▶ 0:15:40Chair Scott: The U.S. senate special committee on aging will come to order. We are once again talking about an important issue that affects millions of american seniors and their families through reauthorization of the older americans act, oaa, and its impact on alzheimer's and heart disease. The oaa is one of the most quietly impactful laws this country has ever passed.
▶ 0:16:06Chair Scott: It is the reason a senior in naples gets a warm home through meals on wheels. It is a reason a daughter in pennsylvania can take a few hours of respite after spending the night caring for her father with alzheimer's. It is the reason a man in west virginia with parkinson's can get to a physical therapy appointment using transportation services. Senior citizens across the country, including new york, coordinate with all these things to support older americans and their families.
▶ 0:16:35Chair Scott: There are a -- these are a few examples. When we talk about reauthorization, we talk about protecting the people who raised us, served our country, build our communities, and need our support. Across the united states, more than 7 million older americans are living with alzheimer's, including 580,000 in my home state of florida. Alzheimer's steals memories and independence, often turning spouses and children into full-time caregivers.
▶ 0:17:02Chair Scott: Nearly one million americans live with parkinson's disease, which slowly robs people of movement, balance, and speech, but not of their determination and dignity. Each year about 90,000 new cases are diagnosed. Behind each one is a family learning to adjust, adapt, and persevere. Behind each of these numbers is a caregiver -- a husband, wife, son, or daughter, providing care around the clock. More than 11 million americans provide unpaid care for people with alzheimer's or another dementia.
▶ 0:17:33Chair Scott: Together they give 19.2 billion hours of informal assistance valued at 400 $13 billion, and that does not include care givens for parkinson's, als, or other diseases of aging. These are people holding down jobs, raising children, who still find time to feed, bathe, and comfort a loved one. They do it out of love and deserve our support. That is why the older americans act is so vital. It works because it is not a big government approach.
▶ 0:18:03Chair Scott: It directs resources to local communities, neighbors helping neighbors. We have seen the impact firsthand through our senior centers and the volunteers who deliver meals, install ramps, and check on seniors who live alone. For families living with alzheimer's, parkinson's, and other age-related diseases, these programs are not luxuries. They are lifelines. They need a hot meal, a few hours of rest, or a ride that keeps someone connected to their community.
▶ 0:18:31Chair Scott: When we talk about reauthorizing the older americans act, we are not just debating cost. We are renewing our commitment to america's seniors, a commitment that in the united states we will stand by our parents and grandparents as they age, and that when disease strikes, families will not have to face it alone. Every service under this law represents compassion made real.
▶ 0:18:54Chair Scott: That is what government should do -- empower communities to care for one another and let them direct resources to meet the local needs because they understand their communities far better than anyone in washington, D.C. does. I have said before and will say again our seniors have spent their lives building and serving this country. This bill is one way we ensure they continue to be supported, respected, and valued.
▶ 0:19:16Chair Scott: I'm proud to lead the authorization of the older americans act this year with ranking member gillibrand, helping committee chairman cassidy and the ranking member. I urge all my colleagues to support this important legislation so we can continue to honor, protect, and care for america's seniors and the families that stand beside them every day. I would like to recognize ranking member gillibrand for her opening statement. Sen. gillibrand one second, I have the wrong paper.
▶ 0:19:50Chair Scott: For americans that can't see. Chairman scott, thank you for calling today's hearing and thank you for our witnesses being here. I am greatly looking forward to our discussion on how our older americans act provides vital, life-sustaining support to older adults and people with disabilities that allow them to live with dignity and independence in the community of their choice.
▶ 0:20:13Chair Scott: Many americans don't realize that the oaa even exists, even though an estimate of one in six older adults and millions nationwide are helped by oaa funding and programs they run each year. In 2020 four alone, oaa allowed older americans to receive over 240 million meals at home or in a community setting. Over 14 million trips to a doctor, the supermarket, or to participate in events.
▶ 0:20:43Chair Scott: Over 10 million hours of help with everyday tasks like dressing or bathing. The oaa is a bipartisan work program that flies below the radar. It helps fill the gaps and serves as connective tissue that improves the efficiency of federal programs like medicaid, medicare, social security, snap, and lie keep -- liheap.
▶ 0:21:12Chair Scott: Older americans want to live and thrive in their communities and the supports administered under oaa allow them to do just that. It is just a bonus that it is also cost-efficient, providing services to the community helps save tax fillers -- taxpayers billions of dollars every year that would otherwise pay for stays in the hospital or institutional care like nursing homes, which are far more expensive.
▶ 0:21:38Chair Scott: In 2024, oaa funding generated 3.39 times of a return on that investment. This means every dollar invested in oaa aging services generated 3.39 dollars in community value and taxpayer savings. Both -- because of the efficient service delivery, older adults avoided millions of days of hospital stays at institutional care. But now is not the time to take her foot off the gas.
▶ 0:22:10Chair Scott: Authorization expired last year even though so far there have been limited interruptions in oaa service because of this lapse, it is vital to pass a reauthorization this fall to modernize the statute and the reflective of the evolving needs of older adults. In june, I was proud to join chair scott and our colleagues in introducing a bipartisan older americans act reauthorization for 2025.
▶ 0:22:40Chair Scott: This bill reflects our bipartisan, bicameral agreement that was included in last december's final appropriations package, which unfortunately ultimately it fell apart. Particularly as the aging population is growing at the fastest rate in our nation's history, and more americans are being diagnosed with aging related diseases each day, it is crucial to reauthorize this legislation that allows for greater flexibility to increase capacity under the law to meet the need.
▶ 0:23:07Chair Scott: Today's hearing, our witnesses will highlight how oaa helps families living with aging-related diseases by providing them with a variety of supportive and nutritional services, health promotion programs, and support for family caregivers. However, oaa services are just one essential piece of this puzzle. It helps these families live well in their communities now.
