Hearings to examine aging and the impact of community during the holidays.

1[Senate Hearing 119-301]2[From the U.S. Government Publishing Office]34                                                 S. Hrg. 119-30156                            AGING IN PLACE:7                        THE IMPACT OF COMMUNITY8                          DURING THE HOLIDAYS9=======================================================================1011                                HEARING1213                               BEFORE THE1415                       SPECIAL COMMITTEE ON AGING1617                          UNITED STATES SENATE1819                    ONE HUNDRED NINETEENTH CONGRESS2021                             FIRST SESSION2223                               ----------2425                             WASHINGTON, DC2627                               ----------2829                            DECEMBER 3, 20253031                               ----------3233                           Serial No. 119-203435         Printed for the use of the Special Committee on Aging3637[GRAPHIC NOT AVAILABLE  IN TIFF FORMAT]3839        Available via the World Wide Web: http://www.govinfo.gov40                                __________4142                   U.S. GOVERNMENT PUBLISHING OFFICE4362-922 PDF                  WASHINGTON : 202644-----------------------------------------------------------------------------------4546                       SPECIAL COMMITTEE ON AGING4748                     RICK SCOTT, Florida, Chairman4950DAVE McCORMICK, Pennsylvania         KIRSTEN E. GILLIBRAND, New York51JIM JUSTICE, West Virginia           ELIZABETH WARREN, Massachusetts52TOMMY TUBERVILLE, Alabama            MARK KELLY, Arizona53RON JOHNSON, Wisconsin               RAPHAEL WARNOCK, Georgia54ASHLEY MOODY, Florida                ANDY KIM, New Jersey55JON HUSTED, Ohio                     ANGELA ALSOBROOKS, Maryland56                              ----------57                McKinley Lewis, Majority Staff Director58                Claire Descamps, Minority Staff Director5960                         C  O  N  T  E  N  T  S6162                              ----------6364                                                                   Page6566Opening Statement of Senator Rick Scott, Chairman................     167Opening Statement of Senator Kirsten E. Gillibrand, Ranking68  Member.........................................................     36970                           PANEL OF WITNESSES7172John Offerdahl, President, Offerdahl's Hand-Off Foundation73  Oakland Park, Florida..........................................     474Jason Resendez, CEO National Alliance for Caregiving Washington,75  DC.............................................................     576Alison Barkoff, JD, Hirsh Health Law & Policy Associate Professor77  and Director of the Hirsh Health Law & Policy Program, George78  Washington University, Former Acting Assistant Secretary for79  Aging and Administrator, Administration for Community Living,80  Department of Health and Human Services, Washington, DC........     781Emily Ladau, Disability Rights Advocate and Author of82  Demystifying Disability, West New York, New Jersey.............     98384                                APPENDIX85                      Prepared Witness Statements8687John Offerdahl, President, Offerdahl's Hand-Off Foundation88  Oakland Park, Florida..........................................    2889Jason Resendez, CEO National Alliance for Caregiving Washington,90  DC.............................................................    3091Alison Barkoff, JD, Hirsh Health Law & Policy Associate Professor92  and Director of the Hirsh Health Law & Policy Program, George93  Washington University, Former Acting Assistant Secretary for94  Aging and Administrator, Administration for Community Living,95  Department of Health and Human Services, Washington, DC........    3396Emily Ladau, Disability Rights Advocate and Author of97  Demystifying Disability, West New York, New Jersey.............    369899                        Questions for the Record100101Alison Barkoff, JD, Hirsh Health Law & Policy Associate Professor102  and Director of the Hirsh Health Law & Policy Program, George103  Washington University, Former Acting Assistant Secretary for104  Aging and Administrator, Administration for Community Living,105  Department of Health and Human Services, Washington, DC........    41106Emily Ladau, Disability Rights Advocate and Author of107  Demystifying Disability, West New York, New Jersey.............    50108109                       Statements for the Record110111Statements from Alabama..........................................    53112Statements from Alaska...........................................    59113Statements from Arizona..........................................    60114Statements from Arkansas.........................................    68115Statements from California.......................................    70116Statements from Colorado.........................................   103117Statements from Connecticut......................................   119118Statements from Delaware.........................................   123119Statements from District of Columbia.............................   126120Statements from Florida..........................................   127121Statements from Georgia..........................................   140122Statements from Hawaii...........................................   142123124                         C  O  N  T  E  N  T  S125126                              ----------127128                                                                   Page129130                   Statements for the Record (cont'd)131132Statements from Idaho............................................   144133Statements from Illinois.........................................   146134Statements from Indiana..........................................   155135Statements from Iowa.............................................   173136Statements from Kansas...........................................   176137Statements from Kentucky.........................................   183138Statements from Louisiana........................................   184139Statements from Maine............................................   188140Statements from Maryland.........................................   189141Statements from Massachusetts....................................   201142Statements from Michigan.........................................   211143Statements from Minnesota........................................   225144Statements from Mississippi......................................   228145Statements from Missouri.........................................   230146Statements from Montana..........................................   235147Statements from Newbraska........................................   237148Statements from Nevada...........................................   238149Statements from New Hampshire....................................   239150Statements from New Jersey.......................................   240151Statements from New Mexico.......................................   259152Statements from New York.........................................   261153Statements from North Carolina...................................   410154Statements from Ohio.............................................   418155Statements from Oklahoma.........................................   428156Statements from Oregon...........................................   432157Statements from Pennsylvania.....................................   438158Statements from Rhode Island.....................................   449159Statements from South Carolina...................................   450160Statements from South Dakota.....................................   456161Statements from Tennessee........................................   457162Statements from Texas............................................   462163Statements from Utah.............................................   477164Statements from Vermont..........................................   479165Statements from Virginia.........................................   480166Statements from Washington.......................................   495167Statements from West Virginia....................................   502168Statements from Wisconsin........................................   505169Statements from Wyoming..........................................   509170Statements from Organizations, Nonprofits, and Providers.........   510171Additional Statements............................................  