Statements on Introduced Bills and Joint Resolution
Floor Speech
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Ms. COLLINS. Mr. President, there is a great deal of activity going on as we seek to conclude the negotiations on so many important issues. However, I don't want us to lose sight of the expiration of the authorization of the Older Americans Act--a very important law that makes a big difference for many of our seniors all across our country-- so I rise today to introduce a reauthorization of that important law called the Modernization of the Older Americans Act. I am pleased to sponsor this reauthorization with Senator Bob Casey, who serves as the ranking member of the Senate Special Committee on Aging, of which I am the chair.
Since 1965, the Older Americans Act has ensured that seniors receive the support they need to grow older independently and with dignity. The OAA programs provide nutritious food, transportation, assistance to caregivers, and in-home services for older adults. Our investments foster a sense of community for older adults and save taxpayers money by reducing hospitalizations and the need for long-term residential care.
I know the Presiding Officer would agree that most seniors would prefer to remain in the comfort, security, and privacy of their own homes if they possibly can. It is the programs of the Older Americans Act that help to make that possible.
As our population grows older, the demand for Older American Act services has grown as well. For example, Meals on Wheels--perhaps the best known of all the OAA programs--provided seniors with 358 million meals last year. In many States, the need is soaring. In Maine, which is the oldest State by median age in the country, there is a waiting list of 400 to 1,500 seniors, depending on the time of the year and the location within our State.
This reauthorization helps to ensure that more seniors in need of nutritious food can be served. At $11 a day, a meal is far cheaper than a $2,400 average cost of a daily hospital stay. Let me give an example of what I mean by that. Using Older Americans Act dollars, the Southern Maine Agency on Aging conducted a pilot study that provided seniors discharged from hospitals with 4 weeks' worth of prepared meals. The results were astounding. Hospital readmissions were reduced by 38 percent--a 387-percent return on investment. If you scaled that nationwide, the savings would be an astronomical $51 billion annually-- just ensuring that a senior who is discharged from the hospital has 4 weeks' worth of prepared meals available to him or her.
We have also included several provisions in the reauthorization to combat social isolation, which can have devastating health effects. In fact, estimates are that prolonged isolation and loneliness have an impact on health that is comparable to smoking 15 cigarettes a day. Just think of that.
My State is already on the forefront of combating this epidemic of isolation. Using Older Americans Act funding, the Maine Eastern Area Agency on Aging has partnered with the University of Maine to implement Project Generations, which brings student volunteers into the homes of local seniors for visits. Our reauthorization includes an increased focus on the detrimental effects of social isolation and would provide States with more resources to develop programs like Project Generations. What a wonderful program this is. It not only gives some company that an older American might not have, but also it is great for those students to have the interaction with our seniors. It truly is a win-win program.
Flexibility and innovation have always been at the heart of the Older Americans Act. What may be needed in the Presiding Officer's home State may be different from what is needed in the State of Maine. Our reauthorization would help communities continue to find creative solutions to meet the needs of our seniors. For example, the Southern Maine Agency on Aging restructured its congregate meals program by hosting meals in multigenerational settings, such as hospital and college cafeterias and small local restaurants. Since then, the program has grown by 55 percent and boosted the local economy by increasing the number of diners from rural areas by 61 percent in the first 5 years.
It is much more interesting for our seniors to go out to a local restaurant for a congregate meal than in some cases going to a senior center. It may be more interesting for them to go to a college cafeteria and have that interaction with younger people. Whatever works, that is the answer. In some areas, it may work to do a college or hospital cafeteria; in another, it is a senior center; and in still others, it may be the local diner that is providing the meal.
The core of the Older Americans Act is protecting the most vulnerable of our older Americans. One critical program is the Long-Term Care Ombudsman Program. This provides advocacy for residents in long-term care facilities, assisting with discharge and also protecting their rights.
There was a disturbing story in one of the weekend newspapers in Maine about a nursing home that was not living up to the quality standards that we need, and that is where the ombudsman program can be absolutely critical because a lot of times, the relatives of residents are very cautious about complaining. They are fearful that their loved one may have nowhere else to go. So the ombudsman program is an important quality control program.
