: How The Older Americans Act1981          Uplifts Families Living With Aging-Related Diseases"19821983                            November 5, 202519841985                       Statements for the Record19861987                             AARP Statement19881989    AARP, which advocates for the more than 100 million1990Americans age 50 and older, thanks the Committee for holding1991this hearing, "Renewing Our Commitment: How the Older Americans1992Act Uplifts Families Living with Aging-Related Diseases." We1993appreciate the opportunity to offer our support for older1994adults and their family caregivers through the Older Americans1995Act (OAA) Reauthorization Act of 2025 (S. 2120). AARP commends1996you for your bipartisan work on this legislation and joins you1997in calling for its prompt passage.1998    For 60 years, the OAA has helped older Americans live at1999home with independence and dignity, deferring or eliminating2000more costly institutional services and hospitalizations. It2001delivers essential services to approximately 11 million older2002adults in a typical year, including home care, job training and2003employment opportunities, family caregiver support, congregate2004and home-delivered meals, case management, transportation,2005adult day care, legal services, elder abuse prevention, and2006long-term care ombudsman programs to help keep people safe. OAA2007programs are cost-effective investments that serve the needs of2008older Americans while helping them to remain in their homes and2009communities as they age, where the vast majority prefer to be.2010    America's older population is growing and so too must the2011resources to help them remain independent and live at home.2012Family caregivers are filling in the gaps, providing care to2013their loved ones at significant expense to themselves in terms2014of both time and money, but the number of family caregivers is2015not likely to keep up with the demand. Now more than ever, OAA2016programs are essential for America's older adults and their2017families.2018    Within the OAA Reauthorization Act of 2025, we appreciate2019and support the effort to strengthen OAA's many successful2020programs, including the National Family Caregiver Support2021Program (NFCSP) and Title VI Native American Caregiver Support2022Services, the Senior Community Service Employment Program2023(SCSEP), nutrition services, the Long-term Care Ombudsman2024Program (LTCOP), the direct care workforce national resource2025center, and housing services, all of which are outlined below.20262027National Family Caregiver Support Program (NFCSP) and Title VI2028Native American Caregiver Support Services20292030    As we mark National Family Caregivers Month, we recognize2031the 63 million family caregivers who are the backbone of the US2032long-term care system. Family caregivers provide about $6002033billion annually in unpaid labor to their adult loved ones. The2034care they provide ranges from bathing and dressing to paying2035bills and transportation, and their assistance helps save2036taxpayers billions of dollars by helping to delay or prevent2037more expensive care. However, despite the many benefits family2038caregivers contribute to the economy and the important role2039they play in preserving the health and well-being of their2040loved ones, family caregivers often face significant financial,2041physical, and emotional challenges. According to Caregiving in2042the US 2025, 55 percent of family caregivers perform medical2043and nursing tasks for their loved ones; too often, they have2044little preparation or training.2045    NFCSP was created in 2000 to support a range of services2046that assist family and other unpaid caregivers. Similarly,2047OAA's Title VI Native American Caregiver Support Services2048provide support for American Indian, Alaskan Native, and Native2049Hawaiian families, including through information and outreach,2050access assistance, individual counseling, support groups and2051training, respite care, and other supplemental services. As our2052nation ages, this support is needed more than ever.2053Importantly, the OAA Reauthorization Act of 2025 builds on2054progress to support family caregivers that began in the 20202055OAA reauthorization through improvements to caregiver needs2056assessments and support services provided to caregivers, the2057accessibility of information about available supports for2058caregivers, and more. We also support the extension of the2059RAISE Family Caregivers Act and Supporting Grandparents Raising2060Grandchildren Act.20612062Senior Community Service Employment Program (SCSEP)20632064    SCSEP provides part-time community service assignments for2065low-income adults age 55 or older who face limited employment2066opportunities, often due to persistent barriers such as age2067discrimination. SCSEP-funded services are available in nearly2068all 3,000 U.S. counties and territories and have helped2069thousands of older jobseekers into jobs providing them work-2070based training and the opportunity to use their skills.2071According to the most recent Department of Labor Workforce GPS2072survey, participants strongly believe that the program helped2073prepare them for success in the workforce (8.4 on a 10-point2074scale). Through the program, many older Americans are able to2075contribute positively to their communities while seeking new2076employment opportunities, making this a true win-win program.2077We appreciate the continued support for SCSEP, the only federal2078program specifically created to assist workers 55 and older to2079gain the skills and experience necessary to be productive2080members of the workforce.20812082Nutrition Services20832084    In 2023, nearly 12.6 million (more than one in ten)2085Americans age 50 and older faced food insecurity and the threat2086of hunger, the highest share in nearly a decade. While only2087part of the solution, OAA nutrition programs are a critical2088component of addressing senior hunger. OAA-funded senior2089nutrition programs also provide more than a meal; they provide2090opportunities for social engagement, offer nutrition screening2091and counseling, and link participants to other home and2092community-based supports. Congregate and home-delivered2093nutrition services provided by OAA reduce hunger, improve2094health, and combat social isolation, which costs Medicare an2095estimated $6.7 billion annually. Research shows that without2096these programs, many older adults would skip meals or eat less.2097We appreciate the efforts to innovate nutrition services within2098OAA, specifically, the codification of added flexibility around2099grab-and-go service delivery methods. This provision will allow2100service providers to better meet the needs of their2101communities. Access to these services is more critical than2102ever, as food insecurity among older adults continues to rise2103and demand for nutrition programs intensifies. With2104fluctuations in Supplemental Nutrition Assistance Program2105(SNAP) benefits and rising food costs, OAA-funded nutrition2106programs are increasingly relied upon to fill the gap, making2107sustained investment essential.21082109Long-Term Care Ombudsman Program (LTCOP)21102111    The LTCOP is the most effective program to advocate and act2112as a resource for the older adults who live in nursing homes,2113assisted living, and other licensed adult care homes. Every2114state - along with Puerto Rico, Guam, and the District of2115Columbia - has a long-term care ombudsman office. These offices2116work to resolve issues related to residents' health, safety,2117welfare, and rights, while helping individuals and their2118families understand and exercise those rights. In 2024, the2119LTCOP processed over 200,000 complaints. By promoting dignity2120and quality of life, the LTCOP plays a critical role in2121ensuring that long-term care environments are safe, respectful,2122and responsive to the needs of those they serve.2123    We support the provisions within S. 2120 to strengthen the2124LTCOP, which effectively advocates and acts as a critical2125resource for the older adults who live in nursing homes,2126assisted living, and other licensed adult care homes.21272128Direct Care Workforce National Resource Center21292130    The direct care workforce is an integral part of the2131nation's healthcare system. Around 12.6 million adults in the2132US need long-term services and supports (LTSS). Despite the2133increased demand for direct care workers, job quality for all2134members of the direct care workforce remains low, contributing2135to high turnover and workforce shortages. The shortage of well-2136trained direct care workers, combined with an expected doubling2137of the older adult population between 2023 and 2040, points to2138an emerging crisis that requires immediate attention.2139    AARP strongly supports efforts to bolster