1032172173                            AGING IN PLACE:174                        THE IMPACT OF COMMUNITY175                          DURING THE HOLIDAYS176177                              ----------178179                      Wednesday, December 3, 2025180181                                        U.S. Senate182                                 Special Committee on Aging183                                                    Washington, DC.184    The Committee met, pursuant to notice, at 3:10 p.m., Room185216, Hart Senate Office Building, Hon. Rick Scott, Chairman of186the Committee, presiding.187    Present: Senator Scott, Moody, Gillibrand, Warnock, Kim,188and Alsobrooks.189190                 OPENING STATEMENT OF SENATOR191                      RICK SCOTT, CHAIRMAN192193    The Chairman. The U.S. Senate Special Committee on Aging194will now come to order. Today's hearing is meant to bring195attention to an incredibly important issue for so many of196America's seniors, especially as we move into the holiday197season. We are here to focus on how to best serve older198Americans who want to spend their senior years in the comfort199of their own homes.200    While there are so many positives about aging in place that201we'll highlight today, we're also here to shine a light on the202often-unreported crisis of isolation and loneliness. We should203be doing everything possible to support seniors who strive to204age in place, and today we'll focus on how Congress can205reauthorize the Older Americans Act, known as the OAA to206continue many critical programs that support seniors with this207goal.208    Last week, we all celebrated Thanksgiving, and later this209month families across America will be celebrating Hanukkah and210Christmas. For many of us, that means spending time with family211and loved ones. My case, I got to help my five-year-old212granddaughter win UNO. She loved giving away plus fours to213people.214    I learned two-thirds of how to do a Rubik's Cube because215that's what my twelve-year grandson does.216    Senator Gillibrand. Wow. Impressed.217    The Chairman. He told me that the last part was the218hardest. While these moments are a time to cherish time with219loved ones, they can also be a difficult reminder of loss for220older Americans who no longer have the ability to spend the221holidays with their friends, spouse or even their children.222    We all know the importance of taking care of our seniors.223For many older Americans who choose to age in place, our goal224should always be to help them have the best possible care and225support. They should always have the opportunity to remain in226the homes and neighborhoods they love.227    That is why community, strong families, faith-based228organizations, volunteers, OAA programs are so important to our229aging population, especially during this time of year. In my230home State of Florida, which is quite a bit warmer than it is231here, there are many seniors who cannot travel during the232holiday season.233    Thankfully, many communities have the resources to give our234seniors the care and attention they deserve. Combating the235feeling of isolation and loneliness for our aging community has236endless benefits from better mental and physical health to237stronger multi-generational relationships with families and238communities, supporting healthier, more resilient communities.239    We can all agree that community matters. Strong families,240faith-based organizations, volunteers, and the program241supported by the OAA create the foundation that allows older242Americans who choose to age in place to remain in the homes and243neighborhoods they love. That's why supporting the successful244programs made possible by the OAA ensuring how faith-based245groups, nonprofits, and service organizations strengthen246families is so important to the work of this Committee.247    During the holidays, when both loneliness and the demand248for caregiving arise, these supports become even more critical.249Aging place is good for families, communities, and taxpayers.250Strengthening these programs is a bipartisan commitment to251dignity, independence, and the American way of life.252    For 60 years, the OAA has helped innumerable seniors by253promoting social connection and life affirming support254programs. Over 10 million older Americans a year are helped by255programs covered by the OAA. The OAA continues to serve as the256backbone of many assistance programs that help ensure older257Americans can age in place with dignity.258    I'm proud to work with Ranking Member Gillibrand as well as259Health, Education, Labor and Pension Committee Chairman Cassidy260and Ranking Member Sanders to fight for the reauthorization of261this important piece of legislation, which is a critical tool262in our arsenal to support seniors. I'm also working with fellow263committee member Senator Warnock on legislation to address264senior home loneliness through Older American Act funding. By265Senior Act expands the scope of grants to include services that266address the loneliness epidemic facing seniors.267    I'm working to pass bipartisan legislation to create a non-268refundable tax credit aimed at adults who provide certain care269for their parents or older relatives in multi-generational270households. My hope is that with this hearing, we can examine271how strong community networks help older adult age in place,272especially during the holiday season when isolation caregiver273stress and multi-generational pressures peak.274    Now, I can recognize Ranking Member Gillibrand from the275cold, cold state today of--it's snowy there?276    Senator Gillibrand. It's cold.277    The Chairman. It's snowy, too.278    Senator Gillibrand. Yes, I bet it is.279    The Chairman. For her opening statement.280281                 OPENING STATEMENT OF SENATOR282             KIRSTEN E. GILLIBRAND, RANKING MEMBER283284    Senator Gillibrand. Thank you, Mr. Chairman. Thank you for285calling today's hearing. Thank you to our witnesses. Thank you286for being here. The holidays are when communities come287together. Whether you celebrate with family or friends or loved288ones, sharing this heartfelt season with the people you love289makes all the difference in the world.290    However, building and participating in one's community is a291year-round endeavor and one that can pose unique challenges for292older adults and people with disabilities. The most important293mechanism that enables this kind of participation is home and294community-based services, or HCBS. HCBS is almost exclusively295available through Medicaid, and the availability of services is296tied to federal funding.297    Our witnesses today will discuss the importance of these298programs and how they allow older adults and people with299disabilities to live in their communities, which is their300overwhelming preference to institutional care. With this in301mind, I am pleased to enter more than 600 statements from302people, families, and organizations about the impact of HCBS303for older adults and people with disabilities into the304congressional record.305    Our witnesses will also discuss the importance of including306these populations in decision-making processes that directly307impact them. This is why today I'm reintroducing my Strategic308Plan for Aging Act. This bill will help states create multi-309sectoral plans for aging, including those who are aging with a310disability, while ensuring the needs, preferences, and views of311the people directly impacted are prioritized in the development312and implementation of a plan.313    I'm especially proud to introduce this bill today on the314International Day of Persons with Disabilities. People with315disabilities should always be included in decisions about their316lives, health, and well-being. I look forward to the discussion317about my Strategic Plan for Aging Act that will help create318inclusive and effective state plans. Thank you, Mr. Chairman.319    The Chairman. Thank you, Ranking Member. I'd like to320welcome our witnesses, all of whom work to ensure aging321Americans and seniors with disabilities age in place,322especially during the holidays, to ensure they remain safe and323engaged.324    First, I'd like to introduce John Offerdahl. John, who325proudly hails from the great State of Florida is the president326of Offerdahl's Hand-off Foundation. In 2012, Mr. Offerdahl327established the Offerdahl Hand-off Foundation. His328organization's mission is to "Feed the needs of those in329crisis."330    In partnership with business, government, civic, and faith-331based organizations. When the Covid pandemic hit our Nation,332Mr. Offerdahl saw a need and stepped up in a big way to serve333seniors in Broward County. Mr. Offerdahl thanks for being here.334Please begin your testimony.335336                  STATEMENT OF JOHN OFFERDAHL,337338                PRESIDENT, OFFERDAHL'S HAND-OFF339340                FOUNDATION OAKLAND PARK, FLORIDA341342    Mr. Offerdahl. Chairman Scott, Ranking Member Gillibrand,343and members of the Committee, it is an honor to speak with you344today about an issue affecting millions of older Americans,345ensuring that seniors can age in place with dignity, safety,346independence, and meaningful human connection.347    As mentioned, my name is John Offerdahl, and I'm the Hand-348Off Meals for Seniors president. We are an older American Act,349home delivered meals service provider in Broward County. I've350been a resident of Broward County since 1986, when Coach Shula351drafted me as a Miami Dolphin. I went on to spend my entire 8-352year NFL career in South Florida.353    Since then, my wife and I have owned restaurants and been354involved in charitable work, including our own Offerdahl's355Hand-Off Foundation. How does an NFL linebacker become a356provider of senior meals? Hand-Off Meals was born during COVID357when Miami Dolphin owners, Stephen