▶ 0:23:32Chair Scott: Other bipartisan landmark laws like the national plan to end parkinson's disease and the national alzheimer's project act that are currently being implemented by hhs help to chart the path to the future. They represent a federal commitment to changing the trajectory of neurodegenerative diseases that impact millions of american lives.
▶ 0:23:51Chair Scott: As we continue this work, it is my top priority to ensure that the voices and needs of older adults and people with disabilities are elevated in federal policy discussions, particularly about the implementation of key statutes that impact their lives today and for years to come.
▶ 0:24:09Chair Scott: I look forward to doing this in my role as ranking member of the aging committee and the senate cochair of the bipartisan congressional concerns caucus, and the soon to be formed americans with disabilities caucus. I will fight. I will always fight to make sure that older adults and people with disabilities can age with health, dignity, and independence in their homes, in their communities, and in the setting of their choice.
▶ 0:24:37Chair Scott: I look forward to hearing from our witnesses today how we can strengthen and administer the oaa to do exactly that.
▶ 0:24:45I Want -- Chair Scott: I want to thank ranking member gillibrand for her hard work on all these issues. Our first witness is erick montealegre, a resident of broward county in my home state of florida. Along with his sister, he is a caregiver for his father, who is diagnosed with mild cognitive impairment four years ago.
▶ 0:25:08I Want -- Chair Scott: He also serves as a trained volunteer and community educator and serves as a long-term care were. Thank you for being here. You may begin your testimony.
▶ 0:25:18Mr. Montealegre: Thank you, members of the committee. I think you for the opportunity to testify today. I live in broward county, florida and am a family caregiver, a volunteer with the alzheimer's association, and a small business owner in the senior care field.
▶ 0:25:36Mr. Montealegre: I've only been in the field for about a year and a half, but every day reminds me of vital programs supporting older adults are, not just for families like mine in florida, but for the nearly 12 million family caregivers nationwide who are caring for someone with alzheimer's. Today I speak to you for most as a son, one of four adult children doing our best to care for her father, alberto, who is living with stage iii mild cognitive impairment. I'm proud to have him here today with me.
▶ 0:26:05Mr. Montealegre: As november is national family caregivers month, it makes thanksgiving especially meaningful. Daddy was diagnosed five years ago when we first noticed changes in 2019. Initially, he lived on his own, proud of his independence. Over time, it became clear he needed more support, and he moved in with my sister.
▶ 0:26:29Mr. Montealegre: With trial and error, we learned how to balance his independence with his safety and find resources that would help them stay connected to his community and family. Caregiving, as many of us here know, is emotionally taxing, physically demanding, financially challenging, and is a full-time responsibility. With the help of our local agency on aging, we accessed services during the older americans act which have made a world of difference to his quality of life.
▶ 0:26:57Mr. Montealegre: At first, dad received home delivered meals which insured he had healthy food and provided the reassurance of a daily check-in. He began attending a local adult day center which has become the heart of his day-to-day life and in many ways the heart of his story. Dad now participates in many activities that keep him engaged and happy. He is learning to play the piano and does lots of art. He is able to exercise regularly and safely at the gym they have on site.
▶ 0:27:24Mr. Montealegre: He gets to play chess, which is something he has enjoyed his entire life that allows him to remain socially and mentally engaged. He is 84 years old and has started taking up dancing, which has been a surprise to all of us. It is encouraging to see him enjoying something new at this stage of life and it gives us hope and the ability to hold back the progression of the disease. The center provides more than just recreation. It gives him cognitive stimulation, physical activity, social connection, and dignity.
▶ 0:27:55Mr. Montealegre: For my siblings and me, it gives us respite and peace of mind, knowing he is in a safe, engaging environment. It allows us to focus our own families, our own careers, without constantly having to worry. I truly believe that the structure, consistency, and connection the center provides are key reasons why my father is doing as well as he is today. It has allowed me to step back from being his care manager and allows me to spend time with him just being his son.
▶ 0:28:24Mr. Montealegre: Dad immigrated to the united states from colombia back in the 1970's. Over the course of the disease, he has lost some of his english and now speaks primarily spanish. This can make it difficult for us to communicate with him on complicated topics such as retirement benefits and planning. The center's bilingual trained staff can speak to him in his native language, helping him and us understand the complicated issues we need to know to make decisions around his care.
▶ 0:28:52Mr. Montealegre: It is hard to overstate what a relief it is to have caregivers who truly understand and speak his language. They can often pick up on nuances in his speech that even sometimes I miss. Hispanics are 1.5 times more likely to develop alzheimer's disease, making it all the more important to prioritize high quality and culturally appropriate programs funded through the older americans act to read they are doing that. They are meeting people where they are and honoring their story.
▶ 0:29:20Mr. Montealegre: In my culture, caring for our elders is part of who we are, and I hope that my children see that example and carry it forward. Reauthorizing and strengthening the older americans act is an investment in our families, our community, and the community. The programs provide families with structure, valuable resources, support, and hope -- hope that my siblings and I can give dad the best care possible, and hope that as our country ages, no family will have to walk this journey alone.
▶ 0:29:50Mr. Montealegre: Thank you again for the opportunity to testify and I look forward to your questions.
▶ 0:29:54Chair Scott: I hope so. Senator alsobrooks will introduce our next panelist.
▶ 0:30:04Sen. Alsobrooks: Thank you to chair scott and ranking member gillibrand. I'm pleased to introduce our next witness, stephen sappington, a condition of mine from harford county, maryland. Mr. sappington is a patient advocate who was diagnosed with parkinson's disease in 2015. Shortly after his diagnosis, Mr.
▶ 0:30:27Sen. Alsobrooks: Sappington became involved with rocksteady boxing, which provides boxing classes for parkinson's patients that are specifically designed to help mitigate symptoms. With funding provided through the older americans act in jeopardy, Mr.
▶ 0:30:43Sen. Alsobrooks: Sappington became a driving force behind the creation of rally against parkinson's, a nonprofit organization dedicated to protecting this vital exercise, education, and wellness resource for people living with parkinson's. Mr. sappington continues to advocate for the reauthorization of the older americans act and the implementation of the national plan to end parkinson's act to better support marylanders living with parkinson's disease. Mr.