the direct care2140workforce through additional support and investments in the OAA2141and appreciates the inclusion of the national resource center2142on direct care workforce.21432144Housing Services and Supports21452146    OAA provides vital resources for millions of older adults2147who want to age in their homes through assistance for home2148repairs and modifications to ensure the home is safe and2149updated with accessibility features. We support the provision2150within the OAA Reauthorization Act that extends the eligible2151housing services to include weatherization.21522153Conclusion21542155    OAA programs are cost-effective investments that serve the2156needs of older Americans while reducing the need for costly2157institutionalization. As America's older population grows, so2158too must the resources to help them remain independent and live2159at home. Older Americans have earned the right to age with2160dignity, and the OAA helps make that possible - now is the time2161to renew our national commitment. We urge prompt OAA2162reauthorization so that our loved ones can continue to turn to2163these services for their health and economic security as they2164age.2165    Again, thank you for your bipartisan leadership on this2166important legislation, and we look forward to continuing to2167work with the Committee on a bipartisan basis.21682169                 U.S. Senate Special Committee on Aging21702171         "Renewing Our Commitment: How The Older Americans Act2172          Uplifts Families Living With Aging-Related Diseases"21732174                            November 5, 202521752176                       Statements for the Record21772178           American Foundation for the Blind (AFB) Statement21792180    The American Foundation for the Blind (AFB) is a national2181nonprofit that creates equal opportunities and expands2182possibilities for people who are blind, have low vision, and2183are deafblind through advocacy, thought leadership, and2184strategic partnerships. We appreciate this opportunity to2185submit a statement about how the Older Americans Act (OAA) can2186maximize opportunities for older Americans who are blind2187through improved coordination between the aging network and2188blindness service providers.21892190Many Older Adults Experience Blindness or Low Vision21912192    Blindness and vision loss is often an age related2193disability. Certain causes of blindness that tend to be age-2194related include Age-Related Macular Degeneration, Cataracts,2195Diabetic Retinopathy, and Glaucoma. According to the 20232196National Health Interview Survey, about 23% of people 65 and2197older are blind or have trouble seeing, even when wearing2198glasses. In addition, there are significant comorbidities2199between blindness and other age-related conditions, including2200hearing loss, mobility disabilities, Alzheimer s and dementia,2201and Parkinsons disease. In fact, research shows a relationship2202between dementia and vision loss.22032204Agencies that serve people who are blind22052206    People who are blind or have low vision benefit2207significantly from access to peer support groups and blindness2208skills training services that empower them to live2209independently and in a way they choose. However, many people2210who experience age-related vision loss continue to go without2211any services, due to a lack of awareness or funding, and they2212frequently end up relying on family members or having to move2213into nursing homes.2214    Private and public agencies across the country serve people2215who are blind or have low vision to equip them with skills and2216mentorship to adjust to living with blindness. Some of these2217blindness skills may include cooking, using assistive2218technology, and Orientation and Mobility skills that help2219people move confidently through their environment with the use2220of a white cane or guide dog. Talking with peers who are blind2221can help with confidence living at home and provide resources2222such as how to use audio description to watch television and2223access the National Library Service to borrow audiobooks or2224braille books.22252226Coordination is an important opportunity in the OAA22272228    Likewise, the aging network helps people to continue living2229in their homes. Area agencies on aging carry out programs and2230services for people who need transportation, who experience2231isolation, and need meal services. In fact, AAAs and meal2232delivery programs may be the only point of regular contact for2233isolated adults.2234    We appreciate that the current versions of the OAA2235reauthorization bill include provisions for supporting older2236individuals with disabilities through improved coordination.2237There is ample opportunity for conscientiously increasing2238coordination between the aging network and blindness services.2239    Through improved coordination, we could shorten the time2240that people experiencing vision loss take to learn about and2241receive vision related services and ensure they receive other2242services they may need that are provided through the aging2243services network. Coordination would also expand awareness for2244caregivers about how their family member can continue to live2245independently as a blind or low vision person. Aging service2246providers could request consultation to ensure their programs2247are fully accessible (e.g. by providing information in2248alternative formats and ensuring blind participants have2249transportation access). Many AAAs hold falls prevention2250training, but even though vision loss is a risk factor for2251falling, many falls prevention trainings are either not2252accessible to a blind person, or they do not provide blindness2253specific resources.2254    Blindness service providers can offer resources about their2255programs to AAAs and to the people they serve to increase the2256rate of referrals. Increasing awareness and referrals would2257ensure that all older adults with vision loss have access to2258peer support and blindness skills training that they need to2259retain their quality of life. Improved coordination is2260necessarily bidirectional as vision service providers need to2261be familiar with the AAA system while blind older adults would2262benefit from receiving more information about blindness2263services and more accessible programming within the aging2264network. Currently this coordination does not exist.2265    The OAA is vitally important for Older Americans, including2266the many who are blind or have low vision. Yet, there are2267opportunities to improve coordination, so that older adults who2268are blind can benefit even more from OAA programs. We hope the2269Committee will prioritize passing legislation that truly2270improves coordination between organizations that specifically2271serve blind adults and those that serve older adults.2272    Thank you for the opportunity to submit this statement for2273the record. Should you have any questions about the information2274raised in this statement, please reach out to Sarah Malaier.22752276    Sincerely,22772278    Stephanie Enyart2279    Chief Public Policy and Research Officer22802281                 U.S. Senate Special Committee on Aging22822283         "Renewing Our Commitment: How The Older Americans Act2284          Uplifts Families Living With Aging-Related Diseases"22852286                            November 5, 202522872288                       Statements for the Record22892290   Alzheimer's Association and Alzheimer's Impact Movement Statement22912292    The Alzheimer's Association and Alzheimer's Impact Movement2293(AIM) appreciate the opportunity to submit this statement for2294the record to the Senate Special Committee on Aging hearing2295entitled "Renewing Our Commitment: How the Older Americans Act2296Uplifts Families Living with Aging-Related Diseases". The2297Association and AIM thank the Committee for its continued2298leadership on issues important to the millions of individuals2299living with Alzheimer's and other dementias and their2300caregivers. This statement highlights the importance of2301policies and programs within the Older Americans Act (OAA) that2302can help meet the unique needs of our nation's growing number2303of Americans living with Alzheimer's and other dementias.2304    Founded in 1980, the Alzheimer's Association is the world's2305leading voluntary health organization in Alzheimer's care,2306support, and research. Our mission is to eliminate Alzheimer's2307and other dementias through the advancement of research, to2308provide and enhance care and support for all affected, and to2309reduce the risk of dementia through the promotion of brain2310health. AIM is the Association's advocacy affiliate, working in2311a strategic partnership to make Alzheimer's a national2312priority. Together, the Alzheimer's Association and AIM2313advocate for policies