Ross, reached out to Dolphin358alumni, who are also restaurateurs to produce and deliver359emergency meals in the neighborhoods surrounding Hard Rock360Stadium.361    With additional support from generous partners, we362delivered more than one million meals across Broward County,363many for homebound seniors. In the years that followed,364emergency COVID funding through the Area Agency on Aging of365Broward County and the Florida Department of Elder Affairs,366allowed us to continue this work. By 2023, our team had367delivered hundreds of thousands of fresh restaurant quality368meals to vulnerable seniors and families who needed them most.369    The success of these efforts led the Broward AAA, under the370leadership of CEO Charlotte Mather Taylor, to rethink a new371model for its home delivered meals program. For the first time,372rather than awarding one contract to the lowest cost frozen373meal provider, our program, Hand-Off meals was one of four374contracts awarded after a competitive bidding process.375    Today, Hand-Off Meals for Seniors is the leading meal376provider in Broward County, delivering more than 4,500 fresh377restaurant quality home delivered meals every week. Now, this378is why I'm here today. I want to emphasize why the improvements379in this model matter. Broward County reflects the future of our380Nation. Florida has one of the highest concentrations of381seniors in America and Broward's population of adults over 85382is projected to increase by 169 percent over the next 25 years.383    The choice between aging in the home or entering384institutional care often hinges on improvements unleashed by385competition. Here are four improvements we have driven so far386in Broward County.387    One, competition among providers promotes better quality,388better services, and outcomes. Providers like us are food389centric, not large institutional frozen meal brokers. Most390meals we deliver include fresh salads, sandwiches, fruits,391vegetables versus institutional frozen meals. While fresh392ingredients and real time production are more expensive, local393production and scattered restaurants across Broward County394creates decentralized pickup points that make the system395efficient and sustainable.396    Two, competition among providers inspires innovation and397efficiencies that lower costs. Providers can leverage a398restaurant's purchasing power, fixed cost, and community399commitment to provide high quality meals at a sustainable rate.400Discounting profits and service of the community-oriented401mission.402    Three, competition among providers invigorates public403private partnerships. Funding partnerships have expanded,404supported by organizations like the Jim Moran Foundation,405Community Foundation of Broward, Miami Dolphins Foundations,406public charities, Walgreens, to help cover the gap between407public funds and the elevated cost of quality restaurant fresh408meals.409    Fourth, competition among providers give seniors more410choice. Seniors retain personal agency over their choice of411choice of meals, delivery, relationships, and aging in place412decisions. In conclusion, this is the kind of improvement we413all hope to see from our government programs. Better outcomes,414lower costs, invigorated partnerships, and more choice.415    Competition among home delivered meal providers is good for416the body and soul of our aging and place seniors. At every417level, this work is a public private partnership, and the Older418American Act is the backbone of the team. As Coach Shula taught419us, in life as in football, it takes a team.420    Chairman Scott, Ranking Member Gillibrand and members of421the Committee, the Hand-Off Meals for Seniors program422demonstrates what becomes possible when fresh high-quality423nutrition is paired with consistent human connection and424allowed to compete for the hunger and heart of our seniors.425    I invite every member of this Committee to visit us in426Broward County, meet our volunteers, talk with our seniors, and427join my wife Lynn, and me on one of our weekly meal deliveries.428I truly believe you'll be inspired. Thank you.429    The Chairman. Thank you, Mr. Offerdahl. Now, we're going to430hear from Jason Resendez. He's the CEO of National Alliance of431Caregiving. In this role, he spearheads research policy and432innovation initiatives to build wealth, health, and equity for433Americans, 53 million family givers. Please begin your434testimony.435436           STATEMENT OF JASON RESENDEZ, CEO NATIONAL437             ALLIANCE FOR CAREGIVING WASHINGTON, DC438439    Mr. Resendez. Good afternoon, Chairman Scott, Ranking440Member Gillibrand, and members of the Committee. Thank you for441the opportunity to testify about the role that family442caregivers play in enabling older adults to age in place in443their communities. My name is Jason Resendez and I'm the444president and CEO of the National Alliance for Caregiving.445    For nearly 30 years, we've documented the experiences of446America's family caregivers and right now we are living through447a profound demographic shift. Every day, 10,000 Americans turn44865. This is a tremendous achievement but it presents challenges449that largely fall on the shoulders of our Nation's family450caregivers who make up the backbone of our Nation's long-term451care system.452    These are our neighbors, our coworkers, our friends, our453family members, many of you, and they've never been under more454pressure. According to our landmark caregiving in the U.S. 2025455research with AARP,63 million Americans, nearly one in four now456provide care for a loved one who is aging seriously ill or is457living with a disability. That's a nearly 50 percent increase458since 2015.459    This surge mirrors a critical reality. 70 percent of older460Americans need long-term services and supports during their461lifetime. Caregiving has become more prevalent, more intensive,462and more isolating. One in three family caregivers are in the463sandwich generation, providing care for children and adults464simultaneously. On average, they spend 27 hours per week465providing care and nearly one in four provide 40 or more hours466weekly, the equivalent of a full-time job.467    These caregivers provide complex support, more than half468administer medications, manage special diets, and change469feeding tubes and family caregivers enable something Americans470overwhelmingly desire, the ability to age and receive care at471home. This matters for two fundamental reasons.472    First, dignity at home. When people age in place, they473maintain control over their care and their lives. Second,474simple economics. We can support more than two people at home475for the cost of one person in a nursing facility but despite476their heroism and their economic value, caregivers face a477growing crisis. Nearly two thirds experience high emotional478stress, 45 percent report physical strain.479    Nearly half have experienced negative financial impacts480because of their care responsibilities and these impacts are481not evenly distributed. Caregivers of color, rural, lower482income and youth caregivers face the greatest hardships. For483example, 28 percent of lower income caregivers cannot afford484basic expenses like food compared to eight percent of higher485income caregivers. Congress recognized this reality 25 years486ago when it created the National Family Caregivers Support487Program through the Older Americans Act.488    The program provides what caregivers need most. Respite489care, counseling, training, and referral services,490acknowledging the vital role that family caregivers play in491supporting older adults, yet we must go further. Under current492Medicaid rules, access to institutional care is an entitlement.493While staying at home requires a waiver, we need to flip this494paradigm. The right thing should be to remain in your home with495institutional care as an option, the backup not the default.496    Consider this, as of 2020 just 12 states spent at least497half their Medicaid long-term care dollars on home and498community-based services for older adults and adults with499physical disabilities. That means 39 states still spend the500majority on institutional care. In these places, older501Americans and people with disabilities who need long-term502support often don't have real options to stay at home.503    The older Americans Act demonstrates what's possible when504we invest in keeping people at home through home delivered505meals, transportation, and caregiver support. We must506reauthorize and fully fund Older Americans Act programs to507strengthen the aging network that connects family caregivers508with the support they need, and we must pair these investments509with smart economic policies that recognize the true value510family caregivers contribute to our economy. We already have a511strong legislative foundation to build on.512    The multi-generational home caregiver tax credit led by513Senator Scott and Welch acknowledges the essential work that514family members provide within intergenerational households and515the Family Act introduced by Ranking Member Gillibrand would516establish a national paid family and medical leave program,517giving workers the security they need to care for loved