▶ 0:16:42Chair Scott: The special committee on aging will come to order. So this is my first committee meeting to chair in six years. How about you?
▶ 0:16:52Sen. Gillibrand: First one. -here --I have been here 15.
▶ 0:16:58Chair Scott: I just got lucky. I want to thank everybody for being here. It is a pleasure to serve as the chairman for the senate special committee on aging for the 119th congress. I look forward to working with ranking member jell-o brand -- gillibrand to help all americans and the government be more accountable to the american people. This is something I've been focused on since my time as governor of florida and I'm excited to continue this work as chairman of the special committee on aging.
▶ 0:17:27Chair Scott: My goal is to make sure every american seniors able to answer yes to these questions -- are you well? They secure these four things, physical health, financial security, a safe community to live in, and family support. If you have all four of these things come your senior years can be the best time of your life. I would like to welcome all the members of the committee.
▶ 0:17:52Chair Scott: Ranking member gillibrand of new york. Also we've got new member dave mccormick from pennsylvania, coach tommy tuberville, fellow governor jim justice. We've got andy kim from new jersey. And we have got some others who I am sure will be here a little later. Aging is not a partisan issue. Whether we like to admit it or not, we are all aging.
▶ 0:18:22Chair Scott: It impacts every single one of us regardless of political party. I think we are trying not to age. I think we have a big opportunity to work in a bipartisan manner to improve the lives of americans -- america's current senior citizens and create change that improve their lifespans and future generations. When you look at the composition of what we are talking about, food safety, medicine safety, all these things, it's an exciting time. I think of how my work here would impact my grandkids.
▶ 0:18:50Chair Scott: I think all of us think about our kids and grandkids. I want them to have every opportunity to live the american dream and have long and healthy lives, mostly around me. My staff and I are excited to work with the members to find common ground and ways we can advance our shared goals. I'd like to recognize ranking member for her opening remarks.
▶ 0:19:11Sen. Gillibrand: Thank you so much, Mr. chairman. It is a delight to be on this committee. Thank you to all the new members for selecting this committee. It is highly relevant for everyone in the united states, but looking at the senate itself it is relevant for us. I'm grateful you are here. I'm excited to serve as the ranking member in the 119th congress. I want to thank senators casey and braun for their leadership during the 118th congress.
▶ 0:19:41Sen. Gillibrand: The committee examined many of the important issues we are hoping to work on together. Senator scott, congratulations on your position as chair. It is a big deal and it is very exciting to get to serve with you. We have ideas in common of what we want to do with the committee, and your agenda you have laid out is inspiring and important and really urgent. I'm pleased to welcome new and returning committee members, and really excited to hear your perspectives, what you learn from your state, what you learn from your own families, what you have learned from your own lives.
▶ 0:20:10Sen. Gillibrand: Having interested and committed aging committee members makes a huge difference in what we accomplish as a committee, so I'm grateful for your leadership. This congress, I hope to continue to work on lowering the cost of prescription drugs, guarding against financial scams, protecting the programs that older adults and people with disabilities rely on like social security, medicaid, and medicare. And here we are discussing how to promote wellness among older americans.
▶ 0:20:39Sen. Gillibrand: We will address accessible housing, financial security, engagement in the community. This conversation is about making sure we are creating and supporting a society that gives people the tools to live and to live well. Those tools are different for everybody, but include resources like nutrition assistance, area agencies on aging, centers for independent living, supportive housing programs, medicare, medicaid, and social security. I believe our job is to make sure these resources exist and are robust enough to support those who need them.
▶ 0:21:09Sen. Gillibrand: Look forward to hearing from our witnesses and discussing ways to improve wellness for older adults and people with disabilities. Thank you, Mr. chairman.
▶ 0:21:16Chair Scott: Thank you, ranking member gillibrand. I will introduce the first witness. I would like to welcome sherry bill purnell of florida county. He has over 25 years of experience in law enforcement.
▶ 0:21:34Chair Scott: Beginning his career with the charlotte county sheriff's office in 1992, in 2015 when I was governor of florida I had the opportunity to appoint him to serve as commissioner on the criminal justice standards and training commission, and he is a member of the officer discipline penalty guidelines task force. Thank you for being here to discuss important public safety and ensuring older americans in florida and across the nation can achieve wellness in their senior years.
▶ 0:22:01Sherriff Prummell: Thank you, chairman scott, ranking member gillibrand, and members of the committee. Today I would like to outline ways in which the charlotte county sheriff's office is working to serve and protect our senior population. Charlotte county does have a very large senior population. Our average age is about 58 years old. We implement several programs within the charlotte county sheriff's office.
▶ 0:22:26Sherriff Prummell: The ones I'm going to discuss here are not going to give you the wow factor, but they make a difference in my community. One of our programs we do is a senior outreach program, where we have our volunteer unit call members within our community twice a week. We've also provided christmas gift and birthday cards with these weekly phone calls.
▶ 0:22:49Sherriff Prummell: And the participants are over 60 years of age, disabled, or living alone with little or no contact to the community. So we are making sure somebody is contacting them each and every -- each week. If we don't hear from them, there is a scheduled time in which we contacted them. If we are unable to get in touch with them, we send somebody out to their house to make sure they are ok.
▶ 0:23:18Sherriff Prummell: You know, we also have the population, they tended to wander at their age, and we have the take me home program designed to assist deputies in locating loved ones who have gone missing or lost. Information about your loved one, if recent photo and description -- a recent photo and description is measured in our system. If the individual wonders or goes missing, this information is shared with patrol deputies immediately upon dispatch in an effort to locate and reunite the family.
▶ 0:23:49Sherriff Prummell: Any office member can register to participate in this program. In addition to that we have our dna syndicates, which enables participants to keeper dna scent article at their home in the event a loved one goes missing. Deputies use that scent to locate a loved one and rear them with family.
▶ 0:24:10Sherriff Prummell: These are handed out by the community affairs team, our mental health unit, and average arbitral members project lifesaver is locally operated by the charlotte county sheriff's office and is strategically designed for a t-risk individuals who are prone to wandering. It uses gps tracking bracelet to locate the wandering party quickly.
▶ 0:24:32Sherriff Prummell: Another thing that we have that we do on a regular basis, we have these in each one of our offices, our operation pill drop. It allows individual to drop off expired and unwanted medication in a receptacle boxes at participating district office locations. This keeps family members and others that might have access to a senior's medicine cabinet from getting those unused medications. We have special vehicle decals.
▶ 0:24:59Sherriff Prummell: We provide free decals for individuals to other deputies of a possible presence of someone who may require special attention within the vehicle, such as a hearing impairment or autism. This way the deputy knows how to approach the vehicle and there may be somebody with a disability inside of it. A real simple program we have is often seen as misplace or leave items behind such as their keys. Through our local lockout program, key tags are provided to help return lost keys to the owners.
▶ 0:25:28Sherriff Prummell: The tags are registered with the special code in our system with the owner's information. If they are found and turned into the sheriff's office, we contact the owner through that registration number. We educate them to not only put their -- not to put their name and address on the keychain in order to protect themselves. That we have our citizen police academy, which is big for our entire community, but it is attended mostly by our seniors.
▶ 0:26:00Sherriff Prummell: The classes are mostly seniors to learn behind the scenes and promote our volunteer program. The class lasts about nine weeks long, and they learned a lot about our different programs within our community policing class. A lot of our outreach we do spend a lot of time visiting local retirement homes to advise of local scams and problems that we see. In addition, we rely heavily on facebook, instagram, our blog and press releases.
▶ 0:26:31Sherriff Prummell: We know seniors do not monitor this, but many family members who work around seniors do. This helps them get the word out to watch for their neighbors. In addition to that we get out there and we educate banks and large retailers in reference to the different scams going on because often the seniors will go to the banks to make a large withdrawals or go to retailers like walmart and target and start buying large gift cards or phone cards.
▶ 0:26:57Sherriff Prummell: And by educating these individuals, they know to alert us when somebody is trying to do that. Lastly, we focus our effort on speaking to neighborhood watches, local churches, and various organizations such as the parkinson's group. We average one or two speaking engagements a week. We work closely with ocean, our charlotte elder affairs network, a group of business owners who want to help seniors.
▶ 0:27:29Sherriff Prummell: Currently we are seeing several different methods in which criminals are tempting to scam our senior population. This includes scammers visiting our website looking up recent arrests and then calling family pretending to have the ability to bail out the arrestee. We are seeing what is referred to as the romance schemes, which can be long-running and generally include a person asking for money while pretending to love someone. Other schemes that have become more pronounced center around sweepstake lotteries or individuals have to play to win.
▶ 0:27:59Sherriff Prummell: In these cases the scammers will ask for gift cards to pay the taxes to get people their winnings. The charlotte county sheriff's office has partnered with charlotte behavioral health care for addition of a caseworker to be assigned to the ccso. This caseworker receives referrals from deputies who during the course of their business identify a senior who might be in need of services as well as calls from the public.
▶ 0:28:22Sherriff Prummell: This caseworker will refer and/or provide services through charlotte behavioral health center and/or make additional referrals to outside entities depending on the elder's needs, or office provides a number of resources including case management assist by giving brief overview of the program, provide the contact number, and in some cases provide hands-on assistance. The case manager follows up by phone if required, and case manager requires contact information for additional assistance if needed.