At an Aging Committee hearing this May, the executive director of Maine's Long-Term Care Ombudsman Program, Brenda Gallant, shared the story of a 94-year-old woman whom she was able to help transition from a nursing home back to her own home after recovering from a fractured hip. Brenda connected the woman with the resources and the technologies to make the transition a smooth one and to help her live successfully back in her own home, just where she wanted to be.
The Older Americans Act is a shining example of a Federal policy that works. Every dollar invested into the Older Americans Act generates $3 by helping seniors stay at home through highly effective and lower cost community-based services.
I thank the dozens of stakeholders we have worked with over the past several months. We have gotten lots of input in preparing this reauthorization, including from the Leadership Council of Aging Organizations, AARP, the National Association of Area Agencies on Aging, Advancing States, the National Alliance for Caregiving, Meals on Wheels America, and the Alzheimer's Association.
Hon. Susan Collins, Chair, Special Committee on Aging, U.S. Senate. Hon. Bob Casey, Ranking Member, Special Committee on Aging, U.S. Senate.
Dear Senators Collins and Casey: On behalf of our nearly 38 million members and all older Americans nationwide, AARP is pleased to support the Modernization of the Older Americans Act Amendments, legislation to reauthorize the Older Americans Act (OAA). We appreciate your leadership and the bipartisan work of Senate Committee on Health, Education, Labor and Pensions Chairman Lamar Alexander and Ranking Member Patty Murray in developing this legislation, and encourage prompt reauthorization of OAA.
The Older Americans Act has a powerful legacy. Since 1965 it has provided older Americans with the support they need to live at home with independence and dignity. In 2017 alone, OAA programs provided services for over 11 million older adults. Those services include home care, congregate and home-delivered meals, case management, family caregiver support, transportation, adult day care, legal services, elder abuse prevention, and job training and employment opportunities for low-income older adults. OAA programs serve the needs of older Americans while deferring or eliminating the need for costly institutionalization.
The Modernization of the Older Americans Act Amendments builds on this legacy. The legislation further strengthens the National Family Caregiver Support Program (NFCSP) by helping to make sure that more caregivers can get their needs assessed when they turn to the program for support, extends the RAISE Family Caregivers Act, and increases funding levels to support the needs of the growing older population. This legislation, which will promote greater responsiveness to the needs of older Americans and their caregivers, comes at a critical time. From 2019 to 2030 we expect to see the 80+ population grow by 54 percent. This age group is among the most likely to need help living independently in their homes and communities .
Again, thank you for your bipartisan leadership in advancing this important legislation. We urge prompt reauthorization so that our loved ones can continue to turn to these services for their health and economic security as they age. If you have any questions, feel free to contact me. Sincerely, Megan O'Reilly,
Vice President, Federal Health & Family Government Affairs. ____ National Alliance for Caregiving, November 15, 2019. Re Senator Collins ``Modernization of the Older Americans Act Amendments'' bill in the 116th Congress. Hon. Susan Collins, Chairman, Special Committee on Aging.
On behalf of the National Alliance for Caregiving (NAC), we are happy to support Senator Collins ``Modernization of the Older Americans Act Amendments'' bill. Thank you for the opportunity to participate in the reauthorization process for the Older Americans Act. This law is one of the most underrecognized supports for family caregivers of adults, and your leadership in the goal to strengthen families and the dignity and independence of aging adults is critical to the communities we serve.
We were excited to have the opportunity to come and meet with your staff and to explore ways that family caregiving could be supported with this reauthorization. Your leadership and commitment to families is evident in the latest draft of the bill and we appreciate the opportunity to provide our input, as follows:
1. NAC recommended that the bill increase the authorized funding level for the National Family Caregiver Support Program (Title IIIE) from the current appropriated level of $181.2 million to $360 million. We recognize that OAA funding has not kept pace with inflation and the growing demands placed on families as the population ages. We remain hopeful that you will be able to support our request.
2. NAC recommended that the bill direct the Assistant Secretary (in Title II) to award a grant to or enter into a cooperative agreement with a public or private nonprofit entity to establish and operate a National Resource Center on Family Caregiving. Although the draft bill does not specifically direct the creation of the Resource Center, Section 215 of the Modernization of the Older Americans Act includes language pertaining to ``(i) Activities of National Significance, which offers a potential for the creation of a Resource Center. We suggest the following modification to strengthen that section:
(i) Activities of National Significance.--The Assistant Secretary [may] shall award funds authorized under this section to one or more public or private nonprofit entities with appropriate caregiving expertise for conducting activities of national significance that--
(1[2]) include, with respect to such programs, program evaluation, training, technical assistance, materials, dissemination, and research; and
([1]2) promote quality and continuous improvement in the support provided to family caregivers and older relative caregivers through programs carried out under this section and section 631.