ones518without sacrificing their financial stability.519    Along with the Older Americans Act, these bills represent520concrete steps toward building a care infrastructure that521supports families across generations. After nearly three522decades of listening to family caregivers tell their stories,523one truth is undeniable. These are ordinary Americans doing524extraordinary work that benefits all of us.525    When we invest in family caregivers, we strengthen families526and build communities where no one faces their hardest moments527alone. That's what makes community living possible.528    Thank you for this opportunity to testify today and I'm529happy to answer your questions.530    The Chairman. Thank you, Mr. Resendez. Now, I'd like to531recognize Ranking Member Gillibrand to introduce our next532witnesses.533    Senator Gillibrand. Thank you, Chairman Scott. I'd like to534introduce our next witness, Alison Barkoff. Professor Barkoff535is the director of the Hirsh Health Law and Policy Program at536George Washington University. Professor Barkoff led the537administration for Community living ACL in the U.S. Department538of Health and Human Services from 2021 to October 2024, serving539as ACL administrator and assistant secretary for Aging.540    Previously, she served as special counsel for Olmstead541Enforcement in the Civil Rights Division of the U.S. Department542of Justice. Professor Barkoff, you may begin your testimony.543544      STATEMENT OF ALISON BARKOFF, JD, HIRSH HEALTH LAW &545546         POLICY ASSOCIATE PROFESSOR AND DIRECTOR OF THE547548           HIRSH HEALTH LAW & POLICY PROGRAM, GEORGE549550         WASHINGTON UNIVERSITY, FORMER ACTING ASSISTANT551552             SECRETARY FOR AGING AND ADMINISTRATOR,553554        ADMINISTRATION FOR COMMUNITY LIVING, DEPARTMENT555556          OF HEALTH AND HUMAN SERVICES, WASHINGTON, DC557558    Dr. Barkoff. Good afternoon, Chairman Scott, Ranking Member559Gillibrand, and members of the Committee. Thank you for560inviting me to participate in today's hearing on Community561Living and Aging in place. My name is Alison Barkoff, and I562have more than 25 years' experience in disability, aging, and563community living policy. The vast majority of older adults and564people with disabilities want to live in their own homes and565communities instead of in nursing homes or other institutions.566    It allows them to be with family and friends, participate567in community activities, work or volunteer, and age in place.568Community living is cost effective and leads to better569outcomes, and federal laws and Supreme Court precedent570establish the right to receive services in the community571instead of institutions.572    The demand for community living is growing exponentially573with more than 10,000 people turning 65 every day and disabled574people living longer, often with aging caregivers. There has575been bipartisan support for policies and programs that make576community living possible.577    Many older adults and disabled people require assistance to578live in their own communities and age in place. I'm going to579briefly discuss the major programs that provide these supports.580First and most importantly, Medicaid funds, home, and581community-based services, or HCBS. HCBS includes home care,582senior day programs, disability employment supports, respite583care and more.584    Neither private health insurance nor Medicare cover these585services and most people cannot afford to pay out of pocket.586Medicaid law requires states to provide institutional care but587HCBS are optional. States can cap enrollment in HCBS programs588leading to more than 600,000 people on waiting lists. The aging589and disability communities have urged Congress to address this590institutional bias and put HCBS on equal footing with591institutional care.592    Despite their optional nature, states have been steadily593expanding their HCBS programs. These efforts must continue and594accelerate to meet growing demand and need, yet reductions in595Federal Medicaid spending to states could put optional services596like HCBS at risk for cuts. Older Americans Act programs also597help people age in place. They support one in five Americans598over 60 with personal care, transportation, family caregiver599supports home delivered meals and more.600    OAA programs complement Medicaid. They can serve people who601aren't yet eligible or on HCBS' waiting list. Annually, they602save hundreds of millions of dollars to Medicare and Medicaid603by preventing unnecessary emergency room hospital and nursing604home admissions. Many OAA programs already have waiting lists605and demand is quickly growing.606    Reauthorization of the OAA and increased investment in its607programs is critical to helping older adults age in place.608Other programs provide community living supports for disabled609people of all ages. This includes independent living services610and Developmental Disabilities Act programs that help people611access community services.612    Demand for these programs similarly, outpaces need and613continued investment in them is essential. We often forget614about the "H" in home and community-based services, but people615cannot live in the community without a home that is both616affordable and accessible. Less than five percent of housing617stock is accessible, and many older adults and disabled people618spend more than a third of their income on housing, often619foregoing medical care or food.620    Many are at risk of homelessness and the fact is, older621adults are the quickest growing homeless population. Federal622housing programs are also critical to community living.623Finally, the Administration for Community Living funds and624overseas community living programs and leads cross agency625initiatives to address barriers like housing and workforce626shortages. Importantly, ACL coordinates to ensure that older627adults and disabled people are considered across federal628policies.629    ACL has been impacted by HHS' reduction in force, losing630almost half of its staff this calendar year. Congress should631ensure that ACL is sufficiently resourced to fulfill its632statutory mandates, support its programs, and coordinate policy633across the Federal Government. Thank you for this opportunity634to testify about the importance of community living and what it635takes to make that a reality for the millions of older adults636and people with disabilities in this country. Thank you.637    Senator Gillibrand. I want to move to our next witness,638Emily Ladau. Ms. Ladau is a disability rights activist, author,639speaker, and digital communications consultant. In her current640role, she provides consultation and editorial services and641manages online presence and communications strategies for642multiple disability related organizations and initiatives.643    In addition to her written work being published in outlets,644including New York Times, SELF, Salon, Vice, HuffPost, Ms.645Ladau is author of Demystifying Disability: What to Know, What646to Say, and How to Be an Ally. Ms. Ladau, you may now begin647your testimony.648649          STATEMENT OF EMILY LADAU, DISABILITY RIGHTS650651              ADVOCATE AND AUTHOR OF DEMYSTIFYING652653             DISABILITY, WEST NEW YORK, NEW JERSEY654655    Ms. Ladau. Chairman Scott, Ranking Member Gillibrand, and656distinguished committee members, I am honored to testify on657this auspicious day as December 3rd is the International Day of658People with Disabilities. I am a proud disability advocate and659my mission is to harness the power of storytelling as a tool to660expand accessibility and inclusion for all.661    As a 34-year-old, my story may seem out of place at a662hearing about aging in place but the disability perspective is663especially pertinent to today's focus on the impact of664community. I want to emphasize that more than one in four665adults in the United States have a disability and of this666group, 43.9 percent are adults aged 65 or older. For those who667are not yet disabled, there is a significant likelihood of668aging into disability.669    Neither a person's age nor disability status should ever be670a barrier to being among loved ones in our homes and671communities. When I was a teenager, my parents and I took a672trip to Florida to visit my grandparents for a holiday673celebration. At the time, my grandpa was in the midst of an674extended hospital stay but his doctor permitted him to come675home for a few hours to join us for a holiday meal.676    As my family was cooking, I sat with my grandpa while he677opened the day's mail. He began to weep over the simple act of678being able to do a task in his own home. It is the only time I679ever saw him cry, and as I look back on this moment, I realized680just how strongly it underscores the immense importance of681being home and not just for the holidays.682    I was born with my physical disability, so I know well the683essential nature of supports and services that empower me to684thrive at home and in my community and how fortunate I am to685have had access to them throughout my life. When my mom, who686has the same disability as me, was born in 1961, a family687member suggested that my grandparents place her in an688institution.689    Thirty years later when