to fight Alzheimer's disease, including2314increased investment in research, improved care and support,2315and the development of approaches to reduce the risk of2316developing dementia.2317    Over seven million Americans are living with Alzheimer's,2318and by 2050, this number is expected to rise to nearly 132319million. Alzheimer's is one of the costliest conditions in the2320United States. In 2024, total payments for all individuals with2321Alzheimer's or other dementia are estimated at $360 billion2322(not including unpaid caregiving). By 2050, these costs are2323projected to rise to nearly $1 trillion. These mounting costs2324threaten to bankrupt families, businesses, and our health care2325system. Unfortunately, our work is only growing more urgent.2326    As the prevalence of Alzheimer's disease and other2327dementias increases, so does the need for care and support2328services for those living with these diseases. The OAA provides2329federal funding and the necessary infrastructure to deliver2330vital support programs and social services to our nation's2331seniors, including those with Alzheimer's disease. These2332critical programs are utilized by millions of low-income2333Americans and provide for such services as home-delivered and2334congregate nutrition services; in-home supportive services;2335transportation; caregiver support; community service2336employment; health and wellness programs; the long-term care2337ombudsman program; services to prevent the abuse, neglect, and2338exploitation of older adults; and other supportive services.2339Twenty-four percent of older individuals with Alzheimer's2340disease and other dementias who have Medicare are also eligible2341for Medicaid, punctuating the need within the Alzheimer's2342community for such programs as the Senior Nutrition Program and2343the National Family Caregiver Support Program.2344    We strongly support the bipartisan Older Americans Act2345(OAA) Reauthorization Act of 2025 (S. 2120), led by Chairmen2346Cassidy (R-LA) and Scott (R-FL) and Ranking Members Sanders (I-2347VT) and Gillibrand (D-NY), which includes expanded efforts to2348address social isolation, a pressing issue for the aging2349population and especially for individuals with dementia. Social2350isolation exacerbates cognitive decline, mental health issues,2351and physical health risks. The Alzheimer's Association's2352Dementia Care Practice Recommendations emphasize the benefits2353of support groups in reducing isolation and improving outcomes,2354including quality of life and communication with family2355members. The establishment of an Advisory Council on Social2356Isolation and Loneliness is an important step toward better2357understanding and responding to this growing public health2358issue.2359    We are grateful that the Supporting Older Americans Act of23602020 (P.L. 116-131) included the bipartisan Younger Onset2361Alzheimer's Disease Act, championed by Senators Susan Collins2362(R-ME) and Bob Casey (D-PA), to codify existing authority to2363provide services to individuals living with younger-onset2364Alzheimer's disease under the National Family Caregiver Support2365Program and the Long-Term Care Ombudsman Program. We appreciate2366that this legislation continues to include this important2367language, ensuring that individuals with younger-onset2368Alzheimer's disease and related dementias can access the2369supports they need. These services are particularly helpful for2370those who may still be raising young children, in the2371workforce, or struggling to secure an accurate diagnosis-facing2372stigma and delays that compound the disease's toll.23732374Supporting Dementia Caregivers23752376    Eighty-three percent of the help provided to older adults2377in the United States comes from family members, friends, or2378other unpaid caregivers, and the emotional, physical, and2379financial costs can be overwhelming. Nearly half of all2380caregivers who provide help to older adults do so for someone2381living with Alzheimer's or another dementia. In 2024 alone,2382more than 12 million Americans provided unpaid care for people2383with Alzheimer's and other dementias, contributing an estimated238419 billion hours of care valued at $413 billion. Of the total2385lifetime cost of caring for someone with dementia, 70 percent2386is borne by families - either through out-of-pocket health and2387long-term care expenses or from the value of unpaid care.2388    Community services provided under the OAA offer invaluable2389support for individuals living with dementia, and, due to the2390unique challenges they face, it is paramount to continue2391prioritizing care coordination efforts within communities2392during the reauthorization process. Dementia often requires a2393multi-disciplinary approach involving medical professionals,2394caregivers, social workers, and community support services.2395Effective coordination helps caregivers navigate the complex2396healthcare and social service systems and ensures that2397caregivers and health care professionals collaborate2398seamlessly, providing comprehensive care tailored to their2399individual needs. Challenges such as cognitive decline,2400communication difficulties, and fluctuating symptoms2401necessitate specialized strategies for coordination.2402Initiatives promoting dementia-friendly communities and2403caregiver education programs play crucial roles in enhancing2404coordination and support networks. By prioritizing and refining2405care coordination, communities can offer a better quality of2406life and support for individuals living with dementia and their2407caregivers.2408    We are also deeply grateful for the reauthorization and2409extension of the RAISE Family Caregivers Act. The Alzheimer's2410Association and AIM have been strong advocates for the RAISE2411Family Caregivers Act since it was introduced in Congress. As2412the caregiving crisis intensifies, especially in the2413Alzheimer's community, this extension will ensure the2414Department of Health and Human Services can fully implement a2415national strategy to better support unpaid caregivers. These2416dedicated caregivers greatly benefit from increased resources,2417training, and support to help them navigate the strain of2418caregiving and improve their health and quality of life.24192420Strengthening the Dementia Care Workforce24212422    We ask that the Committee prioritize policies to reduce2423barriers and ensure individuals living with dementia have2424adequate access to long-term care and home- and community-based2425services. People living with Alzheimer's and other dementias2426make up a significant portion of all long-term care residents,2427comprising 49 percent of all residents in nursing homes and 342428percent of all residents in assisted living communities and2429other residential care facilities. Given our constituents'2430intensive use of these services, the quality of this care is of2431the utmost importance. As a result, we encourage the Committee2432to consider policies to enhance long-term care and support2433services for the growing number of Americans with Alzheimer's2434and other dementias who are eligible to receive OAA services.2435    A strong dementia care workforce is needed to ensure2436quality care for aging populations. For example, the fourth2437most common chronic condition in participants using adult day2438services is Alzheimer's disease or other dementias, and 252439percent of individuals using adult day services have2440Alzheimer's or other dementias. Access to these services can2441help people with dementia live in their homes longer and2442improve the quality of life for both themselves and their2443caregivers. In-home care services, such as personal care2444services, companion services, or skilled care, can allow2445individuals living with dementia to stay in familiar2446environments and be of considerable assistance to caregivers.2447Adult day services can provide social engagement and assistance2448with daily activities.2449    To ensure that care providers are equipped to meet the2450specific needs of individuals with dementia, we strongly2451support the bipartisan Accelerating Access to Dementia &2452Alzheimer's Provider Training (AADAPT) Act (H.R. 3747),2453introduced by Representatives Troy Balderson (R-OH-20) and2454Nanette Barrag n (D-CA-44), which would provide grants to2455expand virtual education and training on Alzheimer's and2456dementia so that more primary care providers better understand2457detection, diagnosis, care, and treatment - and so that more2458providers in rural and underserved communities can receive2459dementia training.2460    By prioritizing a well-trained dementia care workforce,2461Congress can ensure that individuals living with Alzheimer's2462and other dementias receive timely, accurate diagnoses and2463high-quality, coordinated care, no matter where they