3. We recommended extending the RAISE Family Caregivers Act of 2017, and we appreciate the current draft bill which would extend the act for five years.
4. Section 215 of the current draft bill about the National Family Caregiver Support Program addresses our recommendation to increase the use of standardized family caregiver assessment tools. The inclusion of a clear definition for caregiver assessment, identifying and disseminating best practices, and calling for a report on the status of caregiver assessment are excellent proposals to successfully expand assessment tools and access to services for family caregivers.
5. NAC's fifth recommendation was to direct the Assistant Secretary of Health and Human Services to develop a plan to implement recommendation 1-g from the National Academies of Sciences, Engineering, and Medicine's ``Families Caring for and Aging America'' report: ``Launch a multi-agency research program sufficiently robust to evaluate caregiver interventions in real-world health care and community settings, across diverse conditions and populations, and with respect to a broad array of outcomes.'' Noting that this is not in the current draft, we would offer our expertise and be happy to participate in further conversation about how such a research program might be created.
Again, thank you and we look forward to a successful reauthorization this year. Kind regards, C. Grace Whiting, J.D,
President, CEO. Michael R. Wittke, B.S.W., M.P.A.,
Senior Director, Public Policy and Advocacy. ____ West Health Institute, December 2, 2019. Hon. Susan Collins.
Dear Senator Collins: On behalf of the Gary and Mary West Health Institute (WHI), I am writing to thank you and your staff for your tireless efforts to reauthorize the Older Americans Act (OAA). Originally enacted in 1965, the OAA supports a range of vital home- and community-based programs, such as Meals on Wheels and other nutritional support; in- home, transportation and legal services; and elder abuse prevention and caregiver support. Protecting seniors' access to these services is critical in light of the growing population of U.S. seniors, which is projected to reach 56 million in 2020 and more than 73 million by 2030. We urge your colleagues to support reauthorization of this critical legislation before the end of the year.
Based in San Diego, WHI is an applied medical research organization and part of nonprofit and nonpartisan West Health, which also includes the Gary and Mary West Foundation and the Gary and Mary West Health Policy Center. Our organizations work together toward a shared mission dedicated to lowering the cost of healthcare to enable seniors to successfully age in place with access to high-quality, affordable health and support services that preserve and protect their dignity, quality of life and independence.
One of West Health's flagship programs is the Gary and Mary West Senior Wellness Center in downtown San Diego. At the Senior Wellness Center, which is operated by the nonprofit Serving Seniors, low-income seniors receive coordinated care and social support services--all under one roof. Since it opened in 2010, the Center has served over 1.7 million nutritious meals and has provided more than 10,000 seniors with services they need from the Center's 30 collaborative partners, including the Gary and Mary West Senior Dental Center--a separate, onsite nonprofit dental clinic providing affordable oral care to low-income seniors.
In recent years, West Health has focused on shining a light on one of the greatest threats to successful aging: senior malnutrition. Malnutrition disproportionally affects seniors. One out of two seniors are at risk, and disease-associated malnutrition in seniors is estimated to cost $51.3 billion annually. With our nation's rapidly growing senior population, the impact of malnutrition will be even greater if action is not taken now. Thank you for adding malnutrition to routine health screenings in your draft legislation as well as H.R. 4334.
We fully appreciate the value of OAA funded programs in enriching seniors' lives and urge Congress to reauthorize the OAA this year at the highest possible authorization levels. On behalf of the seniors we serve, thank you for your advocacy and leadership. Sincerely, Shelley Lyford, President and Chief Executive Officer. ____ National Association of Nutrition and Aging Services Programs, Washington, DC, November 16, 2019. NANASP Older Americans Act Draft Bill Comments To the Senate Health, Education, Labor and Pensions (HELP) Committee Majority:
Thank you for providing an opportunity to share comments on the draft bill you released for the 2019 Older Americans Act reauthorization.