▶ 0:31:13Sen. Alsobrooks: Sappington, thank you for joining us today to share your story. You may begin your testimony. You can begin your testimony now.
▶ 0:31:22Mr. Sappington: Thank you so much. Hello, chairman scott, ranking member gillibrand, members. My name is stephen sappington. And 73 years old. I've been married for 51 years. I started this disease in 2015. We have nine grandchildren that keep us busy.
▶ 0:31:47Mr. Sappington: For over three years before my diagnosis, my wife and I noticed a number of changes in my behavior. I was taking tiny steps instead of long strides. A once clear handwriting became illegible. I went to gardens and suddenly could not smell the thousands of blooming flowers. My hands began to shake. I had no idea what parkinson's disease was. A family physician referred me to a neurologist.
▶ 0:32:15Mr. Sappington: That is when I was diagnosed in 2015. I was upset and frankly in denial, knowing my family never had parkinson's disease. At that time, a close friend who also had parkinson's -- she and a friend were taking a class called rocksteady boxing. They kept telling me for weeks how great these classes were. I wanted nothing to do with it at the time. Why would I want to go to a boxing class? I was still angry and ignoring the obvious.
▶ 0:32:45Mr. Sappington: I had to recognize I did indeed have parkinson's disease. Eventually, I gave him, mostly to get them off my back. I went to the class secretly determined to hate it. Instead I found it interesting and even fun. It was friendly and welcome -- welcoming. All had parkinson's with different progressions and they were doing exercise specifically to counter the symptoms of the disease.
▶ 0:33:08Mr. Sappington: I started going to three hour long class is four to six times a week. I noticed small but immediate results. He faithfully went for 18 months, and then I heard the funding for these classes was in jeopardy. After talking with the certified trainers, I realized I could not let the classes be stopped due to lack of funding.
▶ 0:33:37Mr. Sappington: Over 200,000 parkinson's people like me are benefiting from these free classes. I decided to start a nonprofit to raise money and keep them going. In 2018, I launched a nonprofit called rally against parkinson's to make that happen. We are all volunteers, mostly seniors with parkinson's and some friends, learning as we went, with help. We were able to secure enough funds to cover costs and keep the class free.
▶ 0:34:07Mr. Sappington: That support made it possible for hundreds of people with parkinson's to keep exercising, connecting, and improving their health. Today, our team take hour-long classes each week. It has been life-changing for so many. Programs like this need long-term funding. My neurologist tells me my parkinson's symptoms have remained unusually steady, saying this never happened before in decades of her practice, and dubbing it a miracle.
▶ 0:34:34Mr. Sappington: I went eight years without needing to increase my medication, something very rare in progressive neurodegenerative disease like parkinson's. I believe the exercise and community programs were the reason why. My diagnosis rocked my world. I did not know what my future would hold. I was skeptical of the boxing class. But that single decision changed my life. That is why the older americans act matters.
▶ 0:35:05Mr. Sappington: Transportation, home delivered meals, support, and community service makes it possible for people like me to take classes that improve mobility, reduce isolation, and help caregivers continue to work. I attend a monthly parkinson's support group meeting, and there are caregiver support group monthly meetings, all funded by the oaa. Thank you. These services don't care parkinson's. There still is no cure.
▶ 0:35:33Mr. Sappington: But they keep us moving, participating, and connected while the researchers pinpoint better treatments. My ask is simple. Please reauthorize and fund the older americans act this year come up with strong support for title iii services. Nutrition programs, transportation, and caregiver support -- these investments help people with parkinson's stay in their homes, in communities, keep living, and stay connected.
▶ 0:36:02Mr. Sappington: I also ask that you support robust federal funding for research and ensure the implementation of the national parkinson's project act and advisory council. These efforts are important pathways to a cure. Thank you for the opportunity to share my story. I will be submitting a written statement and look forward to any questions you may have. Thank you so much.
▶ 0:36:22Chair Scott: Thanks for being here. I look forward to hearing about the boxing. Next witness. >> I would like to introduce an ohioan, duana patton. Ms. patton serves as the president of usa aging, a national organization representing the nation's 600 plus area agencies on aging.
▶ 0:36:46Chair Scott: In this role, she leads efforts to strengthen and modernize the older americans act and ensure that community-based programs like home delivered meals, transportation, caregiver support, and in-home assistance remain accessible to older adults and their families. Additionally, Ms.
▶ 0:37:04Chair Scott: Patton serves as the ceo of ohio district five area agency on aging, where she has worked to expand access to dementia friendly services, improving workforce training, and promoting partnerships across health and aging sectors. Ms. patton, thank you for joining us today and please give your testimony.
▶ 0:37:31Ms. Patton: Chairman scott, ranking member gillibrand, and members of the committee, thank you for the opportunity to speak before you today. I name is duana patton and I'm honored to serve as ceo of ohio district five agency on aging, where I have worked for nearly 31 years.
▶ 0:37:50Ms. Patton: Our agency, located in ontario, richland county, ohio is one of 613 area agencies on aging located across the nation that helps older adults remain independent and supported in their communities. I'm also the board president of U.S. aging, a national association of aaa's.
▶ 0:38:10Ms. Patton: On behalf of these agencies and the millions of older adults and family caregivers we serve, I want to express my gratitude for your continued commitment to improving and prioritizing the older americans act. As the older adult population in the united states continues to rise rapidly, aaa's have seen increased demand for oaa programs and services across the country.
▶ 0:38:34Ms. Patton: Strengthening the oaa, which is administered by the administration for community living, over the next decade will be critical, as it is the cornerstone of the nation's non-medicaid home and community-based services, serving nearly 11 million older americans per year. The aging network carries out these services and includes state units on aging, title vi native american aging programs, and tens of thousands of local service providers.