live. This2464investment will not only improve outcomes for patients and ease2465burdens on family caregivers but also reduce overall health2466care costs by minimizing unnecessary hospitalizations and2467specialist referrals. The AADAPT Act is a critical step toward2468building a more equitable and effective dementia care system2469nationwide.24702471Advancing Brain Health Through Evidence-Based Interventions24722473    The Alzheimer's Association and AIM encourage the Committee2474to recognize the opportunity to promote brain health and risk2475reduction through evidence-based lifestyle interventions. The2476Alzheimer's Association U.S. Study to Protect Brain Health2477Through Lifestyle Intervention to Reduce Risk, known as U.S.2478POINTER, found that a structured lifestyle program - focusing2479on things like improved nutrition, physical exercise, cognitive2480engagement, and health monitoring - improved thinking and2481memory over two years, keeping brain function from declining as2482it normally would with aging. Participants in the structured2483program performed like people who were one to almost two years2484younger, suggesting that these habits can help the brain stay2485resilient against age-related changes. U.S. POINTER is the2486first large-scale, randomized controlled clinical trial to2487demonstrate that an accessible and sustainable healthy2488lifestyle intervention can protect cognitive function in2489diverse populations in communities across the United States.2490The results present a compelling case for investments in2491preventive brain health programs targeting nutrition, physical2492exercise, cognitive stimulation and cardiovascular wellness.2493    OAA-funded programs, especially those authorized under2494Title III-B (Supportive Services), Title III-C (Nutrition2495Services), and Title III-D (Health Promotion), offer the2496infrastructure to deliver these interventions where older2497adults already access services. Implementing POINTER-style2498models into community-based programs would empower older2499Americans to engage in brain-healthy behaviors in familiar and2500trusted settings.2501    This is not only a brain health issue - it is an economic2502imperative. Reducing cognitive decline could help reduce future2503care costs and support healthy, productive aging. As you move2504forward in the OAA reauthorization process, we urge the2505Committee to support funding, legislation, and public health2506initiatives that bring these proven brain health interventions2507into more communities.25082509Conclusion25102511    The Alzheimer's Association and AIM appreciate the2512Committee's steadfast support and commitment to advancing2513issues important to the millions of individuals living with2514Alzheimer's and other dementias, as well as their caregivers.2515We look forward to working with you and again ask that you keep2516individuals living with dementia in mind as the Older Americans2517Act reauthorization effort moves through the legislative2518process.25192520                 U.S. Senate Special Committee on Aging25212522         "Renewing Our Commitment: How The Older Americans Act2523          Uplifts Families Living With Aging-Related Diseases"25242525                            November 5, 202525262527                       Statements for the Record25282529                  Defeat Malnutrition Today Statement25302531    Defeat Malnutrition Today is a coalition of over 1202532members committed to addressing older adult malnutrition across2533the continuum of care. We submit for the record an American2534Society on Aging article written by our national coordinator2535about how Older Americans Act programs can improve the health2536of and reduce malnutrition in older adults.25372538Leveraging Nutrition to Make Older Americans Healthy Again25392540September 15, 202525412542The Trump Administration's MAHA Strategy provides an2543opportunity to address older adults within each of the MAHA2544pillars.25452546By Edwin Walker and Bob Blancato25472548    About one in six Americans is now ages 65 or older, with254911,000 turning age 65 every day. While we can't turn back the2550clock on age, we can help older Americans continue to make2551vital contributions to the economy and society by helping them2552maintain their strength and independence. Disability and2553chronic disease decrease older adult's health, functionality2554and quality of life, with more than half (63.7%) of the older2555U.S. population living with two or more chronic diseases. Good2556nutrition can make a difference, helping increase not only2557older adult lifespan but healthspan, too.2558    Health is built across an entire lifetime, and while2559childhood intervention is important, chronic disease prevention2560and health promotion must continue beyond childhood. If we wait2561until individuals are already frail, we've missed too many2562opportunities to keep people healthy. The Trump2563Administration's plan to Make America Healthy Again (MAHA)2564includes "fresh thinking on nutrition." An emphasis on2565nutrition is also key to Make Older Americans Healthy Again2566(MOAHA)-and here's what needs to be done.2567    Action starts by recognizing that malnutrition is a common2568problem for older adults today. Estimates are that up to one in2569two older adults are at risk for malnutrition, particularly a2570lack of adequate protein, calories and other nutrients, which2571contributes to poor health outcomes, frailty and disability,2572and increased healthcare costs. Congress recognized the2573importance of this issue when it added reducing malnutrition to2574the purpose of the Older Americans Act (OAA) during the 20202575OAA reauthorization. The OAA's disease prevention and health2576promotion services were also updated to include screening for2577malnutrition. Every September, we celebrate Malnutrition2578Awareness Week.2579    OAA programs are administered locally by more than 600 Area2580Agencies on Aging, more than 270 Title VI Native American Aging2581Programs, and more than 20,000 community service providers2582supported by 70,000 volunteers-all trusted by the 11 million2583older adults they serve.2584    These programs leverage federal funds with state, local,2585and participant funding. With its nationwide coverage, well-2586established community ties, and mix of public and private2587support, the OAA network provides an ideal infrastructure for2588MOAHA.2589    With the release of the Trump Administration's MAHA2590Strategy, we see an opportunity to address older adults within2591each of the MAHA pillars.25922593Realigning Incentives and Systems to Drive Health Outcomes25942595    OAA programs provide aging services and nutrition-including2596nearly one million healthy meals every day-to older adults2597across our nation, many of whom are at risk for malnutrition.2598OAA interventions are cost effective. It is estimated that just2599one day in the hospital costs about the same as providing an2600older adult with one year of OAA nutrition program meals.2601Furthermore, OAA programs offer a nationwide infrastructure for2602piloting and scaling innovative interventions (e.g., medically2603tailored meals, protein-rich menus, culturally appropriate2604foods).2605    Identifying individuals at risk for malnutrition who can2606benefit from nutrition interventions often begins in the2607hospital, where disease-associated malnutrition in older2608Americans costs more than $51.3 billion every year. The2609Malnutrition Care Score, or MCS, is the only nutrition-specific2610hospital quality measure approved by the Centers for Medicare &2611Medicaid Services (CMS) for adults ages 18 and older, yet is2612not a mandatory measure. Malnutrition cannot usually be fully2613resolved in the hospital, thus it is important for acutecare2614nutrition plans to link to community nutrition services post2615discharge. Studies document that nutrition-focused quality2616improvement programs in outpatient clinics are feasible and can2617help reduce use of healthcare resources and cut costs.2618    Nutrition interventions, such as medical nutrition therapy2619(MNT) provided by a registered dietitian nutritionist (RDN) can2620lead to more successful disease treatment and health outcomes.2621However, currently MNT coverage is limited, for example2622Medicare only covers MNT for diabetes, kidney disease, or a2623recent kidney transplant. Legislation including the Medical2624Nutrition Therapy Act (MNT Act) and Treat and Reduce Obesity2625Act (TROA) would expand coverage to other nutrition-related2626chronic diseases/conditions where diet and lifestyle changes2627can be effective, including obesity, malnutrition, cancer and2628cardiovascular disease.26292630Research to Drive Innovation26312632    Including older adults in MAHA research ensures innovation2633reaches populations at the highest risk of hospitalization.2634Data is