NANASP is pleased that Sen. Collins' Older Americans Act proposal includes:
Increased authorizations for funding levels. The bill includes continued increases over the next seven federal fiscal years (FY) for Older Americans Act programs, including an increase of over $473 million total for Older Americans Act nutrition programs by FY 2026--increases that are sorely needed for programs that are stretched thin by growing demand.
An increased focus on malnutrition. The bill includes new provisions for malnutrition screening and adds reduction of malnutrition to the purposes of the nutrition program. Since more than one in two older adults is at risk for malnutrition, which increases their risk of disease and death, it is vital to detect this condition early.
Simpler transfer authority between congregate and home- delivered meals programs. The bill includes language instructing states to ensure that the transfer process for nutrition programs is simplified and clarified, maximizing efficiency and minimizing paperwork and confusion.
Creation of a nutrition program impact study. This study would assess how to measure and evaluate the discrepancy between available nutrition services and the demand for such services, which would ultimately lead to data to strengthen the case for much-needed future funding increases for nutrition programs.
Inclusion of culturally considerate and medically tailored meals in nutrition programs' offerings to the maximum extent practicable. As the older population becomes more diverse, it is important to take newly diverse preferences into consideration when providing meals. Medically tailored meals have also been shown to reduce disease burden in older adults and are important to consider offering as well.
An increased focus on social isolation. Through the first- time inclusion of social isolation screening, further coordination of services to address this issue, and creation of an advisory council on social isolation, Older Americans Act programs and services can even more effectively address the needs of socially isolated older adults.
Strengthened family caregiver provisions. Caregivers, including older relative caregivers, need support, and this bill would increase the use of caregiver assessments to analyze their needs as well as allow individual states to determine spending needs for older relative caregivers.
If you have any questions, please contact NANASP's Policy and Advocacy Director Meredith Whitmire. Bob Blancato,
Executive Director. Meredith Whitmire,
Policy and Advocacy Director. ____ Alzheimer's Impact Movement, November 15, 2019. Hon. Susan Collins, Chairman, U.S. Senate Special Committee on Aging.
Dear Chairman Collins: On behalf of the Alzheimer's Association and the Alzheimer's Impact Movement (AIM), including our nationwide network of advocates, thank you for your continued leadership on issues and legislation important to Americans living with Alzheimer's and other dementias, and their caregivers. In addition, thank you for working in a bipartisan manner to reauthorize this important program, including the hearing held by the Senate Special Committee on Aging. We are proud to support this draft of the Older Americans Act (OAA) reauthorization and are pleased to highlight several provisions that are critical to persons living with dementia, families, and their caregivers.
We strongly support the inclusion in the draft of language codifying existing authority to provide services to individuals living with younger-onset Alzheimer's disease under the National Family Caregiver Support Program and the Long-Term Care Ombudsman Program. We are very appreciative for the inclusion of these key elements of the Younger-Onset Alzheimer's Disease Act (S. 901/H.R. 1903).
There are approximately 5.8 million Americans living with Alzheimer's disease. The vast majority of those individuals are over the age of 65, however, approximately 200,000 Americans are under the age of 65 living with younger-onset Alzheimer's disease. Individuals living with younger-onset face unique challenges when it comes to family, work, and finances. They may be parenting young children at home, or still be working as the primary income provider for their families. Due to their young age, they may have more trouble receiving an accurate diagnosis, and even family and friends might question their diagnosis. The stigma associated with younger-onset Alzheimer's can have a significant impact on their well-being and quality of life.
Since 97 percent of all people living with Alzheimer's are age 65 or older, current Alzheimer's support infrastructure focuses exclusively on seniors. As a result, few supportive services are available to those with younger-onset. With other diseases--like heart disease, diabetes, and even cancer--many people living with them are middle-aged and there is a large support structure available to them. Those same support structures are not available for the individuals living with younger-onset Alzheimer's disease. The services provided under the OAA are particularly helpful for individuals with younger-onset Alzheimer's disease and related dementias who need assistance with activities of daily living.
The Younger-Onset Alzheimer's Disease Act is consistent with the National Plan to Address Alzheimer's Disease. The Advisory Council on Alzheimers Research. Care. and Services. which is responsible for updating and implementing the Plan, has noted that persons living with younger-onset Alzheimer's face unique challenges in accessing care. In the 2017 National Plan, the Advisory Council recommended that Congress amend the OAA to allow additional services to be provided to younger adults living with dementia.