▶ 0:39:02Ms. Patton: The oaa enables the local delivery of home and community-based services, which are almost always less expensive than institutional care provided in nursing homes or assisted living facilities. The longer older adults can successfully age at home, the better it is financially for families and the federal government. For over 50 years, aaa's have served as the local leaders on aging. We are social care experts and often the front door to aging services.
▶ 0:39:32Ms. Patton: We receive referrals from caregivers, physicians, and community partners, usually at a time when a person is facing a new or increasing risk related to aging. The club services we provide include nutrition, supportive services, caregiver support, health and wellness, and elder rights. Our person-centered approach recognizes the health of the person and focuses on interventions that will foster better outcomes. A good example of that is miss gray.
▶ 0:40:01Ms. Patton: Miss gray was referred to our aaa following a hospital stay for a chronic health condition. She was not complying with her medication regimen and had poor eating habits. By providing personal care in her home weekly and home delivered meals, Ms. gray has improved health both physically and mentally and has not been admitted to the hospital since she started receiving the services. This is a powerful impact of the older americans act.
▶ 0:40:28Ms. Patton: There are several oaa programs that provide critical support to older adults with age-related diseases. First is the older americans act title iii be supportive services. The bedrock of the act and a lifeline for older adults needing in-home support. Then we have oaa title iii nutrition services program, the largest program in the country that provides nutrition services to older adults in need.
▶ 0:40:56Ms. Patton: Additionally, oaa title iii has evidence-based health and disease prevention programs which support fall prevention and health management for older adults. And title iii e, the national family caregiver support program, supports the family caregivers of older adults. Lastly, authorization of the oaa expired last year. Since the last reauthorization in 2020, aaa's have identified new opportunities to be even more responsive to the evolving needs of older adults.
▶ 0:41:27Ms. Patton: In closing, the lessons we learned during the pandemic underscore the importance of allowing aaa's to continue using innovative practices that have proven effective. The timing of this reauthorization is ideal. It gives us the opportunity to strengthen what works, modernize where needed, and ensure the act continues to meet the needs of older adults, caregivers, and communities across the nation.
▶ 0:41:58Ms. Patton: Chairman scott, ranking member gillibrand, and members of the committee, thank you for the privilege to share my passion and stories from the field. This day for me is particularly meaningful, not only because it marks my mother's 82nd birthday, but also because this opportunity stands as a cornerstone moment in my career dedicated to serving older adults like my mom.
▶ 0:42:24Chair Scott: Thank each of you. You have great stories about the importance of the oaa. We are going to go to questions. Senator mccormick?
▶ 0:42:38Sen. Mccormick: Thank you, Mr. chairman. Thank you, ranking member. Thank you all for taking time to speak with us today. You bring such important perspectives. This is something we are very focused on in pennsylvania with our aging population. Mr. sappington, you have a unique perspective as both a patient and an advocate for parkinson's disease patients and caregivers.
▶ 0:43:01Sen. Mccormick: How does the support you get from the community and volunteers complement federally supported programs like those covered under the older americans act?
▶ 0:43:09Mr. Sappington: Volunteerism is the center of everything. We would not have anything if it weren't for volunteers. I hope I am answering your question properly. I think it works in concert with those benefits provided by the oaa because the oaa provides many services such as transportation, nutrition, and -- well, many other services.
▶ 0:43:39Mr. Sappington: I think without the caregivers, without the support of them, you would not be able to have all of that. None of this would happen. They are synergistic, I guess. From my vantage point, all of these have been very beneficial for all of us.
▶ 0:43:59Mr. Sappington: We would not be able to sustain the program we have at all without that being the case, without the oaa providing transportation, and without providing some of the programs that they have. I know that the support group meetings that I go to are funded by the oaa. So that is something that has been vital for us to get information, get the word out to other people.
▶ 0:44:29Mr. Sappington: To our volunteers, we were able to get large gatherings for these meetings and get the word out about our programs. The efforts go hand in hand. I hope that helps.
▶ 0:44:39Sen. Mccormick: It does, thank you. We have more than 300,000 pennsylvanians that suffer from alzheimer's, and nearly 50,000 parkinson's patients live in our commonwealth, and these numbers don't capture the hundreds of thousands of caregivers who volunteer their time and resources to support their loved ones. Mr. montealegre, your firsthand experience with your father and many others in your community is extremely valuable.
▶ 0:45:08Sen. Mccormick: You have touched on several services supported by the older americans act. What do you think is missing in the programs covered under the oaa that would go a long way toward supporting americans with these neurodegenerative diseases?
▶ 0:45:23Mr. Montealegre: Thank you for the question. I think one of the most important things is time. The sooner that family caregivers can learn what services there are at the diagnosis point -- a lot of families get diagnosed and then they get appointments with social workers who can give them a multitude of options.
▶ 0:45:48Mr. Montealegre: The family needs to understand that the sooner they can get their loved one into this treatment and therapy, the sooner they can start pushing back on these diseases that do not have cures. I think a lot of times there is a slight delay between diagnosis and the start of community resource interventions. If there is anything we can do to shorten or limit that time, it would make an impact.
▶ 0:46:15Chair Scott: Senator alsobrooks?
▶ 0:46:19Sen. Alsobrooks: Thank you to Mr. chair and ranking member gillibrand. Like so many of my colleagues, I am part of what they call the sandwich generation, which means that I am caring for a 20-year-old daughter and also and really privileged to balance that with the caregiving of my parents. I also hear daily from marylanders who are caring for their own family members, and I know how important the responsibility can be.
▶ 0:46:47Sen. Alsobrooks: I share it with each of you, and having a mother who is suffering from dementia. My father was her caregiver and he has most recently turned ill himself. It is the case that so many adult children who are balancing work, childcare, and caregiving -- it can be a really awesome responsibility. We know that a shut down causes so much fear and turmoil for so many people who are just wondering what tomorrow will look like.