imperative to combat public health crises like older2635adult malnutrition. For the first time in 2022, the annual2636National Survey of Older Americans Act Participants (NSOAAP)2637included malnutrition screening questions. Based on this data,2638researchers recently found about a fifth of OAA program2639participants were at malnutrition risk across all OAA programs2640and that there was evidence malnutrition risk may decline with2641continued participation in OAA's home-delivered-meals program.2642Continued collection of and open access to such data helps2643identify and explain the malnutrition problem as well as2644document the impact of successful interventions like OAA2645nutrition programs.2646    Nutrition is fundamental for health and well-being,2647particularly for older adults. The Strategic Plan for NIH2648Nutrition Research includes among its priorities the need to2649"Define the role of nutrition across the life span for healthy2650development and aging." Yet funding for nutrition research has2651remained stagnant at about 5% of total NIH obligations and2652therefore needs to increase . otherwise we're just guessing at2653solutions.26542655Increasing Public Awareness and Knowledge26562657    Public messaging about "healthy aging" is often absent in2658chronic disease campaigns, even though 93% of older adults have2659at least one chronic disease. Awareness of malnutrition is even2660lower: fewer than 1 in 5 older adults who are malnourished are2661correctly identified in healthcare settings. We should2662recognize malnutrition as a chronic disease and MAHA messaging2663must include older adults if we are serious about reducing the2664nation's chronic disease burden across the lifespan.2665    Campaigns should highlight how older adults benefit from2666OAA programs, which follow the Dietary Guidelines for Americans2667to provide healthy food and support older adult's health,2668independence, and dignity. It's estimated that 2.9 million low-2669income, food insecure older adults who could benefit from OAA2670nutrition programs are not receiving meals.26712672Fostering Private Sector Collaboration26732674    OAA programs are the gold standard of public-private2675partnerships. The aging network already partners with thousands2676of local providers, health systems, and insurers to deliver2677meals and services, providing a 1:4 return on federal2678investment. Private insurance is increasingly exploring2679coverage for meals after hospital discharge, with OAA programs2680showing how community partnerships can deliver efficiently at2681scale. Excluding older adults from MAHA leaves a major blind2682spot in cross-sector health collaboration-and ignores a2683population driving much of our healthcare spending.2684    The next step is fully funding the Older Americans Act in2685Fiscal Year 26.This is crucial to ensure older adults get the2686support and nutrition they need to successfully age in place in2687their local communities. Indeed, the right of every American to2688age with respect and community was recently underscored by2689Health and Human Services Secretary Robert F. Kennedy, Jr.'s2690comments on the OAA.2691    As MAHA initiatives take form, leveraging existing networks2692like the OAA nutrition programs and supporting Make Older2693Americans Healthy Again (MOAHA) is critical. Aging is not a2694niche issue. It's a universal experience that should be at the2695center of public health policy, including MAHA. Older adults2696are the fastest growing segment of the population and the group2697with the greatest incidence of chronic disease. Many chronic2698conditions that manifest in older adulthood can be further2699aggravated by nutritional deficits or poor diet later in life.2700Supporting good nutrition in older adults can benefit their2701health and quality of life as well as leading to their improved2702well-being.2703    Edwin Walker is the former deputy assistant secretary for2704Aging in the Administration for Community Living. Bob Blancato2705is the executive director of the National Association of2706Nutrition and Aging Services Programs (NANASP) and the national2707coordinator of Defeat Malnutrition Today.27082709                 U.S. Senate Special Committee on Aging27102711         "Renewing Our Commitment: How The Older Americans Act2712          Uplifts Families Living With Aging-Related Diseases"27132714                            November 5, 202527152716                       Statements for the Record27172718           National Academy of Elder Law Attorneys Statement27192720    On behalf of our more than 4,000 members who are attorneys2721representing older Americans and individuals with disabilities,2722the National Academy of Elder Law Attorneys (NAELA) writes to2723express our strong support for immediate reauthorization of the2724Older Americans Act (OAA). NAELA is the leading professional2725association dedicated to improving the quality of legal2726services for older Americans and individuals with disabilities.2727With 31 active state chapters, NAELA provides elder and special2728needs law attorneys with education, advocacy, community, and2729the resources they need to better serve their clients.2730    Signed into law in 1965, the OAA is "one of the most2731quietly impactful laws this country has ever passed," as2732Chairman Scott noted during the hearing. Ranking Member2733Gillibrand called it a "bipartisan workhorse program that flies2734below the radar" and one that "is costefficient." The OAA has2735been reauthorized by multiple Congresses and signed into law by2736Presidents of both parties, most recently by President Trump in27372020. S. 2120, the bill introduced in 2025 to reauthorize the2738OAA, is co-sponsored by both Chairman Scott and Ranking Member2739Gillibrand, as well as Chairman Cassidy and Ranking Member2740Sanders of the Senate Health, Education, Labor & Pensions2741Committee.2742    The OAA's programs - including meal delivery and help with2743household tasks, transportation assistance, and caregiver2744support - are essential services for our clients. These2745programs allow them to remain in their homes and stay active in2746their communities for as long as possible. This benefits their2747physical and mental health, reduces government spending by2748delaying their entry into institutional care or2749hospitalization, and eases the burden on family caregivers.2750    Should an individual need to move into a long-term care2751facility, the OAA protects their rights through the Long-Term2752Care Ombudsman programs under Title VII. As elder law2753attorneys, we know that individuals living in residential care2754communities are often worried about bringing their concerns to2755management or may have trouble expressing their needs,2756particularly if they experience aging-related diseases such as2757Alzheimer's or Parkinson's. An ombudsman with whom they have a2758trusted relationship can communicate with them and advocate for2759them, easing their concerns and making sure their needs are2760met. Data from fiscal year 2023 shows that Long-Term Care2761Ombudsman representatives worked to resolve more than 200,0002762complaints from residents, their families, and other2763individuals; resolved or partially resolved 71% of complaints;2764and provided more than 500,000 instances of information and2765assistance to individuals, according to the Administration for2766Community Living (ACL).2767    Legal aid programs under Title IIIB are another way the OAA2768helps older adults remain independent and safe. These programs2769allow individuals to access legal counseling for free - which2770they may not have the ability to do otherwise - as they explore2771long-term care options, plan for future financial needs, and2772seek protection from or redress against financial abuse,2773neglect, and exploitation. The process to apply for Medicaid2774long-term services and supports, for example, is complicated;2775individuals who try to do this themselves can easily become2776overwhelmed and make mistakes. Having legal counsel to guide2777them through it can be a lifeline, especially during a time of2778stress. Older adults who are the subject of guardianship or2779conservatorship actions can turn to legal assistance programs2780to help them preserve their independence as long as possible,2781which is particularly important for those individuals with2782aging-related diseases. The ACL states that nearly 1 million2783hours of legal assistance are provided each year by OAA-funded2784legal services providers.2785    In short, OAA programs allow millions of older adults each2786year to age with dignity. NAELA members have seen the2787difference the OAA's programs make in our clients' lives and2788how much older adults and their families depend on these2789services every day. With OAA funding and services, such as2790food-delivery programs, already disrupted due to the federal2791government shutdown, it's even more important that we2792reauthorize the OAA now to ensure the program's critical,2793needs-based services continue to serve older adults throughout2794our country.2795    We hope that all Senators, particularly those on the2796Special Committee on Aging, will cosponsorS. 