I was born, no one made this690suggestion to my parents. Instead, following my stay in the691neonatal intensive care unit, a public health nurse connected692my mom with resources to ensure that I would receive the care I693needed. Because of this, I was able to have regular physical,694occupational and speech therapy starting at just a few months695old.696    By the time I began kindergarten, I was approved for697ongoing Home and Community-Based Services, or HCBS, thanks to698the New York State Care at Home Medicaid Waiver. Medicaid699provided me access not only to vital therapeutic services, but700also to home modifications that enabled me to function as701independently as possible in my family's home. Medicaid also702assisted in the acquisition of durable medical equipment such703as my power wheelchair.704    As you can see by the fact that I'm here today, my705wheelchair gives me freedom to be out and about in the706community. Unfortunately, the Medicaid asset limit, which has707been a mere $2,000 for over 35 years, became prohibitive to my708future career and relationship goals. In my early thirties, I709found myself at an inflection point. I wanted to forge ahead in710my career and build a life with my partner, but I was trapped711in an inflexible system that imposes caps and penalties on712people in exchange for access to life saving services.713    With family support, which most people cannot afford, I714took a risk and decided not to reapply for Medicaid. That said,715what I am sharing is not a success story about transitioning716off Medicaid as this choice has meant foregoing needed care,717such as in-home physical therapy multiple times per week, which718I can only access through the Medicaid program.719    The story here is that HCBS provided by Medicaid was what720set me up for success. This past October, I married the love of721my life and my husband and I are now seeking a community to722call home near our families in New Jersey. We are searching for723somewhere accessible for my physical needs at this stage of our724lives as well as for our future needs so we can safely age in725place. This search has proven arduous in a housing market where726accessible homes are nearly non-existent.727    Our experiences are a stark reminder that the stakes of728today's hearing are much higher than heartwarming tales of729being home for the holidays. Without access to HCBS and without730efforts to prioritize housing in communities that work for731everyone, people with disabilities and older adults will all732too easily be pushed out of our homes and communities and into733institutionalized settings, denied opportunities for everything734from education and employment to recreation and socialization.735    We won't be the only ones missing out. Our friends,736families, colleagues, and neighbors will miss out on all we can737contribute to our communities, both socially and economically.738This isn't just about making treasured holiday memories with739loved ones, although that is a beautiful part of the human740experience. It's also about fostering a country where all of us741can grow older, assured by the notion that we will always have742a place to call home. Thank you.743    The Chairman. You have a choice. It's cold in New Jersey.744It's not so bad in Florida. It's pretty nice right now. Now,745we'll go to questions. Let's start with Senator Moody.746    Senator Moody. Thank you, Chairman Scott, and I think747Florida is experiencing a massive influx at the moment. He748continues to be a cheerleader, having been the former Governor749and contributing so much to its success now and why so many750people want to move there, but we will always welcome others.751    In fact, we are known as the Sunshine State but we're also752known as the Silver State. For good reason, almost a quarter of753our population is considered seniors, and that is why on this754small committee you have the two Florida Senators both755participating and engaging on these very important issues. They756affect so many of Floridians and we think it's important and we757welcome a Floridian with us today.758    We're so glad to have you, so proud of you and your career,759but not just what you accomplished on the field, but certainly760what you have done for your community since. Such a benefit to761the State of Florida and those that call Florida home, so,762thank you for being with us. Aging in place is so very763important and we know that the Older Americans Act in many ways764helps with stability and meaningful assistance to families who765are often stretched thin by caregiving responsibilities.766    I think a hearing like this is so very important. I thank767Chairman Scott and Ranking Member Gillibrand for convening this768hearing focusing on specific programs, yes, but also overall on769the Older Americans Act and how it provides critical support to770seniors and their families. It also helps build community for a771growing number of seniors in America who are living alone.772    Some of the statistics, according to the National Council773on Aging show that 28 percent of adults, 65 and older live774alone, and as we approach the end of the year, we're reminded775that many seniors will face this holiday season in isolation,776and so, we want to ensure that the Older American Act continues777to offer programs that help older adults strengthen their778connections and build supportive communities so this doesn't779have to be the case.780    With that said, I have a few questions for our witnesses,781and certainly, listening to your testimony, I'm kind of going782to go off. I planned some subjects I wanted to talk about, but783I was really interested in your testimony, Mr. Resendez. You784were talking about how there's kind of a flop of where we785should be prioritizing, where we're focusing our resources.786    Right now, I believe you have to have a waiver to stay at787home, and you were commenting on some proposed legislation788specifically by Senator Scott regarding a tax credit. Can you789tell us would any of those concerns be addressed by either the790proposed legislation and if not, what would you recommend for791Congress to address to kind of right size that approach?792    Mr. Resendez. Absolutely. One of the key things to your793question around Senator Scott's legislation is the immense794financial strain that family caregivers face or nearly 50795percent of family caregivers report experiencing at least one796negative financial impact due to caregiving. Out of pocket797costs conservatively due to caregiving is around $7,000 a year,798and a lot of those expenses are not tax deductible.799    Anything we can do for the tax code to better recognize the800contributions and expenses associated with caregiving can help801to alleviate some of those financial strains that family802caregivers face, and then on the imbalance, what we see is an803imbalance between home and community-based spending at the804state level and spending on institutional care.805    There are examples where states are making efforts to set806targets for rebalancing dollars toward more or less costly807home-based care versus institutional care, so, there are808options to explore, to rebalance that spending at the state809level.810    Senator Moody. I know there are many of us that are pushing811to re-up the Older Americans Act. I've co-sponsored that, I812know. Both our Ranking Member and our Chairman are pushing for813that. Are there specific things within that legislation that814would address that imbalance?815    Mr. Resendez. The Older Americans Act as Alison highlighted816greatly compliments home and community-based services. Fully817funding and reauthorizing the Older Americans Act, increasing818funding for the Older Americans Act. One of the things that we819see in our data is between 2015, in 2025 we've seen a nearly 50820percent increase in the number of family care. It's 20 million821more family caregivers.822    Senator Moody. What was that span that you were saying that823increased by----824    Mr. Resendez. Ten years.825    Senator Moody. Ten years.826    Mr. Resendez. Ten years. Twenty million more caregivers in827ten years. Yet, funding for the Older Americans Act and the828National Family Caregiver Support Program specifically has829remained relatively the same. The demand has increased830significantly.831    Senator Moody. Wait, in your testimony though, you832mentioned that you believe, if we took away the incentives that833would push people into institutional care as opposed to at home834caregiving, that you believe we might even be able to save835money by doing that, because I think you said, and I could be836wrong, that it's twice as costly to care for someone in organ837institution setting versus being at home, so, with this rise in838demand, are you saying that we could still save money per839person if we were to shift those resources to in-home840caregiving?841    Mr. Resendez. Absolutely. Helping folks provide care in842their homes for longer enables us to save on things like the843cost of institutionalized care, the cost of ER visits, so, when844we support people providing care in the home, we can save money845over the long term. We've seen that within the Older Americans846Act.847    For example, one of