▶ 0:28:53Sherriff Prummell: Some of the organizations we use our home care providers, transportation, family service center, st. Vincent depaul, active age. Daytime senior care, senior placement services, social service resource center, florida rural legal services, meals on wheels, senior venture meals, dementia alzheimer's caregiver support group, and the dubin center, which is also a support group for caregivers.
▶ 0:29:23Sherriff Prummell: We have more than 90 partners that provide an array of services to our seniors and disabled. The needs of our seniors are not one-dimensional. If there is a need and we can provide it can we find somebody that can.--if there is a need and we can't provided, we find somebody that can. We hit those four bullet points you mentioned earlier when you opened.
▶ 0:29:47Sherriff Prummell: Thank you, chairman scott and ranking member gillibrand, for holding this hearing and focusing on senior population. I look forward to working with members of this committee to develop proactive ways to protect communities from crying.
▶ 0:29:59Chair Scott: Thank you, sheriff. I would like to recognize ranking member gillibrand to introduce the next witness.
▶ 0:30:06Sen. Gillibrand: Maria alvarez is the executive director of new york statewide senior action council, inc., a grassroots, consumer-directed and governed nonprofit that has been serving communities for over 52 years. She has worked with senior citizen groups as an organizer, advocate, and director of housing and caregivers program for over 30 years. She has designed and implemented educational, social service, and leadership programs for older adults.
▶ 0:30:32Sen. Gillibrand: And she has worked with me on my working group on aging, contributing to important priority policies. Ms. alvarez is a board member which serves underserved communities in new york and new jersey. Under Ms. alvarez's, under Ms.
▶ 0:30:49Sen. Gillibrand: Alvarez's statewide has played a role of bringing awareness to others age-friendly banking, abating the safe patient handling law, and re -funding of pharmaceutical insurance coverage. Recently Ms. alvarez has advocated for the patient's right helpline and the state's managed consumer assistance program. Under Ms. alvarez, statewide's federally funded medicare patrol has served to alert and assist millions of new yorkers to avoid medicare fraud. Ms.
▶ 0:31:18Sen. Gillibrand: Alvarez has also weighed in with the new york state in favor of home and community-based services through local area agencies on aging. Ms. alvarez also holds a bachelor's from marquette university and a masters degree in nonprofit management from the new school for social research, where she is a sloan fellow. Tank you coming today, and thank you for your advocacy and expertise and leadership on such crucial areas important to this committee for the older new yorkers who are able to age with dignity and security.
▶ 0:31:49Sen. Gillibrand: I'm honored to have you take the time to be my first witness on this committee.
▶ 0:31:55Ms. Alvarez: Thank you so much, chairman scott and ranking member gillibrand, for inviting me here to come speak with you today. As a participant of the white house conference on aging in both 1995 and 2005, I can tell you there have been dramatic improvements in the system of preventive care and health promotion. Bu we still have a long way to go. Twith your leadership and advocacy, we can continue to make a provement for the seniors of today and future generations.
▶ 0:32:26Ms. Alvarez: Since 1995, the fabric of the older population has changed dramatically. This means that systems to promote healthy aging also need to change and modernize to better serve elders today. There has been a significant increase in the size of the older nonwhite senior citizen population, which is on pace to make up half of the elderly population by 2060.
▶ 0:32:52Ms. Alvarez: Fortunately, though, many elderly can remain in the community despite managing multiple chronical conditions. I suggest one step in the right direction would be to make sure that the 2025 white house conference on aging is held to help the country chart a course for addressing the needs of this group as 20% of this country is now of the age of 65 and over.
▶ 0:33:15Ms. Alvarez: Prior to 1995, medicare and most private insurance would cover treatment of an illness, but not cover the cost of the diagnostic test or prevention. Thanks to action by congress to improve medicare in 1997 and 2003 and the implementation of the affordable care act in 2010, coverage of preventive services has steadily increased.
▶ 0:33:41Ms. Alvarez: Now most preventive tests and immunizations are available without co-pays, and medicare provides an annual wellness exam to help beneficiaries identify health risks, schedule preventive tests, and identify social determinants of health. In addition, the country has invested resources through part threeed of the older americans act to provide evidence-based health promotion programs through the area agencies on aging and community-based agencies.
▶ 0:34:10Ms. Alvarez: Today most communities have programs like chronic disease and diabetes self-management program and falls prevention. Many have been adapted to meet the needs of older persons of different races and ethnicities. These programs are cost-effective approaches and should be expanded.
▶ 0:34:26Ms. Alvarez: At one time, federal and state policymakers considered services like congregate and home delivered meals transportation, case management, and housing assistance as nice but soft services that were not as important as health care.
▶ 0:34:41Ms. Alvarez: It took years of advocacy and research to get the medical system to finally recognize the importance of social determinants of health, which are critical to the ability of older persons to follow needed courses of treatment and maintain healthy lifestyles.
▶ 0:35:00Ms. Alvarez: These are all important improvements that we can build upon, but we cannot ignore the need to recognize that having health care and preventive services available is not sufficient if they are not affordable or if discrimination, actual or perceived, persists. Any problems still exist. Income security continues to be a problem in a country where there is so much abundance. The reality is that one in three senior citizens are not making ends meet.
▶ 0:35:27Ms. Alvarez: Their incomes are under 200% of the federal poverty level, roughly $30,000 a year, and it is not keeping pace with the increasing cost of living. Lest you think that this is one segment of the population, I will tell you that we increasingly see people who look good on paper, who consider themselves to be middle-income, sliding into poverty at dizzying rates. According to several reports, we are about to experience the largest amount of homelessness in the elderly publish and ever.
▶ 0:35:58Ms. Alvarez: We are already seeing it into new york city. More section 202 housing must be developed with soci services attached to them. This will ensure that seniors not only have an adequate place to live, but they have access to all of the programs and services for which they qualify. I cannot end my time without telling you that along with social security, medicare, and medicaid, the older americans act is a law that has had a seismic effect on the elderly population.
▶ 0:36:27Ms. Alvarez: All of those programs form the framework that seniors can rely on to continue to thrive and live in dignity. Now that this generation makes up 20% of the country, we need to strengthen and improve them in their structures as well as in their funding to reflect the fabric of our country today. I have many other points to make, and five minutes is just not enough. I hope that you ask me about them during the time that we have together and consider as a resource to you in the future.
▶ 0:36:57Ms. Alvarez: I have also included a full list of programs and recommendations with mike formal testimony. Thank you.
▶ 0:37:01Chair Scott: Thank you, and thank you for being here. Like to welcome Dr. dawn carr. Dr. carr is the director of the claude pepper center at the florida state university and serves as professor of sociology. Her mission as a scholar and gerontologist is to leverage factors that bolster older adaptability to remain healthy and active as long as possible.
▶ 0:37:25Chair Scott: Before joining florida state university in 2016, she was a researcher at the stanford center on longevity, a postdoctoral fellow in the carolina program for health and aging research at the institute on aging at the university of north carolina at chapel hill, and a researcher at the scripps germ policy center. Thank you for being here to discuss the impact of community engagement on the physiological and emotional well-being of seniors.
▶ 0:37:46Dr. Carr: Thank you, chairman scott and ranking member gillibrand and the rest of the committee. It's an honor to be here today and to have an opportunity to share my testimony with you. I am the director of the claude pepper center, and this is a wonderful center at florida state university that is named for one of the strongest advocates for aging policy in U.S. history, senator claude pepper.
▶ 0:38:17Dr. Carr: And I think he would be very excited about the work you are doing here today. Today I'm here to discuss the importance of expanding the scope of U.S. aging policy to increase chances that future generations of older adults not only survive into old age, but they can thrive once they get there.
▶ 0:38:34Dr. Carr: Health problems in later life are strongly influenced by events, exposures, and behaviors that occur well before we reach our later years although the consequences of regular harmful exposures and habitual behaviors accumulate to erode health over time, there is growing evidence that if we intervene early, we can significant the modified health trajectories.
▶ 0:38:57Dr. Carr: Current clinical care is not designed with this approach, and there will be significant consequences if we don't change our current approach. Older adults who are navigating the period of old age when health problems interfere with daily function, a period sometimes referred to as the fourth age, often experience poor quality of life and they lose the ability to live independently.
▶ 0:39:21Dr. Carr: The needs of this group vary starkly with older people who are healthy and able to engage in a variety of active, meaningful, and purposeful social roles. This is the period sometimes referred to as the third age. This distinction is important because there are stark differences in the needs of up a typical 65-year-old and typical 85-year-old, but also systematic differences in the health and function of older adults of the same chronological age.
▶ 0:39:49Dr. Carr: Much of our current aging policy is focused on problems related to the fourth age. Further, middle-aged adults today face more significant health problems and disabilities than previous generations. In the absence of significant changes, they are likely to face more complex health issues in later life than previous generations, and they are likely to enter the fourth age even earlier.
▶ 0:40:14Dr. Carr: Our society could instead be enriched by a large and growing group of healthy third-agers if we leverage an aging policy framework that emphasizes health maintenance at every stage of life, targeting risks related to aging associated diseases and disabilities, engages older adults' unique strengths that benefit society, and addresses barriers to healthy aging that create inequalities in health outcomes as people age.