The Alzheimer's Association and AIM also deeply appreciate the bill's extension of the authorization for the RAISE Family Caregivers Act from 3 years to 8 years. We have been strong advocates for the RAISE Family Caregivers Act since it was introduced in Congress. There has been a delay in the implementation of the Act and the decision to extend the authorization allows the Department of Health and Human Services to better develop a national strategy for education and training, long-term services and supports, and financial stability and security for caregivers.
For millions of Americans caring for individuals with Alzheimer's and other dementias the emotional, physical, and financial costs can be overwhelming. Caregivers of people with dementia report higher levels of stress, depression, and worse health outcomes than those providing care to individuals without dementia. As a result, Alzheimer's caregivers incurred $11.8 billion in additional health costs last year. We appreciate the bill prioritizing this important program.
We also applaud the bill's strengthening of caregiver assessments. In 2018, more than 16 million unpaid caregivers provided 18.5 billion hours of care valued at nearly $234 billion and face the challenges noted above. Eighty-three percent of the help provided to older adults in the United States comes from family members, friends, or other unpaid caregivers. Nearly half of all caregivers who provide help to older adults do so for someone living with Alzheimer's or another dementia. Alzheimer's takes a devastating toll on caregivers. Compared with caregivers of people without dementia, twice as many caregivers of those with dementia indicate substantial emotional, financial, and physical difficulties. Of the total lifetime cost of caring for someone with dementia, 70 percent is borne by families-- either through out-of-pocket health and long-term care expenses or from the value of unpaid care.
These dedicated caregivers would greatly benefit from increased resources, training, and support to help them navigate the strain of caregiving and improve their health and quality of life. The proposed changes would provide these caregivers with much-needed resources through the National Family Caregiver Support Program, increase the use of caregiver assessments, and identify best practices relating to the programs. These important actions will enhance support for caregivers through skills building, increased resources and information, respite care, counseling, and other helpful benefits.
Finally, the Association and AIM appreciate your commitment to supporting individuals facing social isolation with the inclusion of a report on social isolation. Social isolation is an issue within the aging community as a whole, and particularly in the Alzheimer's and related dementias community. Studies have found that support groups can decrease social isolation and increase social support, ability to accept the diagnosis, cope with symptoms, improve quality of life, and enhance family communication (Alzheimer's Association Dementia Care Practice Recommendations, 2018). Support programs offered through the National Family Caregiver Support Program can work to decrease social isolation. We appreciate the bill's inclusion of a study on the effectiveness of these programs.
Again, thank you for your leadership in ensuring OAA's reauthorization, which will improve the quality of care for people living with Alzheimer's. If you have any questions, please contact Rachel Conant, Vice President of Federal Affairs. Sincerely, Robert Egge, Chief Public Policy Officer, Executive Vice President, Government Affairs. ____ The Jewish Federations of North America, November 25, 2019. Majority Leader Mitch McConnell, U.S. Senate. Minority Leader Chuck Schumer, U.S. Senate. Chairman Lamar Alexander, HELP Committee, U.S. Senate. Ranking Member Patty Murray, HELP Committee, U.S. Senate.
Dear Leader McConnell, Leader Schumer, Chairman Alexander and Ranking Member Murray: The Jewish Federations of North America (JFNA) is proud to endorse the Modernization of the Older Americans Act Amendments. JFNA represents 146 local Jewish Federations, 300 Network communities, and thousands of affiliated social service agencies across the continent. Our movement protects and enhances the well-being of Jews worldwide through the values of tikkun olam (repairing the world), tzedakah (charity and social justice) and torah (Jewish learning). Jewish social services provide support for more than one million vulnerable individuals each year, Jewish and non-Jewish alike, including approximately 100,000 older adults.
For more than 50 years, the Older Americans Act (OAA) has been essential in developing, coordinating, and delivering home and community-based services that help older adults age with independence and dignity in their homes and communities. Without these crucial services, many individuals served by OAA-funded programs in our network are at significant risk of hunger, isolation, and losing their ability to live with health and independence.