the things that we've seen from848research for Older Americans Act programs like the National849Family Caregiver Support Program in respite, is that family850caregivers report that when they have that support, they can851provide care for longer durations.852    Senator Moody. We may be able to mitigate the increased853costs associated with the increased demand 50 percent more in a854decade by shifting that to more in-home care?855    Mr. Resendez. Absolutely.856    Senator Moody. Thank you, Chairman.857    The Chairman. Thank you, Senator Moody. Senator Kim.858    Senator Kim. Thank you, Chairman. Thank you to the four of859you for coming on out here. Ms. Barkoff, I'd like to bring you860in on this conversation. Just given your background here, in861your testimony you stated home and community-based services862include a wide range of care and support that neither private863health insurance nor Medicare even cover.864    Medicaid funding allows for services to exist and ensure865people can comfortably age in place. Yet there are lots of866concerns about Medicaid cuts and I guess I wanted your thoughts867on this. Could you share how cuts to Medicaid can lead to868devastating impacts for home and community-based services and869what consequences this would have on programs that serve older870adults and people with disabilities?871    Dr. Barkoff. Thank you, Senator Kim for that question, and872as you mentioned, the primary funder and the way we are able to873help keep the majority of older adults and people with874disabilities in their own homes is through the Medicaid funded875Home and Community-Based Services Program. States must have876balanced budgets and we have seen historically that despite the877huge demand for more home and community-based services, that878when budgets are reduced, states, the first thing to go are879optional services.880    As my colleague, Mr. Resendez spoke about the fact that881institutional care must be provided to anyone who meets that882level, but if you want to choose to get in-home care, you have883to sit on a waiting list. What we saw, actually, I conducted a884study with other researchers about what states did during the885Great Recession when we saw cuts and every single state cut886home and community-based services around the 2010 to 2013887timeframe, despite wanting to be able to serve more people.888    As states are beginning to look at their State Medicaid889budgets, implement new laws, it's very, very important for the890aging and disability communities to make sure people understand891it is a pennywise and a pound foolish to make those kinds of892cuts.893    Senator Kim. As we're thinking about strengthening the home894and community-based services, we also need to be addressing the895workforce shortages that limit access to those services, so,896the administration for community living, ACL, is critical897component of achieving that, which is why it's so critical that898it stays intact.899    From your experience Ms. Barkoff with ACL, could you share900what federal strategies would be most effective to support901recruitment, training, and retention in the direct care902workforce?903    Dr. Barkoff. I was very proud that during the time that I904was leading ACL we really heard from stakeholders about the905importance of strengthening the direct care workforce and906launched the Direct Care Workforce Strategy Center. It's very907critical to work directly with states on how we can improve908these jobs.909    We need to have better pay, we need better opportunities to910advance in these careers and we really need to bring respect to911these jobs. It's critical that as states are implementing these912new rules, we are already starting to see cuts in rates to913providers, which translates to even lower rates to direct914support professionals and direct care workers.915    If someone can get paid more working at Target or at916McDonald's than doing this incredibly important but not well-917paid work, the shortages that we have will be so much worse.918    Senator Kim. Yes. Ms. Ladau, I wanted to just bring you in919on this as well. You said "Without access to HCBS and without920efforts to prioritize housing and communities that work for921everyone, people with disabilities and older adults will all922too easily be pushed out of their homes." You also shared the923risk you are taking as well by not applying for Medicaid due to924asset limits being so restrictive.925    I guess I wanted to ask you, how should Congress address926the reality? Even with HCBS, many people with disabilities927cannot benefit from these programs because of a lack of readily928accessible housing and the financial reality that qualifying929for HCBS makes it difficult to rent or buy a home?930    Ms. Ladau. Thank you so much for this question, Senator931Kim, and as a newer resident of your state who is currently in932the process of searching for a home, I really do appreciate the933opportunity to talk about this because people with disabilities934are so often trapped in this catch 22 of wanting to be able to935live at home and thrive in their communities, but then facing936the significant red tape that comes with getting the supports937and services that they need.938    For me, I faced the quite frankly, impossible choice of do939I stay on these life sustaining Medicaid services or do I940recognize that the asset cap is holding me back and take a941flying leap, quite frankly, to leave this program. It is an942unfair choice that no one should have to face.943    I really want to name that this is not a choice that anyone944should have to make, but the answer is not to cut funding for945HCBS, it's actually to make economically savvy policy choices946that would first of all focus on incentivizing accessible947housing stock and raising the asset limit for Medicaid.948    Right now, the asset limit, which I mentioned in my949testimony, is $2,000, that hasn't been adjusted for inflation,950that hasn't been adjusted since before I was born, so, when you951think about that, I mean, that alone is reason enough to deter952people from wanting to pursue a career, to pursue finding a953house because they're stuck by this asset limit.954    The other thing I want to name is I did a little research955and double checked and there's a study from 2023. The Kaiser956Family Foundation found that the cost of long-term957institutionalized care was around $11,000 more expensive than958HCBS for Medicaid beneficiaries, so, ensuring policies that959complement rather than contradict each other just makes good960financial sense.961    Senator Kim. Thank you. With that, I'll yield back962Chairman.963    The Chairman. Thank you, Senator Kim. Mr. Offerdahl, what964role do local partnerships such as nonprofits or faith-based965groups play in extending the reach of OAA services?966    Mr. Offerdahl. Okay. Nonprofits play a huge role967specifically this year in the fourth quarter, our Hand-Off968Meals for Seniors kicked off a campaign for volunteer delivery969drivers. We find that volunteers coming, especially through970faith-based organizations like churches and synagogues really971have a heart for people and to serve them, not only to deliver972them food.973    Our efforts were pretty strident. Our goal was 150, we got974to about 35 but it isn't over, and we're going to continue to975work hard on that because we find that our paid delivery976drivers engage. They do wellness checks, but they have a977delivery that has to go onto the next house.978    Volunteers really are the ones that are looking for a979relationship, a connection with our seniors, and they have the980ability to come in and just address and look for those concerns981in the environment of the home, maybe appliances or things that982concern them with the behavior or the acuity of maybe their983seniors, and then refer them back to our aging district. That984type of connection is so much more valuable.985    Volunteers are huge part of that. Again, our faith-based986agencies that hopefully provide most of those will becoming987stronger and stronger, and it takes a while. We've been in this988for a year and a half going on two and we've got another three989years, so we really want to build that up.990    The Chairman. Thank you. Mr. Resendez, what local991approaches other than congregate meals have been most992successful in reducing social isolation among older adults,993especially during the holiday season?994    Mr. Resendez. Absolutely. Through the Older Americans Act995specifically, there are a range of services provided through996the Aging Services Network that help to address social997isolation including, and especially for family caregivers. We998see in our research that one in four family caregivers999experiences social isolation.1000    That's actually up from what we saw just five years ago,1001so, things like individual counseling, support groups, and1002training for family caregivers provided through the National1003Family Caregiver Support Program helps us to address that1004growing trend around social isolation.1005    The Chairman. Thank you. Ms. Barkoff, what we hear1006frequently about the sandwich generation concerning people who1007are caring for both children and aging adults, how do a OAA1008programs better support