▶ 0:40:43Dr. Carr: I believe the following four areas are especially important -- employment, social engagement and social integration, health literacy and lifestyle behavior supports, and health care access and early treatment. First, regarding employment and financial security, working in later life is protective of health as people move into and through the third age.
▶ 0:41:07Dr. Carr: However, older workers are less likely to be hired, offered opportunities for upward mobility, or offered opportunities for training. In addition, individuals and physically demanding or hazardous jobs are more likely to become disabled or retire early with significant financial consequences. Implementing health-protective occupational interventions where possible and midlife retraining for transitions to new career paths can increase the chance that workers remain healthy and fully employed until they reach full retirement ages.
▶ 0:41:38Dr. Carr: Further, making phased retirement or transitions to part-time work opportunities available to all workers will make it possible to remain engaged in paid work longer. Second, social isolation and loneliness accelerate physiological aging. Isolating older adults within communities is not only detrimental to the health and well-being of older people, it also prevents communities from benefiting from their skills and wisdom. There are very few programs designed to reach isolated older adults.
▶ 0:42:06Dr. Carr: Effective programs like meal delivery programs are low-cost and have the added potential of improving access to high-quality, nutritious foods. Expanding these programs is likely to delay onset of disability. In addition, increasing engagement in volunteering not only as health-protective, it also helps people of all generations work collectively to solve social problems.
▶ 0:42:29Dr. Carr: Investing in volunteer infrastructure is not only beneficial to health outcomes, it can provide exponential returns economically. For instance, the senior core volunteer programs have shown an estimated return of between three dollars to be sent and just $3.50 -- $3.50 and $5.08 for every dollar invested. Third, most adults in the U.S.
▶ 0:42:56Dr. Carr: Do not have access to scientifically accurate information or resources they need to gain access to a third age. One important solution is expanding the number of community health workers, which offers one of the most effective solutions for facilitating healthy behaviors across the life course by helping community members of all ages build trust with the health care system and navigate health care services to support healthy aging.
▶ 0:43:21Dr. Carr: Recent research suggests that there is a $2.47 return for every dollar invested in community health workers for the medicaid program alone. Further, lack of access to high-quality, nutrient-dense foods is a persistent problem reinforced by altar processed, unhealthy foods being subsidized , so they are low-cost.
▶ 0:43:45Dr. Carr: Making healthy foods financially accessible and dis-incentivizing consumption of ultra processed food is key to increasing healthy aging. Last, most adults do not see a doctor regularly unless they are facing health problems. We need scientific investments to identify ways to halt disease progression early. This means recalibrating health benchmarks at all stages of life to support long-term, optimal health trajectories.
▶ 0:44:12Dr. Carr: Fo instancer, aggressively treating metabolic and lipoprotein health and middle-aged adults has been shown to reduce risk of dimension, diabetes, heart disease, and cancer, the most consequential aging health conditions. This will require more frequent interactions with health care providers, but it has potential to significantly pay off.
▶ 0:44:36Dr. Carr: A recent study showed that a metabolic and lipoprotein pharmaceutical intervention provided a five-year return on investment of nearly $10 for every dollar invested. In conclusion, to build a future that is enriched by a robust population of healthy third-agers requires us to expand our aging policy priorities to intervene during critical inflection periods so we can modify health trajectories and bolster physiological resilience as we age.
▶ 0:45:05Dr. Carr: If it becomes possible for all adults to remain productively and socially engaged in meaningful ways into late life, old age could become a period of life we all look forward to and our society as a whole will benefit. Thank you.
▶ 0:45:18Chair Scott: Thank you, Dr. carr . Next I would like to recognize Dr. susan hughes. Dr. hughes is the director of the center for research on health and aging at the university of illinois-chicago. Dr. hughes is a gerontologist whose research focuses on evidence-based health programs for older adults. Thank you for being here to discuss the impact of a physical activity on the overall health of older americans.
▶ 0:45:46Dr. Hughes: Thank you so much, chairman scott and ranking member gillibrand, other members of the committee, for this wonderful opportunity to talk with you today, testified today about this very, very important topic of adult -- older adult wellness. It's an honor to be here.
▶ 0:46:14Dr. Hughes: To my background, I direct the center for research on health and aging at the university of illinois-chicago, where I led five successive iterations of our nia center. Like other centers can we design evidence-based health promotion programs were older -- for older adults.
▶ 0:46:38Dr. Hughes: Today I would like to address the limitations of our funding for health promotion programs for older adults and strongly recommended the use of medicare for that purpose going forward. Medicare, as everyone knows, is a wonderful program, served millions and millions of people and greatly improved access to acute care.
▶ 0:47:05Dr. Hughes: However, the designers of medicare missed a major opportunity to cover wellness programs that have the potential to pay for themselves many times over. Medicare advantage plans are managed care options that encompass 54% of beneficiaries.
▶ 0:47:27Dr. Hughes: Medicare advantage plans must offer all of the plans that regular medicare offers, but they can supplement that package any way that they choose. The ability to supplement services makes these plans logical providers of health promotion programs. However, plans will only cover programs if they see an advantage to doing so.
▶ 0:47:56Dr. Hughes: We need help -- excuse me, the administration -- the good news is the administration for communities living in cdc have developed criteria for evidence-based health promotion programs. The administration -- we need help from congress -- I'm sorry -- to develop incentives for medicare advantage plans to include these programs and covered benefits. This will take time.
▶ 0:48:27Dr. Hughes: In the meantime, the only source of funding for our growing number of evidence-based programs is title iii d of the older americans act. Fiscal year 2024 funding for title iii d was $33.6 million nationally.
▶ 0:48:49Dr. Hughes: That amounts to 671,000 per state, or $.31 per senior in the state of illinois. These funds support care management and faults programs -- falls programs. There is no funding for physical activity programs despite overwhelming evidence supporting their impact. 84% of older adults in the united states are sedentary.
▶ 0:49:22Dr. Hughes: And at high risk for obesity, diabetes, heart disease, and all cause of mortality. We know that any physical activity is associated with lower mortality risk. My work with homebound older adults found that arthritis was their most common chronic condition and the condition that interfered most frequently with thieir functioning.
▶ 0:49:55Dr. Hughes: Our follow-up disability study found that persons who had a joint impairment were much more likely to become disabled. Once we understood the pivotal role of their extremity joints, we developed an intervention to improve their function.
▶ 0:50:18Dr. Hughes: The last eight weeks it provides flexibility, aerobics, and systematic lower extremity strength training, and uses group problem solving with peers to promote physical activity.
▶ 0:50:32Dr. Hughes: Our trials found significant gains in physical activity the eight weeks that were maintained at 18 months and accompanied by a significantly improved joint pain, lower extremity strength and mobility, and decreased anxiety and depression at the same time points.
▶ 0:50:55Dr. Hughes: Medicare spent $43,000 per total hip and knee replacement in 2023. Fit and strong costs $300 per participant. I hast no harmful side effects and large effect sizes. Drugs have a clear pipeline from bench to uptake.
▶ 0:51:24Dr. Hughes: Our growing number of evidence-based programs have no similar pipeline for distribution. We have no way to communicate program benefits to clinicians who can recommend them and no way to reimburse program providers. Currently title iii-d is critical but insufficient to meet growing demand caused by more programs coming online.
▶ 0:51:55Dr. Hughes: We need to reauthorize oaa, increase funding for title iii-d , and create a new title for physical activity. Currently nia and cdc are creating great programs that unfortunately have nowhere to go in terms of a route for distribution.
▶ 0:52:22Dr. Hughes: To impact older adult wellness, congress needs to improve coverage of evidence-based health promotion programs by medicare plans. Excuse me, by managed care plans.
▶ 0:52:41Dr. Hughes: This effort would require a full-fledged partnership between the national institute on aging, cdc, to speed up the process hopefully of disseminating programs that meet clear criteria for adoption. Thank you for this opportunity to share our work with you.
▶ 0:53:09Dr. Hughes: I hope this has been helpful and I look forward to your questions.
▶ 0:53:12Chair Scott: Thank you, Dr. hughes. Now we will go to question. I will go ahead and pass my time to senator mccormick.
▶ 0:53:22Sen. Mccormick: Thank you, Mr. chairman, and thank you, ranking member gillibrand, for kicking this awful som it is great -- taking this off. It is great to be here. This is a big issue in my state of pennsylvania. My first question is for you, Dr. carr. You alluded to the research on part-time work opportunities in your written testimony.
▶ 0:53:54Sen. Mccormick: What are the benefits of someone choosing to remain in the workforce, and what are the barriers that older workers face as they seek to remain in the workforce?
▶ 0:54:05Dr. Carr: Thank you for the question. So one of the clear benefits of part-time work is obviously being able to be paid longer. And oftentimes it's not possible to work full-time, or it's very challenging as we get older because there may be some physical health problems that people need to address, making it more difficult to maintain that full-time workload or caring for other family members.
▶ 0:54:35Dr. Carr: There is a lot of reasons why part-time work is helpful, and it's meaningful. I mean, all of us in this room I think have jobs that are extremely meaningful that would be very set to give up, because it gives us-- sad to give up, because it gives us a sense of meaning and purpose in our life. Those things are both helpful because they make us feel good, but also they improve our physical health.
▶ 0:55:02Dr. Carr: A lot of work I've done over the years with my colleagues has shown remarkable protective effects on physical health as well as cognitive health with continued engagement and paid work. That alone I think is an important piece by itself. We also find that the health effects, health benefits of working are roughly the same for part-time work and full-time work as we move into later life.