2120 as soon as2797possible. We appreciate the Committee's continued interest in2798this vital program, and we look forward to working with you to2799serve America's older adults through reauthorization of the2800Older Americans Act.28012802                 U.S. Senate Special Committee on Aging28032804         "Renewing Our Commitment: How The Older Americans Act2805          Uplifts Families Living With Aging-Related Diseases"28062807                            November 5, 202528082809                       Statements for the Record28102811National Association of Nutrition and Aging Services Programs Statement28122813    The National Association of Nutrition and Aging Services2814(NANASP) on behalf of our 1000+ aging services members commends2815the Chairman Rick Scott, Ranking Member Kirsten Gillibrand, and2816the Senate Special Committee on Aging for holding this2817important and timely hearing regarding how the Older Americans2818Act (OAA) and its programs serve older adults-especially those2819with disabilities, including age-related disabilities-and how2820efforts can be strengthened in rural America and in2821coordination with health care systems.2822    Important because of what the Older Americans Act and its2823programs mean to the daily lives of the 12 million Americans2824age 60 and over served by these programs and timely because it2825is time without further delay to reauthorize this important act2826which S.2120 would do. We especially appreciate ranking member2827Senator Gillibrand being a co-sponsor of this measure.2828    The largest program components of the OAA are its three2829nutrition programs: Title III C-1 (congregate nutrition2830services), Title III C-2 (home-delivered nutrition services),2831and the Nutrition Services Incentive Program (NSIP). These2832programs are the focus of today's discussion because they2833provide more than just meals, they improve health, reduce risk2834of malnutrition, and ensure the continuation of vital services2835and supports that allow older adults and people with2836disabilities to live independently in their communities.2837    For older adults and people with disabilities, the value of2838the OAA nutrition programs is many-fold.28392840      
Participants at congregate meal sites are not only2841receiving a nutritionally balanced meal (meals must meet2842federal standards, including providing at least one-third of2843the Dietary Reference Intakes) but also opportunities for2844socialization, wellness checks, referrals to other services,2845volunteers who engage them, and a community anchor.28462847      
For home-delivered meals, older adults who are frail,2848homebound, isolated, or have functional limitations receive a2849nutritious meal at home, a wellness / safety check from a2850caring volunteer or staff person, social contact, and2851connection to other community supports.28522853      
These nutrition programs are especially important for2854older adults with disabilities or age-related functional2855challenges because the statute explicitly prioritizes persons2856with "greatest social or economic need," including those with2857physical disabilities, limited mobility, and those at risk of2858institutionalization.28592860    More than one in five older Americans live in rural areas2861where challenges such as limited providers, long travel2862distances, and higher rates of disability and isolation make it2863harder to access services, maintain good nutrition, and stay2864socially connected. OAA programs, especially the nutrition2865programs, play a critical role in enabling older adults and2866people with disabilities to live in their communities with2867dignity, independence and safety.2868    These communities therefore need strong partnerships2869between the OAA network (state units on aging, area agencies on2870aging, local providers) and state health agencies, rural2871hospitals, and public health systems. For example: As rural2872health systems implement the new Malnutrition Care Score and2873the Age-Friendly Hospital Measure-which help hospitals identify2874malnutrition risk among older patients and tailor discharge2875planning-there is an opportunity for hospitals to formally2876partner with OAA nutrition programs so that when older adults2877with disabilities are discharged home, their nutrition concerns2878are addressed immediately in the community. By aligning2879nutrition screening in hospitals, referral to OAA nutrition2880programs, and follow-up coordination, readmissions may be2881reduced, older adults with disabilities can be better supported2882in their home communities, and health systems and community2883providers can jointly track outcomes.2884    To be clear: the OAA nutrition programs are more than "just2885a meal." To the older adults and people with disabilities they2886serve, these programs represent a lifeline. They promote better2887health and can help prevent malnutrition, they provide2888critically important socialization to combat isolation and2889loneliness, and for home-delivered recipients they offer a2890daily wellness check. They engage volunteerism, foster2891connection, offer nutrition education and support chronic2892disease management. The nutrition program under Title VI of the2893Act for Native American older adults also plays a vital role in2894tribal communities.2895    Given all of this, it is important that Congress act2896without further delay to reauthorize the OAA. The Act2897celebrated its 60th anniversary in 2025, marking one of the2898most successful federal programs ever enacted. Yet the world2899for older Americans has changed dramatically. Earlier this2900year, the Administration announced a major reorganization of2901Department of Health and Human Services that profoundly impacts2902the Administration for Community Living (ACL), which2903administers the OAA. While we await those results, NANASP along2904with Meals on Wheels America, National Council on Aging,2905USAging, and Advancing states urge that all aging programs be2906housed within a single agency-the Administration for Children,2907Families, and Communities-with strong aging leadership and2908adequate resources to maintain the aging network's integrity.2909    Enable state units on aging and area agencies on aging to2910fully participate in new funding streams like the Rural Health2911Transformation Grants, telehealth infrastructure and workforce2912grants to enhance rural nutrition services.2913    Today's hearing can be a catalyst to move reauthorization2914forward on a bipartisan basis to ensure more older adults and2915people with disabilities live with dignity and independence in2916their communities, especially those with greatest social and2917economic need. Let us all work together to make this happen.2918    The OAA celebrated its 60th anniversary in 2025. It did so2919with the reality that it is one of the most successful federal2920programs ever enacted hearing can be a catalyst to get2921reauthorization moving. Today's hearing is a catalyst to get2922the reauthorization moving on a bipartisan basis to ensure2923older adults and people with disabilities live with dignity and2924independence in their communities. Let us all work together to2925make this happen.2926    Thank you for your consideration.29272928    Sincerely,29292930    Bob Blancato2931    Executive Director NANASP29322933                 U.S. Senate Special Committee on Aging29342935         "Renewing Our Commitment: How The Older Americans Act2936          Uplifts Families Living With Aging-Related Diseases"29372938                            November 5, 202529392940                       Statements for the Record29412942              National Rural Health Association Statement29432944    The National Rural Health Association (NRHA) is pleased to2945submit a statement to the Special Committee on Aging Hearing,2946How the Older Americans Act (OAA) Uplifts Families Living with2947Aging-Related Diseases. We appreciate the Senate Aging2948Committee's continued commitment to the needs of older adults,2949including the more than 60 million Americans that reside in2950rural areas. NRHA submits this statement to highlight the2951unique needs of older adults in rural communities and uplift2952the importance of improving age-friendly care, nutrition2953access, and caregiver support.2954    NRHA is a non-profit membership organization with more than295521,000 members nationwide that provides leadership on rural2956health issues. Our membership includes nearly every component2957of rural America's health