these families and benefit seniors who1009are trying to age in place?1010    Dr. Barkoff. The Older Americans Act, actually, one thing1011people don't know about the Family Caregiver Support Program is1012that it supports basically any family caregiver who is caring1013for--who is more than 50 years old and caring for anyone other1014than a child with a disability.1015    It actually has a whole breadth of caregivers that are part1016of those programs, and the Older Americans Act provides1017supports like respite and the support groups that Jason1018mentioned, but it also helps families access services, so, if1019you are caring for a child as well as an aging parent, you may1020be able to take advantage of senior centers and adult day1021programs that can really help.1022    Respite care is critical to family caregivers and that1023combined with some of the disability programs that the ACL also1024funds can really provide a great compliment of programs to1025support all types of caregivers, including Sandwich caregivers.1026    The Chairman. Thank you. Ms. Ladau, what steps can local1027communities take to make holiday programs more accessible for1028older adults who are not only trying to age in place, but also1029have disabilities as well?1030    Ms. Ladau. Thank you so much for this question, and as I1031mentioned during my testimony, this has far reaching1032implications, well beyond simply celebrating the holidays, but1033during the holidays, people should be able to access1034festivities like anyone else, and first and foremost, I think1035about the fact that many festivities are closed to certain1036people simply because they cannot access their family members'1037homes because those homes are not accessible.1038    When we're thinking about how we can increase inclusion1039within the community, we first need to be thinking about the1040housing stock and how we can improve and incentivize creating1041accessible homes. For programming within the community, we need1042to be thinking about how we can do it in an accessible way.1043    For example, many local towns, including the one that I1044used to live in, have holiday shopping events where you go1045around, you support local businesses. It's meant to be a boon1046for the local economy. However, as a wheelchair user, I often1047cannot get into many of these local shops because they are not1048made wheelchair accessible, thereby excluding me from the1049festivities, but also excluding my wallet from the festivities.1050    When we're thinking about how we can create fun and1051accessible holiday festivities, we need to be mindful of the1052fact that these shops need to be accessible, not just for a1053Christmas shopping experience or a Hanukkah shopping1054experience, but all year round, and the economic impact will1055pay in dividends.1056    The Chairman. Thank you. Let me turn it over now to Senator1057Alsobrooks.1058    Senator Alsobrooks. Thank you so much to Chair and invite,1059and our Ranking Member for holding this hearing today, and1060thank you as well to each of our witnesses for taking time to1061be here. I often speak in this Committee about my own1062experience and I know that my experiences is so similar to so1063many other Americans. As a caregiver, as a member of what's1064known as the sandwich generation, and it is true that every1065single day I balance my role as a United States Senator with1066that of being a mother and a daughter, ensuring that my aging1067parents have the care they need as they navigate the health1068challenges that if we live long enough, we'll surely come.1069    Countless Americans share my story and strive to make their1070own family members live with dignity and access to the care1071they need, and yet, so many are left without the resources or1072necessary community support and many more seniors are without1073family to advocate for them or the resources they need to1074afford to care.1075    They unfortunately slip between the cracks. I just can't1076imagine what the average American does. I have to tell you, in1077my own experience, I had a really sweet moment just last night1078with my mother who has dementia and my father has been her1079caregiver now for the last couple of years.1080    Like so many families, it is often the caregiver who then1081becomes sick, and so he was recently given a really, really1082serious cancer diagnosis, and so it has just brought to bear1083the struggles that so many have with having the care they need1084at night and so on and so forth.1085    It has really--it continues to help me understand how1086important this is, so, I'm joined here today by tremendous1087advocates for seniors and individuals with disabilities,1088including the former Assistant Secretary for Aging and Head of1089the Administration for Community Living under the Biden1090administration.1091    I'm also proud to introduce the Strategic Plan for Aging1092Act, along with Ranking Member Gillibrand, building upon the1093great work that my state is already doing to support community1094living for seniors and individuals with disabilities, and so,1095my first question for Ms. Barkoff is, professor, I want to just1096mention that Secretary Kennedy has gutted the agency that you1097used to lead with a reduction in force.1098    I would be remiss if I didn't ask you to briefly share for1099the record the importance of that agency's work in advancing1100independence for older adults and people with disabilities?1101    Dr. Barkoff. Thank you so much, Senator Alsobrooks for that1102question. ACL is the only federal agency focused on community1103living for older adults and people with disabilities, and what1104many people don't appreciate is that ACL does not only fund and1105oversee and support the incredible programs that we've been1106talking about throughout this hearing, but it plays a critical1107role in coordinating across of all of HHS and the Federal1108Government to make sure that older adults and disabled people1109are considered in all policies.1110    As you mentioned, ACL has been significantly impacted by1111the reduction in force. Less than half the staff remain, the1112entire policy team, evaluation team, every single one of its1113regional staff, the grant team, the budget team, the1114communication team, and external affairs, and ACL is having a1115hard time doing what it needs to do to be able to play its1116critical role in supporting the aging and disability networks,1117and the unique role that it plays in coordinating programs.1118    I hope that Congress will continue to fund ACL and HHS will1119continue to staff ACL to be able to meet its statutory mandates1120and the critical role it plays in community living.1121    Senator Alsobrooks. Thank you, and you mentioned the staff1122cuts but there have been staff cuts in the proposed1123reorganization of the Administration for Community Living. As1124you mentioned, undermine the agency's mission to help seniors1125and others living with disabilities, and the Baltimore Sun1126reported last month as well on the disturbing proliferation of1127unlicensed assisted living facilities in my own state.1128    These facilities are housing elderly and vulnerable1129residents in substandard conditions, all in exchange for their1130social security or disability checks, and they're engaging in a1131practice experts called benefit or senior trafficking, and so,1132Professor Barkoff, you have extensive experience working both1133to protect seniors and individuals with disabilities and going1134after bad actors that abuse these populations from both your1135time at HHS and the Department of Justice.1136    Can you talk to us about how can we give states the tools1137to better monitor and go after these bad actors and prevent1138them from operating unchecked?1139    Dr. Barkoff. Thank you for that question, and I also saw1140this report, and the abuse and neglect and exploitation in1141these types of unlicensed assisted living facilities,1142unfortunately is not limited to Maryland. It exists really1143across a number of states in these boarding care homes or adult1144care homes.1145    It's incredibly important, ACL plays a major role in1146implementing Elder Justice, the Adult Protective Services1147Programs, the Long-term Care Ombudsman Program, really working1148with states to prioritize how to identify this type of abuse1149and neglect, how to make sure law enforcement knows how to work1150with these networks.1151    What I can unequivocally say is when you look at and this1152Committee has had a number of hearings on the resources1153available to Adult Protective Services and Ombudsmen, it is1154minuscule compared to the serious abuse and neglect that is1155happening to older adults and people with disabilities.1156    Senator Alsobrooks. Thank you so much.1157    The Chairman. Thank you, Senator. Ranking Member1158Gillibrand.1159    Senator Gillibrand. Thank you. To Alison Barkoff, average1160electricity costs have risen 11 percent since January of this1161year, which is more than three times the rate of inflation.1162Families just can't keep up with the spiking costs,1163particularly older adults on fixed income in the winter when1164heating costs are necessary to keep them alive.1165    Approximately 2.4 million