The Jewish community is disproportionately older than the general population in this country with approximately 28% of American Jews already over the age of 65, and the fastest growing demographic in the Jewish community is those over the age of 85. Jewish family service agencies, Jewish vocational service agencies and Jewish community centers are a key component of the country's Aging Services Network and, in a classic public-private partnership, provide many services funded through the OAA, including case management, transportation, congregate and home-delivered meals, adult day care, elder abuse prevention and intervention, family caregiver support, home care, legal conservatorship, and support groups.
This year's reauthorization process produced the Modernization of the Older Americans Act Amendments in the Senate, a bill that, if enacted, will significantly move the ball forward in how our country and its Aging Services Network treat and care for seniors. The very first substantive provision of the bill (after the authorization of appropriations) incorporates ``person-centered, trauma- informed care'' (``PCTI'') as a new objective of the Older Americans Act. This principle, which is subsequently defined in the bill, represents a new trend in service delivery that will positively impact both clients and agencies. It incorporates a holistic approach to service provision that promotes the dignity, strength, and empowerment of trauma victims by referencing knowledge about the role of trauma in trauma victims' lives. The inclusion of the PCTI approach in this bill is indicative of the forward and necessary progress embedded in the Modernization of the Older Americans Act Amendments.
The Modernization of the Older Americans Act Amendments authorizes a technical assistance center to serve older adults experiencing the long-term and adverse consequences of trauma. This includes but is not limited to Holocaust survivors. Holocaust survivors are specifically mentioned for the first time within the Older Americans Act in the context of providing additional outreach to older individuals ``including Holocaust survivors'' who are at risk of institutional placement. The bill also emphasizes cultural considerations in the provision of congregate and home-delivered meals.
This Older American Act reauthorization incorporates new support for age-friendly communities, a major new focus on social isolation in older adults, an updating of, recognition and support for multigenerational families, and assistance to family caregivers with an extension of the RAISE Family Caregivers Act. Each of these provisions and many others contained in the bill will serve our nation well. JFNA also is pleased with the lengthy reauthorization period and relatively robust funding increases for the Older Americans Act, which help safeguard support and removes uncertainty for
Collectively, this reauthorization vehicle that is very worthy of support and JFNA looks forward to its enactment. Sincerely, Stephan O, Kline, Interim Director of the Washington Office and Associate Vice President, Public Policy The Jewish Federations of North America. ____ Advancing States, December 9, 2019. Majority Leader McConnell, U.S. Senate. Minority Leader Schumer, U.S. Senate.
Dear Majority Leader McConnell and Minority Leader Schumer: On behalf of ADvancing States, I am writing you in support of efforts to reauthorize the Older Americans Act (OAA). ADvancing States is a nonpartisan association of state government agencies that represents the nation's 56 state and territorial agencies on aging and disabilities. We work to support visionary state leadership, the advancement of state systems innovation, and the development of national policies that support home and community-based services for older adults and persons with disabilities. Our members administer a wide range of services and supports for older adults and people with disabilities, including overseeing OAA programs and services in every state. Together with our members, we work to design, improve, and sustain state systems delivering long-term services and supports for people who are older or have a disability and for their caregivers.
We are writing to you to strongly encourage the U.S. Senate to pass a bill to reauthorize the OAA as soon as possible. Authorization for critical OAA programs, such as homedelivered meals and caregiver supports, expired September 30, 2019. We know that members of the Health, Education, Labor, and Pensions committee have been working diligently to craft a bill to reauthorize the OAA. We appreciate these bipartisan efforts and strongly encourage the U.S. Senate to pass a bill to reauthorize the OAA as soon as possible.
If you have any questions regarding this letter, please feel free to contact Damon Terzaghi or Adam Mosey. Sincerely, Martha Roherty, Executive Director.
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Ms. COLLINS. I urge my colleagues to take a look at this bipartisan bill.
We are overdue to reauthorize the Older Americans Act. This is our opportunity not only to reauthorize it but to make it even better and more responsive to the needs of America's older Americans.
Thank you very much. ______
By Mr. DURBIN:
S. 3058. A bill to amend the Higher Education Act of 1965 to establish fair and consistent eligibility requirements for graduate medical schools operating outside the United States and Canada; to the Committee on Health, Education, Labor, and Pensions.
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