▶ 0:55:30Dr. Carr: If you think about effect sizes, part-time work is quite potent in a lot of ways. Regarding the barriers that he mentioned -- you mentioned to continued part-time work, there's a lot of different kinds of things, and certain groups of people face more barriers than others. It is easy if you're in a high-ranking kind of role to negotiate singular opportunity to maybe consult or move into a part-time job mentoring others, doing things of that nature.
▶ 0:55:57Dr. Carr: But for a lot of workers, there aren't too many choices that are -- that pay sufficiently or are meaningful enough for it to be worthwhile or even available as an option except hourly work or maybe stepping back and doing work that is in very cognitively engaging -- isn't very cognitive ly engaging.
▶ 0:56:21Dr. Carr: That lack of opportunity -- we don't have a lot of institutionalized opportunities for people to take on or transition into an intended part-time role. It is more haphazard, or one-on-one basis.
▶ 0:56:33Sen. Mccormick: Thank. Sherriff, a question for you. You made mention of these scammers taking advantage of all of us, but in focusing on the elderly. What are some of the protective measures that you would recommend, particularly for hoaxes that are telephonic? What can people do to protect themselves and recognize the potential scam call?
▶ 0:57:00Sheriff Prummell: The best defense is a better offense because we gotta get out in front of this because a lot of these scams are very difficult to track down. Many offenders are not just outside your state, but they are outside the country. What we try and do, especially with the jail scam, irs scams, things like that, we try to tell everybody to give a safe word.
▶ 0:57:24Sheriff Prummell: This way if somebody is calling you saying "little johnny, I'm arrested in jail, I need bail money," there is some safe word that they both know that that person is going to use so if the scammer isn't going to know the safe word, they are not going to know to use it, and the person on the other end will catch on to that and realize it is a scam.
▶ 0:57:46Sheriff Prummell: The most part is we educate, educate, educate in every way possible and to everyone possible, because as you stated, everyone is being scammed, but our seniors are especially being targeted.
▶ 0:57:57Sen. Mccormick: Thank you.
▶ 0:57:58Chair Scott: Thank you, senator mccormick next I will turn it over to ranking member gillibrand.
▶ 0:58:05Sen. Gillibrand: I would like to defer my time to senator also brooks.
▶ 0:58:15Sen. Alsobrooks: Thank you to chair scott and ranking member gillibrand for convening this really important meeting. I'm enthusiastic about joining the senate special committee on aging and really pleased to be here today. I want to thank all of our witnesses who have come here today. Thank you so much for your presentations and your work and all the information that you have shared. As the daughter of 2 aging parents, I have witnessed like so many some of the challenges that our seniors face.
▶ 0:58:42Sen. Alsobrooks: Our seniors have spent their entire lives, many of them, working to earn benefits such as social security and medicare. And I view these programs as a premise we have made to our seniors. I am committed to ensuring that every senior regardless of their background of circumstances has access to resources and opportunities that they need to thrive. With that I will begin my questions. I would like to say to Ms. alvarez, direct the first question to you.
▶ 0:59:10Sen. Alsobrooks: Like so many americans, I'm a part of what they call the sandwich generation, which means I'm caring for a 19-year-old daughter as well as my aging parents. While I'm really grateful for the opportunity to support my parents and understand the rewards that come with caregiving, I also recognize how challenging it is to bear the full weight of caregiving responsibility.
▶ 0:59:34Sen. Alsobrooks: We know that many federal programs that are so critical to our seniors and that guarantee the support and stability that they need are really in jeopardy. In maryland we have over 1.2 million residents who are over 60, and the maryland department of aging overseas a range of these programs. But maryland also relies heavily on federal funding.
▶ 1:00:00Sen. Alsobrooks: And so I wonder, do you believe that volunteer-based organizations who we rely on very often have either the capacity to adequately fill the gaps that would be left by produced federal funding, and do you believe that organizations likewise have the obligation to provide that care, particularly in states like maryland, where federal programs are vital to seniors?
▶ 1:00:28Ms. Alvarez: Hello? Ok. Thank you very much for that question. So to answer your question, right now if there is a reduction -- if things stay the same, if the funding state just the same, just by the fact that we have a larger senior population and more and more aging in every single day, there are 10,000 people who turned 65 every single day in this country, so with no increased
▶ 1:01:00Ms. Alvarez: Funding and more people to serve, that constitutes a cut. So just starting from that point, I would say that we can't afford not to increase the funding. Decreasing it would put us in a crisis. And then when you are talking about the mission of organizations that manage volunteers, that is their mission.
▶ 1:01:30Ms. Alvarez: My organization also -- we are volunteer-based as well. It is our mission to do it. However, being realistic, we have to be able to marshal our resources effectively so that we can to do a good job and be responsible in our work. With less funding, it's not possible, right?
▶ 1:01:56Ms. Alvarez: We are constantly thinking of ways that we can get more people, because there are people out there who are very well-meaning and who want to do the work, but we also have to have the wherewithal to administer all of this work with volunteers coming in, as well is the job at hand, which is an increasing senior population.
▶ 1:02:20Sen. Alsobrooks: Thank you. And next, Dr. carr, I just have a question also for you. The question is regarding the cost of increasing prescription drug medications. This is yet another area where I have seen really so much struggle. I mentioned my parents. My father is my mother's caregiver. One of the things I note in maryland and around his nearly 90% of all of our seniors take prescription drug medications.
▶ 1:02:50Sen. Alsobrooks: We also know that over 20% report that it is extremely difficult to afford this medications. We know that access to affordable prescription drugs is not just about health, but it is about dignity as well and peace of mind. The question is how can we ensure that our seniors will have reliable access to affordable prescription drug medications?
▶ 1:03:12Dr. Carr: Yes, I agree that making sure that everyone has access to the medications that they need is extremely important. I don't have a clear history of studying prescription drug costs, but I can say that in order for us to be able to maintain a healthy aging population, inadequate access to
▶ 1:03:42Dr. Carr: Prescription drugs will undermine our efforts. The scientific advancements in pharmaceuticals are astonishing and playing a big role in helping with prevention at all ages. There is lots of room for pharmaceuticals to play a strong role in coordination with other health care efforts to ensure healthy outcomes.
▶ 1:04:06Dr. Carr: In terms of financial supports, it would be largely undermining to the efforts to ensure healthy aging future if we did not have a financial support for all of the pharmaceutical needs of older adults.
▶ 1:04:21Chair Scott: Thank you, senator. Now hear from senator tuberville.
▶ 1:04:29Sen. Tuberville: Thank you come Mr. chairman. Thrilled to be on this committee for you. You laid out a great vision for this committee. Are americans doing well? I think most americans would respond to that question with concerns or worries. Americans are not just seniors, are concerned about their safety, finance, stability for communities. The fact that so many americans are concerned about their general welfare is unacceptable. We live in the most abundant country in the world.
▶ 1:05:00Sen. Tuberville: Anxieties about things like public safety, harmful chemicals in foods, financial security, and retirement secure it shouldn't be at forefront of americans' minds, but they are. Deletes and washing-- elites in washington have ignore these concerns for far too long and americans are tired of it. With president trump's election and republicans taking back the senate, we're going to leave no stone unturned things to our chairman I want to make sure that when americans are asked about their wellness, they respond with hope and optimism, not fear and anxiety.
▶ 1:05:32Sen. Tuberville: I look forward to digging into these with you come Mr. chairman. Should be fun, should have a good time, and maybe we casn make some progress. Sheriff, real quickly, I know you hit the spam and robo calls. I've gotten spam texts as I'm sitting here and it is annoying, and I'm sure for seniors sitting around, they get absolutely sick of it. What can we do on the federal level to help this?
▶ 1:05:59Sen. Tuberville: Is there anything we can do to eliminate some of this garbage?
▶ 1:06:04Sheriff Prummell: You know, I don't know who will ever be able to eliminate it, because with the ai and all the different technology, they are using technology to commit the crimes, and we are trying to use technology to catch them, so we are trying to keep up. Problem is a lot of legislation on state levels and federal levels isn't keeping up with technology. It is years behind. So that's a big thing that we need to look at, legislation in technology.
▶ 1:06:35Sheriff Prummell: You know, when people receive phone calls and all that, now they can spoof numbers, so they can use a number that is very familiar with them. We have people that use the sheriff's office number when they are trying to do the jail scam, because they can easily spoof the numbers. It is trying to keep up with technology. We really need to get a handle on it.
▶ 1:06:55Sen. Tuberville: Yeah. Dr. hughes, we've got a serious nutrition and wellness problem in this country. Serious. Can you speak of the importance of a lifestyle in earlier years to help our young people understand what they are getting ready to get into in later life?
▶ 1:07:14Dr. Hughes: Yeah, I think that's a great question. I think we have a real opportunity to educate people early on, develop a life course perspective to health education, physical fitness, so on and so forth.
▶ 1:07:34Dr. Hughes: It is going to be far more cost-effective in the future if we can get people to adopt good, healthy nutrition habits, physical activity, other types of activities that will really, really improve their functioning and quality of life as they age, and into old age.