▶ 0:47:13Sen. Alsobrooks: The older americans act exists to bridge the gap for caregivers, to ensure that older adults can live independently and with dignity, and to support the families who care for them. Last year, congress got to the five yard line on a bipartisan reauthorization of this critical law before a tweet by elon musk undermined the progress.
▶ 0:47:34Sen. Alsobrooks: So at the very same time that families are being requested to do more with less, we know this administration moved to dissolve the administration for community living, weakening the agency responsible for coordinating the support nationwide. Our responsibility is clear. We must reauthorize and strengthen the older americans act and ensure the programs and agencies that carry it out have the staffing and stability needed to meet rising need, especially during a shutdown that in my opinion has gone on too long.
▶ 0:48:04Sen. Alsobrooks: I look forward to hearing from each of you today in discussing how we can protect and strengthen the systems I have seen -- that our seniors depend on so that they and their caregivers are supported and not left behind. The first question for Ms. patton or Mr. montealegre is about the cuts and shutdown. The administration for community living is the backbone of the older americans act. It keeps the nation's aging network coordinated and functioning.
▶ 0:48:33Sen. Alsobrooks: Over the past year, we have seen sweeping staffing reductions along with a proposal to dissolve the agency altogether and fold its functions into a larger, less specialized division at the department of health and human services. Layered on top of these cuts, we are 36 days into a shutdown that has frozen or delayed essential work across the agency.
▶ 0:48:54Sen. Alsobrooks: What does it mean for families and caregivers when the acl loses staff, loses structure, and is unable to operate its older americans act programs?
▶ 0:49:04Ms. Patton: Thank you for the question. I think that is where the older americans act, where we see its greatest strength, is because it does start at the federal level, through state units on aging, all the way down to the local level.
▶ 0:49:22Ms. Patton: During the pandemic, the aaa's, we were required to be very nimble and to come up with ways in which during trying times or challenging times, whatever the reason, to make sure that individuals and families had the services and supports that they need.
▶ 0:49:38Ms. Patton: So when we think about the older americans act and the way it is designed and the importance of the reauthorization, it is making sure that no matter what is happening around us, that we have the ability to serve the people in our communities, to take care of the individuals in a timely way and to think about caregivers. So that is the value of the older americans act.
▶ 0:50:04Ms. Patton: Because there is this federal perspective and the authority to administer the older americans act -- but then it works its way all the way down to the local level, or we can be innovative and responsive to the needs of individuals.
▶ 0:50:19Sen. Alsobrooks: Mr. sappington, I want to thank you for being here today and for the work you have done in maryland in keeping our community exercised and moving -- programs like the one you have been involved in. Your testimony I think underscores something really important about the older americans act -- and it is how it helps people to live well today and also helps people to have hope for tomorrow.
▶ 0:50:41Sen. Alsobrooks: As someone who is living with parkinson's, you know personally what it means to rely on the day-to-day support for the longtime search for better treatments. How did the services that the older americans act supports, like transportation, caregiver resources, and community exercise programs help people with parkinson's maintain function, stay connected, and live well day-to-day?
▶ 0:51:05Mr. Sappington: Thank you for the question. I will try to do my best to answer that. The oaa provides vital support in terms of transportation and the caregiver support that people with parkinson's desperately need.
▶ 0:51:20Mr. Sappington: The fact that it is a federal program -- it obviously needs to be supported and reauthorized to prevent any disruptions to critical supports like home care, transportation, or caregiver assistance.
▶ 0:51:37Mr. Sappington: I am also going to say the national plane to an parkinson's act would go hand-in-hand with the oaa because the oaa provides what people need now, the services they need to get from point a to point b, to be connected and to continue to stay active, as well as the nutrition and the caregiver supports. So the oaa is vital to people with parkinson's and those who have neurodegenerative diseases in our population.
▶ 0:52:08Mr. Sappington: They both go hand in hand with the national parkinson's act. One is basically providing people what they need now to live with their older americans, to live with their neurodegenerative diseases, and the other looks for a permanent and to those diseases. So the kind of work hand-in-hand. There is a need for both. Thank you for that question.
▶ 0:52:38Sen. Alsobrooks: Thank you so much.
▶ 0:52:39Chair Scott: Ranking member gillibrand, I would love it if everybody would cosponsor the reauthorization.
▶ 0:52:53Sen. Moody: Thank you for this hearing on an important topic. Let me welcome my fellow floridian from broward county, erick montealegre. Appreciate you being here. Thank you so much.
▶ 0:53:06Sen. Moody: And to all of our witnesses today, this is so important, and these hearings help us not only highlight how certain policies help americans with the challenges we might face in getting policies pushed through congress -- this is all part of that process, and such an important part. We appreciate you taking part in today's hearing.
▶ 0:53:30Sen. Moody: I was raised by a mom who dedicated her entire career to helping seniors, aging americans working with the groups that are supported through the older americans act. It is probably no surprise when I became florida's attorney general one of the first things I did was set up a senior protection team, which was an interagency team to focus on how we can better serve aging americans.
▶ 0:54:00Sen. Moody: As you know, we are the sunshine state in florida, but we are also the silver state, I like to say. It is so important. I would like to thank the attorneys that work with me and the investors that worked with me. They did so much to protect seniors in our state.
▶ 0:54:16Sen. Moody: I think one of the things that gets lost in this piece of legislation is that it authorizes grants for long-term care ombudsman program and specifically the elder abuse, neglect, and exportation prevention programs. I know that we have people here -- a volunteer with the all summer's association. Previously, I believe you served as a long-term care ombudsman. And I know Ms.
▶ 0:54:45Sen. Moody: Patton, you as well. And I would like to talk to you because so many of these programs -- and not just those that are specifically designed to prevent or hold people accountable for abuse and exploitation, but also the programs like meals on wheels and other programs where we have interaction with our aging population so we can better identify those seniors that may be in need.
▶ 0:55:11Sen. Moody: I would like to hear from you how important those programs are to our aging population, based on your own personal experience. We will start with you, Mr. montealegre.