care, including rural community2958hospitals, critical access hospitals, long-term care providers,2959doctors, nurses, and patients. We work to improve rural2960America's health needs through government advocacy,2961communications, education, and research.29622963Background29642965    Older adults living in rural areas make up a2966disproportionate share of the aging population. In 2020, about29671 in 5 people living in rural areas in the United States were296865 and over, compared to 16 percent in urban areas, and face2969compounding challenges including higher poverty rates, greater2970social isolation, limited means of transportation, food2971insecurity, and reduced access to long term care and home- and2972community-based services.i These difficulties are magnified by2973ongoing rural hospital closures and workforce shortages.2974    The OAA has been a reliable source of caregiver relief,2975nutrition support, and assistance navigating services for many2976rural families. The OAA created the Administration on Aging,2977part of the Administration for Community Living (ACL), and2978established a national aging services network that includes2979state agencies, Tribal aging programs, Area Agencies on Aging2980(AAAs) and community-based organizations. Together, this2981network provides services that play a critical role in helping2982older adults remain in their homes and communities. In rural2983America, that mission cannot be met without strengthening OAA2984funding and flexibility to reflect the realities of rural2985service delivery.29862987Economic Challenges29882989    Poverty: Rural older adults often struggle financially due2990to limited employment opportunities, lower Social Security2991benefits due to reduced lifetime earnings, and rising health2992care costs. The poverty rate among rural older adults is 132993percent, which is 9.6 percent higher than the national2994average.ii With limited fixed incomes, even minor changes in2995finances, such as unexpected healthcare costs, can cause2996immense strain for rural older adults.2997    Housing: Housing insecurity is reported to be the leading2998cause of stress among rural older adults, with many living in2999substandard conditions due to the unavailability of senior3000housing programs.iii Rural Americans have a lower median3001household income compared to urban households, sitting around3002four percent lower.iv Inaccessibility of affordable and3003available housing for rural older adults further exacerbates3004economic challenges faced by this population and is an obstacle3005to positive healthcare outcomes. Healthy homes promote good3006physical and mental health. Good health depends on having homes3007that are safe and free from physical hazards. Residents who3008experience difficulty paying rent, mortgage or utility bills3009are less likely to have a usual source of medical care and more3010likely to postpone treatment and use the emergency room for3011treatment.v3012    Payment & Health Care Costs: Rural older adults spend an3013average of 20 percent more on health care than their urban3014counterparts.vi Additionally, Medicare is the primary source of3015care coverage for rural older adults; however, Medicare only3016covers nursing home care in limited circumstances (up to 1003017days of skilled nursing care following a hospitalization).3018Outside of this, Medicare generally does not cover long-term3019care in nursing homes or any assisted living. Rural older3020adults typically rely upon Medicaid to help pay for these3021costs.3022    Additionally, limited transportation infrastructure and3023reliance on emergency services in rural areas contribute to the3024high costs of healthcare for rural adults, as well as heighten3025the challenges older rural adults face in accessing care.30263027Social Challenges30283029    Caregiver Support: Rural families carry a disproportionate3030share of the caregiving responsibility because the formal long-3031term care system in rural areas is thinner and continues to3032contract. Rural areas have experienced higher rates of nursing3033home closures, consolidation of home health agencies, and3034reduction in hospice and in-home support teams. These closures3035force older adults and their families to travel farther for3036care or manage complex health needs at home with limited, if3037any, professional support. As a result, family, friends, and3038neighbors become the default care system where they support3039loved ones with dementia, mobility limitations, or multiple3040chronic conditions while also balancing work, transportation3041challenges and financial constraints.3042    Even when services exist, workforce shortages limit3043availability of rural caregivers. Rural nursing assistants,3044home health workers, and long-term care staff are consistently3045underpaid, leading to turnover and service gaps. The result is3046caregiver burnout and turnover. Expanding caregiver support,3047in-home care capacity, and respite access under the OAA are3048needed not only to protect caregiver health but also to enable3049older adults to remain safely in their homes and communities.3050    Transportation: Unlike urban areas, most rural regions lack3051public transit systems or rideshare services. Older adults who3052no longer drive often have no alternative way to get medical3053appointments, grocery stores, pharmacies, senior centers, or3054social visits. As a result, losing the ability to drive can3055lead to instant isolation and access challenges. These3056transportation barriers contribute to missed medical care,3057delayed treatment, and worsened chronic disease outcomes. OAA-3058funded transportation programs attempt to fill these gaps but3059are consistently under-resourced and face higher per-trip costs3060due to long travel distances and dispersed populations in rural3061areas.3062    Isolation & Mental Health: Rural older adults are more3063likely to live alone farther from neighbors, and in communities3064where gathering places have declined due to hospital closures,3065shrinking senior centers, and loss of local businesses. Social3066isolation is linked to higher risks of depression, cognitive3067decline, vulnerability to elder abuse, and earlier mortality by3068up to 30 percent.vii OAA supported congregate meal programs and3069senior centers have historically served as anchors of3070connection, but many rural providers struggle to maintain3071programming or transportation to bring people together.30723073Health Care Access30743075    Workforce: Developing, retaining, and sustaining the rural3076healthcare workforce is often challenging in rural areas. As a3077result of these workforce shortages, rural older adults often3078struggle to access primary care providers, nurses, and other3079specialty care providers. Rural areas have 64 percent fewer3080health care workers per capita than urban areas.viii This in3081turn leads to limited access to preventive care and chronic3082disease management for older adults. Community health workers3083(CHWs) integration into the healthcare system offers one method3084to help bridge gaps in health care delivery and increase access3085to care. CHWs play an increasingly vital role in delivering3086culturally competent education, care coordination, and social3087support, especially in rural settings where clinical workforce3088shortages persist.3089    Infrastructure: Healthcare infrastructure that can help3090support the rural older adult population is integral in3091providing long-term care (LTC) support and addressing the needs3092of the rural aging population. This includes home health or3093home and community-based services, or institutional3094infrastructure such as skilled nursing facilities (SNFs),3095assisted living, or long-term care facilities. Rural counties3096have a higher percentage of residents 65 or older and have a3097higher percentage of the population that identifies as having a3098disability, which indicates a greater need for age-friendly3099resources. Access to high-quality nursing home care in rural3100communities and investments in long-term services and support3101(LTSS) are needed to allow rural residents to access support3102and care at home or in their local communities. As mentioned,3103Medicare often does not provide coverage for many LTC costs.3104Residents of rural communities who are Medicare beneficiaries3105tend to use more skilled nursing services and have a higher3106rate of covered days as compared to urban communities.ix3107Funding for LTC services as well as reimbursement adjustments3108for these facilities can help prioritize, sustain, and increase3109support for health infrastructure for rural older adults.3110    Nutrition: Reliable access to nutritious food is3111foundational to healthy aging, yet rural older adults face3112higher rates of food insecurity and malnutrition due to limited3113grocery access, long