▶ 1:08:02Sen. Tuberville: You know, our young people don't have it as good as we had growing up because we use fresh fruit and vegetables and they eat all this processed food and now. I don't know where it is going. I hope we can get a handle on that. Dr. carr, whether it be friends or family, what is the significance of community and social engagement?
▶ 1:08:25Dr. Carr: Can you repeat that question?
▶ 1:08:29Sen. Tuberville: I'm going to read it myself. Whether it be friends or family, what is the significance of community and social engagement? What can community do? Not just your family, but your community, your social outcome, boyfriend, girlfriend, husband, wife? How can that work together to help us have a better, longer life?
▶ 1:08:54Dr. Carr: Well, it's been very interesting the last 20 years because I think for the first time scientific efforts have been able to show that friends matter a lot. The growing research showing mortality consequences of loneliness and social isolation have really accentuated our understanding of why relationships matter.
▶ 1:09:18Dr. Carr: I think for a long time, things like friendships and family relationships were thought of as sort of soft, not real health behaviors.
▶ 1:09:32Sen. Tuberville: Make a huge difference.
▶ 1:09:33Dr. Carr: Yes. But I think there is clear evidence, and sometimes when I talk to people, they say what are the key issues were anything about longevity, I put social health broadly speaking at the top of the list. And that isn't just you have a good marriage or you have a few good friends, but the interconnected relationships we have within our community are heavily related to that.
▶ 1:09:57Dr. Carr: So if we are in a community where we belong and we are able to have our needs met and work as part of a team, like I mentioned I think in my testimony solving problems together, those are really powerful relationships that help us feel like we matter and we have a place in the spaces we are in.
▶ 1:10:16Sen. Tuberville: Yeah. I don't want to ask this to anybody, I just want to put it on the record -- hopefully we will talk about this in the future. Americans are suffering from a record-breaking trillion dollars of credit-card debt. Trillion. What can we do in the future as a group --
▶ 1:10:35Chair Scott: Dr. hughes
▶ 1:10:37Chair Scott: Dr. hug--
▶ 1:10:39Chair Scott: Highest interest rates for credit cards ever.
▶ 1:10:43Sen. Tuberville: Interest rates and the debt, and we keep racking up. People are broke, they don't have cash --
▶ 1:10:50Chair Scott: Highest interest rates on credit cards ever.
▶ 1:10:53Sen. Tuberville: Thank you, Mr. chairman.
▶ 1:10:56Chair Scott: Senator kim.
▶ 1:10:59Sen. Kim: Thank you, chairman, thank you, ranking number. I will pick up where my colleague was getting at, this issue about loneliness, mental health in particular. I think that is something that is becoming all the more apparent in our society. I think we have a mental health crisis of the nation right now. It affects young kids. I've got a seven-year-old and nine-year-old and I'm worried about that generation. But just all throughout this.
▶ 1:11:28Sen. Kim: From my standpoint it feels like we don't have the workforce we need right now be able to address this. I guess I wanted to get a little more sense from you about what are some of the best practices. Are there certain states or communities that are doing this better, things we can draw on? It's hard to -- we don't want to reinvent wheels here, but if there are certain things we can lift up to a federal level, I'm interested in trying to explore that. I thought I would tease that more from you.
▶ 1:11:58Dr. Carr: I agree that we don't have the resources to address the mental health issues we are facing as a nation. And it is getting worse, and the pandemic was a big spike that hasn't really recovered fully in that regard. In terms of specific case examples, I think that is a wonderful suggestion for the work that we should be doing, identifying some communities that are getting it right. I'm not familiar with any specific individual communities.
▶ 1:12:26Dr. Carr: I will say that communities in which there are opportunities for people to have all of their basic needs met are doing much better than ones that are suffering in terms of issues with high levels of unemployment and poverty.
▶ 1:12:48Dr. Carr: And that's partially because there is this connection with having meaningful roles and connections and being able to connect with other people within the community. Volunteering is one of the ways that a lot of people have been able to maintain those relationships in and -- above and beyond having those basic needs met.
▶ 1:13:10Dr. Carr: I think that places where there is a lot of intergenerational engagement, this is particularly useful to a healthy sort of social fabric. But within this recommendation, I am going to be looking for some great communities that provide excellent examples that we should be able to look at.
▶ 1:13:32Sen. Kim: I would love to stay in touch with you about that. Mr. chairman, I think that is something this committee could do, draw upon these different issues of mental health and financial situations, and try to -- it's hard here in congress to come up with something completely from scratch, a new, completely novel idea.
▶ 1:13:54Sen. Kim: But if there are pilot projects, other examples we can draw upon, scale, try to examine the fight, that is something we can lift up-- exemplify, that is something we can lift up in this work. Ms. alvarez, similarish type question. If you don't mind, I will be a little personal. I was listening to one of my collies talking but she is part of the sandwich generation, I am as well.
▶ 1:14:20Sen. Kim: My father had a major accident last summer, is not able to walk anymore, and is now having significant cognitive decline. We are really struggling with this. Ms. alvarez the thing that really stood out to me was the difficulty of her family trying to get a sense of, what is my father eligible for, what types of resources are out there?
▶ 1:14:43Sen. Kim: Even navigating medicare, like I am a united states congressman at that time and was having so much trouble just trying to navigate -- I cannot imagine what other americans have to deal with. From your standpoint, what have you seen as the best examples of getting that information out there, and the challenges often that I raise for my family and those I talk to, you are experiencing this in an emergency situation where things
▶ 1:15:13Sen. Kim: Have changed dramatically in your life. Are there ways we can prepare people better so it is not under this crucible of pressure and emotion in terms of trying to get to it? I wanted some of your thoughts.
▶ 1:15:29Ms. Alvarez: Thank you for bringing that up. Statewide, we operate three help lines. A lot of our work -- we are a grassroots is asian, and -- grassroots organization, and we go into the community. There are hard-to-reach populations. They might be ethnic minorities, they might be rural areas. We are constantly thinking of ways in which to outreach to different areas.
▶ 1:16:01Ms. Alvarez: We have gotten to the point where we are doing a lot of ads in the newspapers because we know seniors like to read the newspaper. We do radio interviews and a ton , a ton of outreach into the community through tabling events, fairs, anywhere they invite us, we are statewide, as the name connotes. It is important not only to reach the senior, but the caregiver.
▶ 1:16:28Sen. Kim: Yeah, the family.
▶ 1:16:30Ms. Alvarez: The friends. It is important, because many times those are the people who are assisting or even making decisions, dependent on what state the person is in. I will say, if you are looking for a community project that works, we are very proud of her project that we have with our senior medicare patrol program, where what we have done is to out community organizations,
▶ 1:17:01Ms. Alvarez: Community-based organizations that are trusted sources. Working with them, we train people that are active in the community. We train them on different issues, who then go speak with their peers. I always find that the most effective way of reaching out to others is through your peers. You will listen to your friend.
▶ 1:17:27Ms. Alvarez: And we ask them, we don't dictate what it is we want to do. We have the content we want to communicate of course, which is the fraud and health and things like that, but how they want to be communicated to -- that is up to the community. We go to the community and ask them. They know best. That is not only that.
▶ 1:17:55Ms. Alvarez: They know and are trusted, but also they are then empowered with information. They become leaders, and they are empowered to go out. It is a mixture of a lot of things. The other thing I wanted to follow up --
▶ 1:18:11Sen. Kim: If you don't mind, keep it brief. I don't want to go too long. I don't want to cause trouble on my first hearing.
▶ 1:18:18Ms. Alvarez: It is on me. [laughter] the family caregivers -- no, it is a statistic that is very important. It is family caregivers on an average spend 20% of their own income on the person they are caring for, with a senior.
▶ 1:18:38Ms. Alvarez: We were talking about financial issues before, it is important to note that, because that then my put the person caring for in jeopardy and they are not able to build wealth or they will be in more debt moving forward and be worse off than the person they are caring for.
▶ 1:18:56Sen. Kim: Thank you so much. I yield back.
▶ 1:19:00Sen. Scott: Your health plan should have an health care advocate that should be able to help you navigate battle system.
▶ 1:19:08Sen. Scott: Most of these, especially these bigger companies, they have a whole program now of advocates that are supposed to be helping -- because how would you know? I used to be in the business and people would call me all the time. Other than that, you will not become an expert. That is where it should be done. Senator johnson?
▶ 1:19:30Sen. Johnson: Thank you, Mr. chairman. I am a late entrant onto this committee. I mainly joined because he became the chair and I think you laid out a pretty good vision for what you want to do with this committee. It will come as no surprise to you -- I think my community members will quickly learn I'm not a real fan of the federal government. I think it causes or exacerbates more problems than it solves.
▶ 1:19:57Sen. Johnson: I think the question you will hear repeatedly out of me -- I certainly heard a lot of support for government programs. My overriding question is what is the negative unintended consequence of a well-intentioned program? I will lay one out. I'm currently working on a program -- my project, we are trying to make sure everyone is aware of how much the federal government spends. In 2018, total government spending was $4.4 trillion.
▶ 1:20:27Sen. Johnson: We had the pandemic, shot up to $6.6 trillion. If you are a normal family, if you have an illness, you go back down to the previous level. We did not do that. For the last five years we averaged $6.5 trillion. Last year we spent about $7 trillion. It is completely unsustainable. The result has been the devaluation of our currency.