▶ 0:55:23Mr. Montealegre: Thank you, senator murray. I like to think of the ombudsman program less as a compliance program and more of a cooperation program. Residents often have needs that they can have trouble expressing, or maybe don't know who to express those needs to.
▶ 0:55:40Mr. Montealegre: The ombudsmans would uncover those needs through asking, through developing relationships, and then bring those needs to the management of a facility to try to resolve or two may just bring that to awareness. Most of the time when I was in the program, that was exactly the case. It was a need that was not being addressed because there was no awareness. And that was some of the best work that I could do.
▶ 0:56:09Sen. Moody: Any tweaks you think need to be made to the legislation? Probably in many cases once you made them aware, that was remedied and people were provided better care. But do you think there need to be tweaks in the legislation to provide better coordination with law enforcement when these instances might be identified?
▶ 0:56:29Mr. Montealegre: The ombudsman are required reporters. There is a process in place. In florida, there is a process in place to report that to authorities immediately if needed. I'm not sure about legislation. I would say that I think there is an education piece that needs to be done at the community level so that the residents are aware of their rights and aware of what we can do to benefit them. So many times I would say to someone, I'm your ombudsman, and they are like, what?
▶ 0:57:00Mr. Montealegre: Once they understand what my responsibility was and my role wasn't supporting them, they opened up. And I think that is just a lack of clarity to the population.
▶ 0:57:12Sen. Moody: I will ask you, Ms. patton, same question.
▶ 0:57:16Ms. Patton: Great question. In ohio at our aaa, we actually administer and sponsor the ombudsman program, so I'm very familiar with that. In parts of our region, we administer the adult protective services program. And I think one of the amazing things is that the older americans act allows aaa's to be the front door.
▶ 0:57:40Ms. Patton: A lot of times people are coming into a aaa at the front door needing information and assistance or a referral somewhere. Through the process of talking with them and building this trust, we often learn about things that are going on in their lives that maybe they might not open up to, that are very appropriate for a referral to an ombudsman program or to adam adult protective services program.
▶ 0:58:06Ms. Patton: A lot of times, people do find themselves in situations and they don't even realize that they have rights or they might be being exploited. So the fact that the older americans act exists and area agencies are across the country working with ombudsman programs, whether they sponsor it or it is somewhere else in their community, or adult protective services or law enforcement -- the fact that aaa's are boots on the ground in their community, we like to think that those collaborations happen.
▶ 0:58:36Ms. Patton: I think when we think about the reauthorization of the older americans act and the fact that we want to impart more flexibilities, that there can be more of that, more collaboration at the local level to protect individuals.
▶ 0:58:52Chair Scott: Thank you, senator moody.
▶ 0:58:56Sen. Kim: Thank you, chairman. I wanted to build off of what you were just talking about. You noted the area agencies on aging are often front doors for families navigating aging-related challenges. I guess I want to ask you, how can we strengthen coordination across the local, the state, and the federal levels to make it easier for older adults and caregivers to access the full range of support that they need?
▶ 0:59:23Ms. Patton: I think that part of that comes with awareness of what aaa's can do and do do in their communities, talking about it. I love the stories the gentlemen have shared here with me today. When there is this awareness and there is conversations about things that are sometimes a little difficult to talk about, it builds that collaboration.
▶ 0:59:53Ms. Patton: When the aging network, aaa's, other partner agencies can be at the table and talk about policies, talk about funding, talk about challenges that can exist, great programs and innovative ideas come to be.
▶ 1:00:07Sen. Kim: You are saying they are where the rubber hits the road and as a result the insights they could be able to provide can really encourage that kind of creative, innovative thinking?
▶ 1:00:18Ms. Patton: Absolutely. Aaa's through many years have been innovators. The act has allowed us to do that.
▶ 1:00:28Sen. Kim: When you zoom out a little bit, I guess I wanted to get a sense of your overarching priorities. Do you have ideas of what are some of the most critical priorities congress should consider as we are working to reauthorize the oaa, to be able to ensure that programs are meeting the needs of today?
▶ 1:00:45Ms. Patton: I think it would be easy for folks to talk about funding, but when we talk about the older americans act and the way that it exists, and its purpose, it's to make sure that there is this local perspective -- that local organizations can work together to determine what the needs are in their local communities, and that there is flexibility to ensure that maybe the way somebody needs a home delivered meals in one part of
▶ 1:01:19Ms. Patton: The region or country is not necessarily the same way somebody needs it in another part of the country.
▶ 1:01:24Sen. Kim: I appreciate that. Mr. montealegre, there is something that I felt connected with things you talked about when you have highlighted the importance of culturally and linguistically appropriate care. How can oaa programs better ensure that caregivers of older adults from diverse communities have equitable access to this kind of support?
▶ 1:01:46Mr. Montealegre: I think it is important to understand that as people progress through disease, very often they start losing languages and revert to original native languages. So it is important to establish where our community came from, so we can train and bring in the right people with the right skill set to support those people who have for whatever reason lost the ability to speak english.
▶ 1:02:16Mr. Montealegre: That would keep them engaged with therapies and with community resources that would help them stave off the progression of disease.
▶ 1:02:25Sen. Kim: I appreciate that. It is something I have been grappling with myself. My father is somebody who has been declining quite rapidly over the last year, and actually just a couple weeks ago got the formal diagnosis of alzheimer's. He is somebody that has lost the faculty to speak english. He does not actually realize he is not speaking english. He thinks he is. But it has been very difficult.
▶ 1:02:51Sen. Kim: There are very few places where we can get care, caregivers, and get the kind of support in korean. It has been very challenging to be able to do so in a way that I feel like he is taken care of while I am here at the capitol. I agree with you wholeheartedly on that front. Just as we are talking through this, chairman, I'm grateful that you brought this up.
▶ 1:03:18Sen. Kim: Again, I do think -- and we have talked about this before -- that this is a unifying issue. This is something that all of us understand is part of the human condition in terms of what our families are going through at a time when we are certainly having deadlocks and challenges in other types of policy debates.