travel distances, and rising food and fuel3114costs. In nearly one in five rural counties, there is no full-3115service grocery store at all and more than 20 percent of rural3116Census tracts qualify as food deserts.x,xi For older adults who3117no longer drive, this means that even basic staples like fresh3118produce and medication snacks become difficult or impossible to3119obtain. OAA nutrition programs directly counter these3120conditions. Congregate meals provide structured social3121engagement and routine safety checks, reducing the risk of3122cognitive decline and loneliness. Home delivered meals like3123Meals on Wheels support older adults who are homebound or have3124mobility limitations. These meals in rural communities are not3125simply supplemental, they are the primary balanced meal of the3126day and a key part of managing diabetes, hypertension, stroke3127recovery and heart disease.3128    Overall, rural communities are home to a large population3129of older adults. Many factors contribute to the challenges and3130barriers this population faces in terms of healthcare access.3131The OAA is a key solution to help improve social drivers of3132health, offer support to care-givers and rural adult health3133needs, and address key issues in health workforce and3134infrastructure in rural communities. Addressing these3135challenges can help improve the overall health and disease3136management of older adults in rural areas.3137    NRHA thanks the Committee for the opportunity to weigh in3138on supporting the health of the older population living in3139rural areas throughout the country. For further information on3140this topic, please reference NRHA's policy brief, Older3141Americans Act: Greatest economic and social needs of older3142rural adults. If you have any questions or would like to3143discuss our response further, please contact NRHA's Government3144Affairs and Policy Director, Alexa McKinley Abel.31453146    Sincerely,3147    /s/31483149    Alan Morgan3150    Chief Executive Officer3151    National Rural Health Association31523153---------------------------------------------------------------31543155(i) US Census Bureau. U.S. older population grew from 2010 to31562020 at fastest rate since 1880 to 1890. Census.gov. Published3157May 25, 2023. Accessed November 12, 2025. https://3158www.census.gov/library/stories/2023/05/2020-census-3159unitedstates-older-population-grew.html31603161(ii) RUPRI Center for Rural Health Policy Analysis. Nursing3162Homes in Rural America: A Chartbook. 2022. Accessed November316312, 2025. https://rupri.org/wp-content/uploads/Nursing-Home-3164Chartbook.pdf31653166(iii) National Council on Aging. What is the USDA Home Repair3167Loans and Grants Program? Published October 2, 2024. Accessed3168November 12, 2025. https://www.ncoa.org/article/what-is-the-3169usda-single-family-housing-repair-loans-and-grants-program31703171(iv) Bishaw A, Posey K. A comparison of rural and urban3172America: Household income and poverty. US Census Bureau Blog.3173Published 2016. Accessed October 28, 2019. https://3174www.census.gov/newsroom/blogs/randomsamplings/2016/12/a--3175comparison--of--rura.html31763177(v) Robert Wood Johnson Foundation. Housing and health.3178Published May 2011. Accessed November 12, 2025. https://3179www.rwjf.org/en/insights/our-research/2011/05/housing-and-3180health.html31813182(vi) Gunja MZ. Rural Americans struggle with medical bills and3183health care affordability. The Commonwealth Fund. Published3184July 24, 2023. Accessed November 12, 2025. https://3185www.commonwealthfund.org/blog/2023/rural-americans-struggle-3186medicalbills-and-health-care-affordability31873188(vii) Siuba JM, Carroll E, Haire E, et al. Addressing social3189isolation in older adults as a determinant of health. In: Pack3190MH, ed. 2023. Accessed November 12, 2025. https://imph.org/wp-3191content/uploads/2023/06/imph-social-isolation-2023-3192accessible.pdf31933194(viii) Bureau of Labor Statistics. Occupational Employment and3195Wage Statistics (OEWS) tables. Published April 2, 2025.3196Accessed November 12, 2025. https://www.bls.gov/oes/current/3197oes291141.htm31983199(ix) National Rural Health Association. Rural nursing home3200landscape: White paper. Accessed November 12, 2025. https://3201www.ruralhealth.us/nationalruralhealth/media/documents/3202advocacy/white%20paper/rural-nursing-home-landscape-white-3203paper-.inal.pdf32043205(x) The Food Trust. The grocery gap: Who has access to healthy3206food and why it matters. Accessed November 12, 2025. https://3207thefoodtrust.org/wp-content/uploads/2022/06/3208grocerygap.original.pdf32093210(xi) US Department of Agriculture Economic Research Service.3211Food Access Research Atlas: Documentation. Accessed November321212, 2025. https://www.ers.usda.gov/data-products/food-access-3213research-atlas/documentation32143215                 U.S. Senate Special Committee on Aging32163217         "Renewing Our Commitment: How The Older Americans Act3218          Uplifts Families Living With Aging-Related Diseases"32193220                            November 5, 202532213222                       Statements for the Record32233224     VISIONS/Services for the Blind and Visually Impaired Statement32253226    As the President and CEO of VISIONS/Services for the Blind3227and Visually Impaired-one of New York State's oldest and most3228trusted nonprofit organizations serving older adults who are3229blind or visually impaired-I thank you for your leadership in3230advancing the reauthorization of the Older Americans Act.3231    For nearly a century, VISIONS has empowered tens of3232thousands of older adults to remain active, independent, and3233engaged in their communities despite vision loss. Today, the3234four leading causes of blindness-age-related macular3235degeneration, cataracts, glaucoma, and diabetic retinopathy-3236affect millions of Americans, and their prevalence increases3237dramatically with age. These are not just medical conditions;3238they are life-changing diagnoses that threaten safety,3239mobility, and emotionalwell-being-think of not being able to3240prepare food safely for yourself in your own home, not being3241able to take a walk safely on your own, or communicate through3242your smartphone that you need help.3243    Through programs supported in part by the Older Americans3244Act and by our partnerships with the New York State Commission3245for the Blind and local area agencies on aging, VISIONS3246provides the essential services that make independence3247possible:32483249      
Vision rehabilitation training that helps older adults3250safely navigate their homesand neighborhoods;32513252      
Orientation and mobility instruction that restores3253confidence to walk, travel, andparticipate in community life;32543255      
Assistive technology support that teaches individuals to3256use adaptive devices,magnifiers, and screen readers to stay3257connected to loved ones; make telehealth appointments, support3258and social engagement programs that combat isolation and3259depression, financial independence through online banking,3260allowing older adults to continue living where they choose-with3261dignity and purpose.32623263      
Caregiver support services that equip unpaid family3264members with the resources,respite, and guidance they need to3265sustain care at home, helping older adults remain safely in3266their communities and reducing the need for costly nursing home3267placement.32683269    As our population ages, the need for these services will3270more than double in the next 25 years. Without reauthorization3271and sustained investment in the OAA, the network of providers3272like VISIONS-those who are on the front lines every day helping3273older adults maintain independence-cannot keep pace with the3274growing demand.3275    At VISIONS, we witness daily the transformative impact of3276coordinated, community-based care envisioned by the OAA. A 78-3277year-old New Yorker who has lost her sight to glaucoma can3278learn to cook safely again. A retired veteran with diabetic3279retinopathy can use speech-enabled technology to pay bills and3280stay connected to family. These are not extraordinary stories-3281they are everyday outcomes made possible because Congress has3282chosen, time and again, to invest in independence, dignity, and3283community for older Americans.3284    I urge Congress to reauthorize and strengthen the Older3285Americans Act, ensuring that older adults with vision loss and3286other disabilities have continued access to the vital supports3287they need to live full and meaningful lives.3288    Thank you for your commitment to our nation's seniors and3289to the organizations that serve them.32903291    Respectfully submitted,32923293    Molly E. Eagan3294    President & CEO3295    VISIONS/Services for the Blind and Visually Impaired, New3296York, NY32973298                         [all]