▶ 1:20:53Sen. Johnson: 19 1the 2019 dollar is now worth $.80. I could ask you the question, how much more devastating is that devaluation of a senior's wealth compared to the loss of one government program? Mismanagement of social security is profound.
▶ 1:21:20Sen. Johnson: The social security administration, life expectancy was less than 62. Being 69 myself, I'm glad life inspect and see has increased, but with that you end up with alzheimer's, with more cancers. You end up with really difficult problems we are all trying to solve here. I appreciated senator tuberville's comment about social intervention, or interaction.
▶ 1:21:51Sen. Johnson: I think that has been a recurring theme. That is sort of the number one solution, strong families, supportive communities. That doesn't come from the federal government. I want to have everyone think of the federal government programs you are advocating for, the cost of those things, helping drive the one for nature lynn dollar deficit.
▶ 1:22:18Sen. Johnson: If we want to prioritize spending on seniors, and we want to help those who cannot help themselves, and seniors are often in that category, what spending can we put down on the priority scale and not do? My mission is to wean as many americans off government as possible so we can rely on our communities. That is where the solution lies. I'll end on this.
▶ 1:22:50Sen. Johnson: I want your comments. Part of the isolation we are finding is if everyone thinks they can get a quick check from the government, nobody has to feel responsible for mom and dad. People become more isolated the less they are connected to their community, or even dependent on their family and community. I will start with you, Dr. hughes. Can you comment on some points I made there?
▶ 1:23:21Sen. Johnson: Got to press that button.
▶ 1:23:23Dr. Hughes: Okay, sorry. [laughter] tech-challenged here. I think there is a number of -- I understand where we are headed with the current deficit, and obviously it is huge. It is not trivial. We have issues with maintaining social security, the future of social security.
▶ 1:23:56Dr. Hughes: There are also a lot of people out there working on this problem. What I've read is it is not an insurmountable one. There's is a program at boston college headed by a person, a health economist, she spent her whole life working on this issue, and she's basically come up with some relatively simple,
▶ 1:24:28Dr. Hughes: Straightforward ways of getting us --
▶ 1:24:32Sen. Johnson: Can I --
▶ 1:24:35Dr. Hughes: Go ahead.
▶ 1:24:37Sen. Johnson: We had lots of surplus money for years. There were tens of workers for every retiree. Now we are down to under 3 to 1. But we did not invest that money. We spent it. We replaced it with government bonds. Had we invested those in something like a down jones -- dow jones index fund, this was a couple years ago, we had $8 trillion in hard assets.
▶ 1:25:08Sen. Johnson: We spent it. It is mismanaged. The federal government did that. The other unintended consequence, we led seniors to believe -- boy, just get to the age of 65 and we will pay for your retirement, your health care. I don't know any senior that can really get by on just social security benefits. That is a poverty-stricken life.
▶ 1:25:30Sen. Johnson: We lead people to believe that, because we don't educate our kids, hey, save for your retirement, because you will not want to live off what social security provides. By the way, we bankrupted it anyway and it will not be able to provide those benefits in 10 years. Professor carr?
▶ 1:25:56Dr. Hughes: I would disagree that the program is going to be bankrupt anyway. Respectfully. I think there are things that we can do to keep the program solvent. I'm not a healthy economist. This is not my area of expertise, but I know there are people out there who are working very hard on this.
▶ 1:26:23Dr. Hughes: They have some very good ideas about how we can increase the share from people who have more wealth, for example, in terms of their contribution to social security. We have already increased the retirement age. There are other things we can do along that line. As people become healthier and have longer life expectancy.
▶ 1:26:55Dr. Hughes: Of course, it is a very, very important issue, and one that everyone should be very concerned about and working hard.
▶ 1:27:06Sen. Johnson: I will relentlessly point out how the government screwed up time and time again. The definition of insanity is doing the same thing over and over and expecting different results. We continue to rely on the federal government to solve these problems, we have to find different solutions, so thank you Mr. chairman.
▶ 1:27:24Sen. Scott: Senator kelly?
▶ 1:27:26Sen. Kelly: Thank you Mr. chairman and congratulations on your new role. Same to you, ranking member jayla brent. Glad to be returning to the aging committee, this congress almost 1/5 of arizona's relation is 55 and older -- elation is 55 and older. Arizona is a great place to raise a family.
▶ 1:27:56Sen. Kelly: It is also a great place to retire. It's got great weather, especially this time of year. And I am looking forward to continuing to work with my colleagues on this committee to make sure that stays the case. And one of the things we can do is adequately fund senior programs and services, making health care more affordable and accessible, and by giving people the ability to choose where and how they age.
▶ 1:28:24Sen. Kelly: I want to take this opportunity to remind many of my constituents who happen to be watching that my office here in arizona, we are here to help. If you need help with a federal agency, and that includes a problem with your social security benefits or an issue with the va, we are here to help, so please go to my website or give us a call if you need assistance.
▶ 1:28:53Sen. Kelly: I know we've got two big years ahead of us in this congress, and I'm looking forward to making some positive change for arizonans and folks across the country. My first question is for Dr. carr. I see in your bio that you are an asu grad. One of my kids went to asu. The other is at u of a.
▶ 1:29:19Sen. Kelly: You mentioned meal delivery as an example of a low-cost program that has a very valuable impact on older adults, especially those who are socially isolated. This is something we heard a lot about as we worked on the reauthorization of the older americans act.
▶ 1:29:39Sen. Kelly: Many of our area agencies on aging have a lot of interest in home delivered meals, and yet they have to put folks on a waitlist for these services. For some organizations, this is the first time they've ever had was a waitlist for meals.
▶ 1:29:59Sen. Kelly: That is one reason why I was glad that our bipartisan senate passed more flex ability for how local agencies can use their nutrition funding, allowing them to move more money toward delivery, if that's what the local community needs.
▶ 1:30:18Sen. Kelly: In the same spirit of meeting people where they are, last congress, then-ranking member braun and I introduced legislation to help free banks provide delivery services for the senior food box. This got a great reception in arizona, and I would like to put it out there that if any of my colleagues on this committee would like to work with me on this this year, I am willing to do that.
▶ 1:30:50Sen. Kelly: Could you talk about why these kinds of programs are so valuable, and from your perspective why are they important for congress to continue to support?
▶ 1:30:58Dr. Carr: Thank you for the question. Yes, I am in arizona state grad and my brother went to the university of arizona, so I can imagine what that is like sometimes. One of my earliest memories is going in the car with my grandmother, door to door, delivering meals with these programs.
▶ 1:31:26Dr. Carr: It was a big part of our family growing up, volunteering to support our community, in the tempe area where we grew up. I think the home delivered meals programs as the secret sauce of a foundation for healthy aging, because it does a whole bunch of things at once. It has the opportunity to help make sure that people have food, which is important. It promotes social engagement.
▶ 1:31:55Dr. Carr: We know with some colleagues, I know at other universities who are really big experts in this field have shown that the more frequently a person gets a meal delivered to their house, the better the outcome, because there is more frequent interaction. The small bits of social engagement are potent in terms of their benefits for feeling less isolated and feeling more valued in the community.
▶ 1:32:25Dr. Carr: The person delivering the meal also gets benefit from the volunteering and engagement in the community and they feel valued. There is almost no program I can think of that has those combinations of things that are so collectively relevant. If there was a program that could have more impact, I can't think of one that is as inexpensive as this one could be to expand.
▶ 1:32:53Sen. Kelly: It is interested you get an added benefit from doing this. The food is the goal. I delivered meals during covid, and I saw seniors multiple times. I could tell they were getting something out of this beyond this delivery of lunch and dinner. Thank you. I will have a couple questions for the record, Mr. chairman.
▶ 1:33:18Sen. Scott: Thanks, senator kelly. Senator warner.
▶ 1:33:23Sen. Warner: Thanks very much, chair scott, and congratulations on holding the first aging committee hearing of the year. I look forward to working with you and also with ranking member jell-o brand -- gillibrand together this congress. Too many seniors are struggling with high out-of-pocket costs for medications that they need to ive. That is why I have been laser focused on reducing prescription drug costs and improving access to health care.
▶ 1:33:54Sen. Warner: I'm proud that my bill included in the inflation reduction act, lowers the cost of insulin to no more than $35 a month out-of-pocket for seniors. And as of january 1 this year, seniors will not pay more than $2000 in out-of-pocket costs for their prescription drug coverage each year.
▶ 1:34:19Sen. Warner: I can tell you as a pastor that I have seen the impact that this has on the lives of ordinary people. I have seen it up close. I'm proud that the spending cap was made possible again and included in the inflation reduction act. Dr. hughes, how does lowering out-of-pocket drug costs who out-of-pocket drug costs w help seniors?
▶ 1:34:47Sen. Warner: We talk about things in theoretical terms, but give us a clear picture of the human impact of this.
▶ 1:34:53Dr. Hughes: We all depend right now on prescription drugs. Prescription drugs have almost replaced regular routine medical care. In terms of lifesaving and health maintenance effects. These are a lifeline.
▶ 1:35:15Dr. Hughes: For people who are -- because of income constraints, unable to get a medication renewed, do I have to make a choice between rent or food or something else and a needed medication, that shouldn't happen. It shouldn't happen to older adults. It shouldn't happen in the united states of america.
▶ 1:35:43Dr. Hughes: I just think that this medicare -- the deficit reduction act has just been great in terms of the prescription -- inflation, excuse me, the inflation reduction act.