▶ 1:03:38Sen. Kim: I do hope that our ability to draw upon the struggles that so many families are facing when it comes to aging-related challenges -- I know, as I said, we have kind of plunged into the deep end as a family, and it has been overwhelming for us. It has been a very difficult last year. Things I never realized we would have to confront, and to do so while I am also raising an eight-year-old and a 10-year-old -- it has been a lot.
▶ 1:04:07Sen. Kim: This is not just academic to me or theoretical to me. I'm grateful to you all for coming out here and talking to us about this. We will do everything we can hear to try to push forward on this reauthorization that provides help to so many americans. With that, I will yield back to the chairman.
▶ 1:04:26Chair Scott: Thank you, senator kim. Sen. houston thank you for hosting this hearing today. In preparation for this hearing, I was doing a little research, and I saw this problem of isolation, loneliness, is getting worse. It did hit perhaps a peak during the covid pandemic.
▶ 1:05:01Chair Scott: And people between the ages of 50 and 80 reported being isolated, one in three people. That loneliness and isolation is associated with an additional $6.7 billion in medicare spending.
▶ 1:05:21Chair Scott: If we can do better at limiting the loneliness and isolation, we will have less cognitive decline . They maintain it for a longer period of their life and have a better quality of life. Quality of life is a big deal. In doing some of the research, I know my parents are 86 and 87.
▶ 1:05:49Chair Scott: They have myself and a brother and sister, and so I have a family structure that helps a lot. A lot of people don't have that. Our society, for a variety of reasons in terms of family formation, mobility, and people living all around the country or all around the world -- being without adult children makes it harder on them. I will start with my ohioan, Ms. patton.
▶ 1:06:17Chair Scott: What have you seen over the years, the trends not just as a matter of policy, but as a society? How can we do better?
▶ 1:06:26Ms. Patton: I think through the pandemic, social isolation came to be. We started talking about it. A lot of those statistics, we are very aware of those. I think that we need to make sure what we are doing is not just saying that someone is socially isolated, but meeting them where they are.
▶ 1:06:51Ms. Patton: The gentleman over here talked about the fact that he was able to go to a senior center and did not realize the value that that would bring. I like to tell this story, real quickly, if I could -- we had a gentleman during the pandemic that could not go to the grocery store, was afraid to go out in public, but we had grab and go meals. So he came to the agency, picked up a grab and go meal, and had better nutrition. He was diabetic.
▶ 1:07:22Ms. Patton: He was living on pop tarts and hotdogs. That's what he was eating because that's what he could fix. But after he began getting the grab and go meals, he lost weight and his diabetic medication was reduced. In addition, he made friends because we made the grab and go meal experience something in which the individuals engage with our staff and engage with each other.
▶ 1:07:46Ms. Patton: Today, that very same gentleman is coming to the congregate meals site and is healthier, happier, and certainly more engaged with the community. So I think what we have to do is we have to be creative and we have to think about what makes someone socially isolated, and what would help them become more engaged in their community. It might not be going to a senior center or a meal program.
▶ 1:08:14Ms. Patton: It might be that they become one of those volunteers in an innovative program that a aaa has created where they pick up the phone and they are calling somebody else. It could be that simple.
▶ 1:08:25Sen. Husted: We know that every agency on aging is different. This is administration. It is innovation. What are some of the examples or best practices that you have seen used to create that engagement?
▶ 1:08:42Ms. Patton: One of the great examples is the phone a friend, where seniors are engaged in telephone calls back and forth with each other. We have leveraged schools in our communities where we invite them to participate with us to have intergenerational programs where we can provide the transportation for a senior to get to the school and they read to a student.
▶ 1:09:09Ms. Patton: In addition, a lot of the older americans act programs bring people into the home, because people are remaining in the community versus in an institutional setting. By working with meal providers, personal care providers, and people that are in the home, making sure they are building a relationship with the individual -- maybe sometimes they are bringing puzzles or books or things for people to do so they can be more engaged, whether they are at home or in the community.
▶ 1:09:38Sen. Husted: Thank you. Thank you, Mr. chairman.
▶ 1:09:40Chair Scott: Ranking member?
▶ 1:09:43Sen. Gillibrand: Thank you. I wanted to ask a little bit about how the oaa connects older adults to multiple social services -- sort of a general experience from you, erick and stephen. Things like medicaid, snap, heap, that older americans rely on.
▶ 1:10:09Sen. Gillibrand: How does this serve as an umbrella for organizational structure for delivery of critical services? In particular, how does it affect rural americans? One in five of our older americans are in rural america. Ms. patton?
▶ 1:10:23Ms. Patton: The older americans act is the umbrella of many services. It allows us to connect people to the services you had mentioned, medicaid and snap. A lot of times, we will work with individuals in our agencies that come to the front door or are participating in a program, and we want to make sure they are connected to the resources that are available to them, whether it is snap or medicaid.
▶ 1:10:53Ms. Patton: One of the things we also do is we are, in many cases, a medicaid diversion. So trying to use the lowest cost intervention that is possible. The funding sources, the programs that exist. And then connecting them to these services at the right time when they need them. A really good example of snap is an individual that gets snap but does not have transportation is not going to be able to leverage those.
▶ 1:11:23Ms. Patton: So we have actually, in our network, been able to leverage the older americans act services and help people connect and use the services that they may be eligible for. Sen. gillibrand do you have any anecdotes about how it has worked for you?
▶ 1:11:42Mr. Montealegre: I will go next. In broward, the agency serves as an umbrella organization. But we also are air an experimental organization as well, where they are reaching out to technology companies -- for example, robot puppies, robot cats -- to help people deal with feelings of loneliness as well as like radar for alert monitoring, things like that.
▶ 1:12:12Mr. Montealegre: These are things I was not even aware of that existed or were needed. I think the agency is constantly looking for other things that could help. And then they vet those resources.