▶ 1:36:09Dr. Hughes: It has really been a great piece of legislation, and I think it has the normans -- has enormous potential to help a lot of seniors.
▶ 1:36:25Sen. Warnock: I agree that seniors should not have to choose between food on the table and prescription drugs. I look forward to building on this and working on it not only as a member of this committee but a member of the finance committee, where a lot of these issues related to cost and seniors comes up through the various programs we have.
▶ 1:36:48Sen. Warnock: I am grateful for senator casey's work last congress to champion the issue of medicaid home and community-based services. Medicaid provides coverage for home and community-based services that allow older adults and people with disabilities to receive the care they need from the comfort of their home without going broke. Paying for it.
▶ 1:37:12Sen. Warnock: However, in georgia, over 7000 people are on waiting lists to access these services. We have the better care, better jobs act last congress to enhance medicaid funding. How woodcuts to medicaid -- how would cuts to medicaid proposed by some of my colleagues affect access to home and community-based services for seniors?
▶ 1:37:41Dr. Carr: Medicaid and home and community-based services are actually a more cost-effective way to help care for older adults with disabilities than nursing homes. If people don't have the care they need, it can spill over onto family members who are providing the best care they can, which can be problematic because then they may also be unable to work themselves, which I think has ripple effects that
▶ 1:38:13Dr. Carr: Are consequential for families. And then I think we would anticipate that in the absence of receiving care people need at home, they are more likely to go into a nursing home, and even if people do have money saved and are not yet on medicaid within six months, they are usually spent down to medicaid.
▶ 1:38:34Dr. Carr: And that is very expensive for our system, and it doesn't meet people's needs to stay in the community. I think the consequences of not allowing people to have the services they need to stay in their home and get care for as long as possible is the most cost-effective way to protect medicaid costs, among other things, not the least of which is supportive of quality of life
▶ 1:39:04Dr. Carr: For older people.
▶ 1:39:04Sen. Warnock: Thank you so much. It is fair to say this has an adverse impact, certainly on the seniors, but also on their families, an impact on all of us through the ripple effect. Thank you so much for your testimony and I look forward to continuing to work on this committee and senate finance committee to make sure we protect medicaid and other critical programs our seniors rely on.
▶ 1:39:31Sen. Scott: Thank you, senator. Sheriff, what role do you see for law enforcement promoting healthy older adults in their committees? Do you think there is any role for law enforcement to be involved?
▶ 1:39:45Sherriff Prummell: Yes, I do. We are out there engaged with our community. My philosophy is that you deal with quality-of-life of life issues within your community. If you deal with the quality of life issues, they won't explode into crime issues. We have one of the lowest crime rates in the state, but you have to stay engaged with your population, whether they are kids or seniors.
▶ 1:40:12Sherriff Prummell: We have a great volunteer program and we encourage all of our retirees to join. We have a volunteer program about 70 members. They have a purpose. They are out there helping the community, they are giving back, they are staying engaged with us. In the same sense, they become part of our family. Even when they come to the point when they decide to retire out of our volunteer program, we are still checking on them.
▶ 1:40:41Sherriff Prummell: We are still making sure they are ok and getting what they need.
▶ 1:40:49Sen. Scott: What are some of the fraud trends you have seen?
▶ 1:40:53Ms. Alvarez: There are so many frauds that we have a fraud of the month. That is how much fraud there exists. Recently, we just had the -- I'm sorry, medical equipment fraud, where someone might call you and ask you if you want a back brace.
▶ 1:41:22Ms. Alvarez: Somebody just calls you on the phone. We know that a back brace is something that is personal. That should be prescribed by a doctor that knows you. Recently we had someone who received like 50 back braces because somebody got a hold of their medicare number and charged it to their account.
▶ 1:41:47Ms. Alvarez: There are other forms of -- if there is anything happening in society, there is a fraud for it. When covid started, that fraud really skyrocketed. One of the things they were saying is -- because there is covid, you will get a new medicare card, and we will send you a test along with it. We are going to send you a laminated card.
▶ 1:42:16Ms. Alvarez: We will send you all sorts of different frauds. The reality is there is no new card. You have the card and that is what you have. It goes on and on. Anything that is happening, there is a fraud for it. We get up in the morning to do that valuable work, a scam artist, that is their job. If they were doing something productive with their time, they would be very successful.
▶ 1:42:44Sen. Scott: How does participating activities like paid work or volunteering impact the physiological or psychological or physical health of older americans?
▶ 1:42:57Dr. Carr: There is a lot of evidence that both are protective of physical, psychological and cognitive health. With regard to volunteering, there isn't a lot of specific research that says here's the thing about volunteering that improves your health.
▶ 1:43:19Dr. Carr: There have been a lot of researchers trying to figure out why it works, one of which -- and there is some initial evidence related to the fact that when you help other people, you actually respond better physiologically to dress. There is a buffering effect of being engaged in your community to feeling better when you face everyday challenges. That is not the only issue.
▶ 1:43:48Dr. Carr: You are more physically, cognitively engaged when you are engaged in volunteering. That is largely the reason we think that remaining engaged in those activities are so good for your health over time. I had mentioned earlier, 20 hours a week of work is pretty protective. It depends on what kind of work that is. If you are engaged in a physically demanding or dangerous work, it is not health protective.
▶ 1:44:20Dr. Carr: It has to be work that allows people to maintain their health and be engaged, so it's important to keep that in mind.
▶ 1:44:27Sen. Scott: Ranking member gillibrand?
▶ 1:44:30Sen. Gillibrand: I want to congratulate the chairman on such a wonderful panel. Each one of you has had such important information to contribute. I think all the senators feel you are exactly the right people to answer their questions. I just have a couple. I want to focus on the financial security issue.
▶ 1:44:50Sen. Gillibrand: Social security is one of the most popular programs ever enacted him and tens of millions of older adults use their social security benefits to buy groceries, medicines, housing, to just basically live on. For many older adults, their social security benefits are insufficient and they have a difficult time making choices.
▶ 1:45:14Sen. Gillibrand: We have talked about some of those choices between heat and food and medication and not taking their medication or spreading out their medication inappropriately. We heard real horror stories of people trying to make ends meet. Ms. alvarez and Dr. carr, can you amplify these tough choices they have to make? How does it affect their well-being? I imagine it affects their mental health.
▶ 1:45:42Sen. Gillibrand: When you are struggling on the basic survival, that must provoke enormous anxiety. I want to talk about how we can amplify or expand upon financial security to take awy some of those burdens. I would like your insights on that.
▶ 1:46:00Ms. Alvarez: First of all, seniors are constantly juggling. If you are on a fixed income, they are constantly juggling their finances. They say, well, can I get away with not paying for my prescription drugs and cutting them in half, things like that, for a month. Can I get away with not paying my rent for a month?
▶ 1:46:24Ms. Alvarez: We know that constant juggling will come to a head, where if you simply do not have much of money coming in and you have to pay bills, things are going to collapse. Programs that the older americans act has, those are all programs that shore up people who don't make ends meet.
▶ 1:46:53Ms. Alvarez: We work with this older economic security index, and basically in new york state -- not new york state, in the united states, the average social security income is $29,678 dollars, a little less than 200%. But it costs more money than that to actually live on an average in any community in the united states.
▶ 1:47:19Ms. Alvarez: So when we have heating, when we have the snap program, when we have the medicare savings program, when we have those things, people are able to then benefit from programs that will keep money in their pocket. One concrete thing I want to say is that the medicare savings program helps with out-of-pocket costs for your health insurance and your prescription drugs.
▶ 1:47:50Ms. Alvarez: It pays for your copayments, things like that. It is calculated that if a person is not accessing one federal program, they are not accessing four other federal programs. That is an average of $7,000 that someone could have in their household. So that they don't have to spend money on.
▶ 1:48:18Ms. Alvarez: Because we have these programs, that is what will keep people in the community with dignity.
▶ 1:48:25Sen. Gillibrand: Dr. carr? Do please expand on the older americans act and why that matters.
▶ 1:48:32Dr. Carr: Sure. I will say a couple briefings. -- brief things. One, I don't and we want to live in a society where we allow old people to suffer in poverty. These programs are really critical to ensuring that that is the case, but they don't solve the problems entirely. Second, being poor is bad for you in every aspect.
▶ 1:48:59Dr. Carr: Poverty is not the consequence of something you do wrong in old age, it is a lifelong effect. A lot of these things that we see with older adults is due to things that accumulated over the course of their lives. In later life, we many times don't have the ability to recover financially when things go wrong and we run out of money, despite our greatest efforts.
▶ 1:49:24Dr. Carr: These are protective of the most vulnerable people who have nee ds and want to stay in the community. The older americans act is critical to make sure we don't have a massive group of people living in nursing homes because they have no other choices.
▶ 1:49:40Dr. Carr: I think in the absence of other opportunities, we can't place these burdens on families or communities in other ways, so helping support people with these relatively small interventions by allowing them to stay in their homes is beneficial to the larger community.
▶ 1:49:59Sen. Gillibrand: Agreed. Dr. hughes, would you like to add something?
▶ 1:50:05Dr. Hughes: Could you repeat that?
▶ 1:50:09Sen. Gillibrand: Do you want to add to the conversation of why fixed income is such a challenge and why the older americans act is so important?