▶ 1:12:29Mr. Montealegre: Going to the agency gives a sense of confidence that there are all these different things, and we feel they are safe to try without possibly having our family members fall into some kind of bad situation or trap. That certainty makes it easy for us to reach out to them and say, hey, we are a safe source.
▶ 1:12:54Mr. Montealegre: Other organizations partner automatically because they know that if they can get the agency's buy-in and support, the population in the community will
▶ 1:13:04Reach Outsen. Gillibrand: Under, stephen?
▶ 1:13:10Dr. Sappington: Grassroots programs are often the closest to the lead. And they see first what helps older adults and people living with these cognitive diseases stay healthy and engaged. Increasing the funding for the agencies on aging so they can partner with the support community-based nonprofits.
▶ 1:13:35Dr. Sappington: Area agencies on aging can also offer technical support and guidance to older adults who want to start local programs but may lack the experience or resources. And transportation is often the biggest barrier for keeping older adults and people with parkinson's and other neurodegenerative diseases. >> have you use any of those transportation services? >> yes I have. >> give us an example of what it did for you.
▶ 1:14:05Dr. Sappington: I got a call from a gentleman that had just been diagnosed with parkinson's. He thought it was the end of the world, his parents had died, his girlfriend had just broke up with him. He was diagnosed.
▶ 1:14:21Dr. Sappington: He came back in, an infomercial was on, and I reached out to some people in the media and was doing a thing on parkinson's and how to fight back against that, and he thought his world was coming to an end and sodomy give me my phone number. I spent the next two and a half hours walking him off the edge, and meeting with him. He was in baltimore city. I was up around the pennsylvania line.
▶ 1:14:53Dr. Sappington: Anyway, we ended up meeting halfway, and I hooked him up with a way to get from 20 miles away where he was to a rock city boxing class that he would be able to take advantage of. That worked out very well.
▶ 1:15:08Sen. Gillibrand: Thank you. >> tell me about your boxing. What do you do?
▶ 1:15:17Dr. Sappington: It is fun. I want to go back and say those trying to get me to go, they were right. >> it is always better. >> yes it is. You recognize it is always better later. But they play music. Everything they do is designed to combat a symptom of parkinson's.
▶ 1:15:42Dr. Sappington: Parkinson's is one of those things where your brain interferes with your muscle's ability to respond and your body. That is why they get the shakes, and your body not behaving the way it should. First of all, they play rock music of our generation, it gets you involved with it from a musical standpoint, that is wonderful.
▶ 1:16:06Dr. Sappington: Then they give you short commands, when you have to use your brain and your mind to stay active. . You are going to throw x amount of combinations and punches into heavy bags. Or they have ladders painted on the floor, you have to step in and step out. Much like you see football players do with tigers. Ours are not tires because they would be falling all over the place.
▶ 1:16:33Dr. Sappington: These are painted on the floor and you have to use footwork and strengthen your brain to tell your muscles what to do. If you keep doing that, the muscle memory becomes a very strong and it can override some of the symptoms, and that is wonderful. Parkinson's even takes away your voice.
▶ 1:16:55Dr. Sappington: Very often -- even with the commands they give, to -- the more you exercise it, the more you can strengthen your voice. It works out very well. >> you don't have to box a person? >> no, that was one of the things I harbored under, why what I want to go boxing? >> I don't need another problem. >> I appreciate the question. Exactly where I was, from my standpoint.
▶ 1:17:24Dr. Sappington: >> how did you find the services? How did you find out about them?
▶ 1:17:30Mr. Montealegre: Not fast enough to be pretty honest. We started using internet searches to try and find what options there were. That is when we started getting confused. You put in dementia, any of those searches, tons of things come up. After having gone through several rounds of talking to the wrong people, I found the right people.
▶ 1:17:57Mr. Montealegre: They were able to get us to take classes for us so we could understand what was going on, to learn about what dementia progression looks like, what some symptoms are that might happen, what adaptations we can make to help family members with that education they gave us the confidence to keep looking. At that point, we don't even know what we don't know. You don't know what to look for. Being in those classes, it tells you this is what you need to look for.
▶ 1:18:25Mr. Montealegre: It is really developing like a new vocabulary for things that we had never heard of before. >> do you have any other stories you want to tell us about how you have changed people's lives?
▶ 1:18:38Ms. Patton: Thank you for asking. I have been very inspired by the witnesses here today and the questions that have come from the committee.
▶ 1:18:54Ms. Patton: What I would really like to share is the things that we talked about, this discussion has inspired me to think about the value of the older americans act, the value of conversations like this with people that can tell stories and make a difference in policy and in practices. It saddens me when erick says he did not get the information fast enough.
▶ 1:19:27Ms. Patton: Through the older americans act and the innovative approaches for aaa's, and the programs we have, I'm thinking about 3d and in the evidence-based programs, is where we are touching individuals and how invaluable it is we are meeting people before they are in crisis. That we are leveraging the funds and the programs under the older americans act to get to families, caregivers, and individuals before the crisis. >> do you think you help people and save money? >> absolutely.
▶ 1:19:59Ms. Patton: We help people and save money. The sooner that we do that and the more innovative we can be, yes. >> have you helped people stay active in their job or volunteering?
▶ 1:20:10Ms. Patton: Yes, through the older americans act transportation services, through the ability to work collaboratively with other organizations. We have many individuals that come and volunteer at our meal sites that might not otherwise get out. >> is there any reason at all you think we should not reauthorize the oaa? Is there any, in your wildest imagination, can you imagine what we would not do that? No.
▶ 1:20:42Ms. Patton: It is pretty simple, isn't it? On behalf of the ranking member, I want to thank you guys for coming here. I want to thank you for your testimony. Having a hearing like this gives us an opportunity to hopefully inspire all of our colleagues to focus on this and get this done as quickly as possible. I would like to thank everyone for being here and participating. I look forward to members across the island.
▶ 1:21:06Ms. Patton: If anyone has additional quickness -- questions for the witnesses, the hearing record will be open until next wednesday, five :00 p.m. Thank you for coming.