▶ 1:50:18Dr. Hughes: The older americans act is part of the fabric of our society, the services that it provides and funds. There are so many communities in the united states that really depend on these services. Part of the problem is that a lot of people don't understand where the money is coming from.
▶ 1:50:44Dr. Hughes: If they knew where it was coming from and why, I think there would be much greater ground support.
▶ 1:50:56Sen. Gillibrand: That makes sense.
▶ 1:50:58Dr. Hughes: The meals, there is no question about the home delivery of meals being hugely valuable. They were hugely valuable in illinois during the pandemic. There was research showing that they reduce emergency department use, they improve nutrition, they do all kinds of things.
▶ 1:51:22Dr. Hughes: What is really amazing is how much the older americans act has achieved with so little in terms of resources. I think that is an amazing success story. My testimony was attempting to build on that and provide more.
▶ 1:51:50Sen. Gillibrand: I agree. Thank you. With the chairman's permission, may I ask sheriff prummell one question about fraud? I appreciate your testimony about the work you do in your community. It is so much appreciated. I heard so many stories about seniors that have fallen to these scams, the grandchild scam, the irs scam, the cryptocurrency scam. They are literally endless.
▶ 1:52:19Sen. Gillibrand: They are heartbreaking, because our seniors are duped. They either take money out of their bank account, they send money through multiple means, but it's so rare that we get this money back. I also talked to law enforcement up and down my state and across the country. They have very few will tools to go after these transnational criminals because they are using the internet, the phone, information like who just got arrested, as you testified.
▶ 1:52:52Sen. Gillibrand: What can we do to crack down on the scams more? Is there anything we should be doing to get justice? Let's say we can't defeat the chinese network of scammers. Should we be doing something to make sure the victim is given some measure of relief? Should we create a fund for that ? What would you recommend? You are dealing with the crime and not being able to put someone in jail most times.
▶ 1:53:22Sherriff Prummell: That is the problem. Most of your criminals are not just outside the state, they are outside the country and the reach of local law enforcement. Your federal agencies have, but they won't touch a case unless it reaches a certain dollar amount, which I understand because their plate is full.
▶ 1:53:42Sen. Gillibrand: Do you know what the dollar amount is?
▶ 1:53:45Sherriff Prummell: Close to $1 million.
▶ 1:53:47Sen. Gillibrand: That will not help anybody. Every scam I hear of his a $5,000 or $10,000 skin. I hear where bank accounts are completely eliminated, but it only reaches $100,000.
▶ 1:54:02Sherriff Prummell: I understand you cannot flood the fbi and secret service with these cases because they have other responsibilities. It is heartbreaking because people are duped out of their life savings. They worked hard for that money for retirement, and now all of a sudden it is gone. 99% of the time it is not recovered. You will have some of the financial institutions.
▶ 1:54:31Sherriff Prummell: Very rarely, depending on the dollar amount, will reimburse the victim, partial or all of it. That is where. There is no set fund I am aware of that will help get that victim back on their feet.
▶ 1:54:46Sen. Gillibrand: Thank you, Mr. chairman.
▶ 1:54:49Sen. Gillibrand: Can I follow --
▶ 1:54:51Sen. Scott: Can I follow-up? We care about these frauds. I was talking to someone the other day. They said if you go to 50 years ago, the fbi put a lot of effort into bank robberies because the local sheriff's offices would not have had the resources to do it. Today if there is a bank robbery, you don't really need the federal government to help you guys. What you really need is help on issues like this.
▶ 1:55:20Sen. Scott: Has there been any conversation by law enforcement to say, that was great that the fbi, whoever helped us 50 years ago, we don't need their help anymore, maybe a small county, but you don't need it, right? You have to focus on these things that you don't have the resources to do and don't have the authority. Has there been any conversation with law enforcement?
▶ 1:55:44Sherriff Prummell: No discussion I am aware of. We are involved with a lot of federal agencies with regards to investigations that cross over the borders, but mostly they are focused on terrorist type investigations and drug enforcement. As for the fraud investigations, we don't have a task force. They have some task forces with the secret service, but I don't hear much coming out of it.
▶ 1:56:12Sen. Scott: In the organizations you are involved in, if there is a discussion or you think we ought to have a hearing on that, where should people focus their time? There is not unlimited dollars. You don't need all the federal help in your county for things that they were not going to help you on.
▶ 1:56:39Sherriff Prummell: Most of this stuff within my county we can handle. When you are dealing with these major fraud cases that cross not just state lines but the country lines, we don't have an arm that reaches that far. We don't have the technology to trace them. They can spoof these numbers. They can hide I.p. Addresses so it's not easy to trace them anymore.
▶ 1:57:06Sen. Gillibrand: You need our top leaders.
▶ 1:57:09Sen. Scott: Stop doing stuff that they don't need. Changing subjects a bit, Dr. ca rr, we talked about we will get a return investment if we spend this money. What about spending money on healthy eating? How much money would we save if we got everybody to eat healthy all their life? Or even starting when you are 65.
▶ 1:57:36Sen. Scott: Has anybody done any study about the problems of ultra processed food or extra sugar intake that would save us money on the others? I told senator gillibrand, the problem we have in my business life, if someone says if you spend money here, I will save money over there. I will cut the money over there and spend it over here, because I can make it happen.
▶ 1:58:07Sen. Scott: In my job as governor of florida and here, no one has come up with a program that saves money. They all cost more money. How many of you vote for tax increases? Nobody wants their taxes to go up. We have to figure out how to do this in a manner -- and healthy eating seems logical. Have you seen any research?
▶ 1:58:28Dr. Carr: I'm not an expert in nutrition, but it matters for lifestyle broadly speaking related diseases. Almost all of the major illnesses of aging are related to lifestyle. Nutrition is hard to study because we can't put people in a hospital for 30 years and watch them eat a certain diet and compare it over time, but we have learned a lot.
▶ 1:58:59Dr. Carr: You are right to say that ultra processed foods is that you mental health and costs us immensely. You mentioned sugar. There are lots of different studies looking at the consequences of poor nutrition across a variety of categories. Inadequate protein consumption as we age, which becomes more important, and other varieties of things.
▶ 1:59:27Dr. Carr: If you're talking about a nutrition intervention to save money, I cannot help but assume it would save money long-term if we found a way to make healthy foods accessible, easy to encourage people to consume instead of the things that companies have helped us --
▶ 1:59:50Sen. Scott: I'm not anti-sugar. I like a nice chocolate dessert, but there is a way to have healthier sugars too.
▶ 1:59:58Dr. Carr: Yeah. I agree with you. The challenge we have in terms of saving money over time, we need to be paying more attention to these ways to save money by improving health over the long-term. This is a long game when we are talking about these things.
▶ 2:00:22Dr. Carr: If the federal government is positioned to start helping us play a long game with healthy aging, I am really excited about that. I think nutrition is part of that equation.
▶ 2:00:35Sen. Scott: You have shown that the fitness strong program is successful. What do they do with that data? Do they just do the report, or do they do something with it?
▶ 2:00:51Dr. Hughes: We have been working with the illinois department of public health. We were very fortunate to get funding from them. We were able to disturb the program through illinois, including rural areas.
▶ 2:01:16Dr. Hughes: The department of public health had money from the cdc and the city of chicago people had funding from the aoa. We were able to use that money to get the program out to a lot of people in rule areas -- rural areas, to african-americans, we have an hispanic version of the program, to people who really don't customarily access health promotion programs.
▶ 2:01:49Dr. Hughes: In terms of national, we have worked really hard on disseminating the program. We now offer the program in 32 states nationally. We have a partnership with the national recreation and parks association to offer the program in collaboration with them. Again, with cdc funding.
▶ 2:02:18Dr. Hughes: What I was trying to get at with the testimony is anybody know who has an evidence-based program, you have to reinvent the wheel. You have to do it all by yourself. There is no playbook. There is no cookbook. There is no nothing to help people who are developing these programs.
▶ 2:02:50Dr. Hughes: And to help older adults to improve their wellness, to improve their functioning, spending years of their lives developing these programs. In public health it has always been important to us.
▶ 2:03:13Dr. Hughes: If we find something that works, you have to get it out into a community where people can benefit from it. That has been the motivating force for what we do.
▶ 2:03:36Dr. Hughes: I think that this is a very important unity to think creatively about what we can do to maximize health promotion interventions with, for example, a hypothetical case where we had to present before the boston consulting group to get our funding from the department of public health, we said, okay, if we were able to demonstrate a
▶ 2:04:11Dr. Hughes: 3% reduction in use of total joint replacement surgery, the program would pay for itself. So over and over again. I think these programs save money and they benefit people. They are very cheap, and people like that.
▶ 2:04:40Sen. Scott: And you are doing something good for people.
▶ 2:04:43Dr. Hughes: Yes.
▶ 2:04:45Sen. Scott: It is not like you're selling something that is bad for them. Do you have anything else?
▶ 2:04:52Sen. Gillibrand: I just want to thank the chairman and each of our panelists for their excellent testimony and outstanding insights on the challenges that so many of our seniors are facing right now. Thank you.
▶ 2:05:05Sen. Scott: I would like to thank everyone for participating. I look forward to working with members across the aisle. If senators have additional questions for the witnesses, the record will be open until next wednesday at 5:00 p.m. Thank you everybody for being here. Good job.