Americans rely on the LIHEAP1166program, Low-Income Home Energy Assistance Program just to1167afford their energy bills and make cost efficient repairs to1168their heating systems. Can you tell us what ways does LIHEAP1169support older adults and people with disabilities the ability1170to live in their community of choice? How would funding cuts to1171LIHEAP impact this population?1172    Dr. Barkoff. As you mentioned, so many older adults and1173people with disabilities are living on fixed incomes and are1174low income, and programs like LIHEAP are incredibly important1175to help them be able to afford to stay in their own homes and1176communities. LIHEAP is a program that is targeted to the people1177who are most vulnerable to adverse health conditions when they1178don't have access to adequate cooling or heating, and the1179statistics based on HHS' own data is over 42 percent of LIHEAP1180goes to households with older adults and more than 35 percent1181to households with people with disabilities.1182    Cuts to this program can make remaining in the community1183and aging in place both unaffordable and unsafe.1184    Senator Gillibrand. Thank you. For Emily Ladau, this past1185weekend, we commemorated the 50th anniversary of the1186Individuals with Disabilities Act or the IDEA. The IDEA1187guarantees students in preschool and K-12, a free and1188appropriate public education at the least restrictive setting1189possible. The Department of Education plays a crucial role in1190making this guarantee a reality for millions of students across1191the country, including 550,000 students in New York State.1192    However, I was alarmed at the targeted reduction and forced1193notices that were sent to the Office of Special Education1194Programs within the Department of Education during the1195government shutdown and they sent a letter imploring the1196administration to immediately reverse these RIF notices.1197    Ms. Ladau, can you talk about how important accessibility1198and reasonable accommodations are for students K-12 and how1199cuts to the Department of Education will impact our students1200with disabilities?1201    Ms. Ladau. Thank you, Senator Gillibrand. First of all, for1202your advocacy to ensure that access to education for all1203children remains intact, and also, for bringing up this very1204vital topic, and I really want to be sure to draw a very clear1205connection between this question and the topic of community1206living.1207    Because being able to live at home and be the beneficiary1208of HCBS is such a vital part of the equation that actually1209allows kids with disabilities to attend school, which was true1210for me because I grew up attending a local public school and I1211had a section 504 plan that secured the reasonable1212accommodations that I needed to fully participate and succeed1213in school.1214    Both IDEA and also section 504 of the Rehab Act are really1215essential protections for students, and the Department of1216Education plays such a vital role in enforcing these laws and1217distributing resources, so I, like you, have grave concerns1218about these efforts to dismantle the Department of Education1219through reductions in force, funding cuts, and also relocation1220of key programs like moving the Office of Special Education1221Programs to exist under HHS.1222    Which I do believe could send this country backward toward1223segregating students based on diagnosis rather than expanding1224educational opportunities, so, I'll just wrap up by saying that1225I believe the changes that this administration is currently1226pushing are not going to, as they claim, "Improve outcomes by1227empowering parents, states and communities," but instead1228threaten the futures of more than seven and a half million1229students with disabilities who, like all students should have1230access to education as a pathway to graduation, college or1231career training, employment, and of course economic opportunity1232in the community. Thank you.1233    Senator Gillibrand. Thank you. For Mr. Resendez, today we1234have highlighted the services and supports that older adults1235and people with disabilities need to live independently. These1236services and supports are often provided by direct care workers1237who assist older adults and people with disabilities, with1238activities of daily living, such as dressing, and bathing in1239home settings.1240    Unfortunately, these workers may face systemic challenges1241and turnover in this workforce approaching 80 percent, they1242already faced this in 2023. More recently, the Department of1243Labor has published a proposed rule that would exclude home1244care workers for minimum wage and overtime pay protections.1245    It's why I'm introducing my Domestic Workers Bill of Rights1246Act next week to patch the flaws in existing labor laws to1247ensure that workers who provide home and community-based1248services and other domestic workers have the same rights and1249dignity as workers in other professions. Could you please speak1250to the importance of the direct care workforce and to both home1251and community-based services and elaborate on some of the1252challenges this workforce faces and how protections like those1253outlined in my domestic workers bill of rights could help?1254    Mr. Resendez. Thank you for the question, Senator1255Gillibrand. One thing is clear; family caregivers rely on1256direct care workers. We see this in our research. One third of1257family caregivers use paid help, direct care workers, home1258health aides to help support their care recipients. This1259partnership between family caregivers and direct care workers1260is essential.1261    Without adequate paid help, family caregivers will shoulder1262more intensive responsibilities. With 24 percent already1263providing 40 or more hours of care a week. Our research shows1264that 28 percent of family caregivers now have difficulty1265finding affordable services like in-home healthcare up from 221266percent in 2015.1267    Anything that we can do to stabilize the direct care1268workforce benefits not just these essential workers, but also1269millions of family caregivers who rely on them as being part of1270care teams to deliver care in the home sustainably for long1271periods of time.1272    Senator Gillibrand. Thank you. Thank you, Mr. Chair.1273    The Chairman. Thank you, Ranking Member. Mr. Offerdahl,1274what lessons from the Broward County pilot could be replicated1275nationwide to modernize home delivered meals?1276    Mr. Offerdahl. Great question. One of the things that our1277district did was our FPD for multiple service providers and the1278four service providers that got awarded, two of them were1279restaurant centric service providers, two of them were catering1280service providers. The combination kind of covers all the1281gamuts.1282    It's a great combination. Personally, I think one of each1283category is probably more manageable by the aging district but1284giving that the catering can do customized, they can do kosher,1285they can do a lot of different things, the restaurants can do1286on time production with fresh quality food. It provides a great1287choice, a specialization of both service providers, but a1288choice to the senior that I think they need, right?1289    The agency for a senior is critical in-home care, but in1290also the choice of food, so, I think that alone, at the same1291time the restaurant providers can contract out with other1292restaurants for specific meals to create variety. We had a1293relationship with Padrino's Cuban cuisine, that type of fresh1294quality food and Broward County really connects, so, the1295ability to do that along with others, it has to be--it has to1296be profitable for the for the subcontractor, but they often1297will discount their profits to be part of a community1298engagement program that brings a lot of awareness and charity1299to them.1300    I'm very excited because I have another three years to kind1301of test this model and continue to improve it, and at the end1302of the day, I totally believe that the seniors who are home1303bound will receive the benefit of that effort.1304    The Chairman. That's great. Mr. Resendez, how would a1305targeted tax credit for adults caring for aging parents help1306families manage the pressures associated with multi-1307generational living?1308    Mr. Resendez. We see one of the ripple effects of family1309caregiving is financial impact. Nearly 50 percent of family1310caregivers experiencing at least one negative financial impact.1311Two thirds experiencing two or more negative financial impacts,1312including going into debt, taking out high interest rate,1313credit cards and loans.1314    Anything we can do to recognize the economic value that1315family caregivers contribute and the economic cost of1316caregiving on families is a step in the right direction. We1317know that family caregivers spend on average $7,000 or more on1318out-of-pocket expenses to support caregiving. Think about1319things like adult diapers and things to make your home more1320suitable for caring. Those things are not tax deductible, so,1321targeted tax credits can help us in the tax code better1322recognize and value the contributions of family caregivers,1323particularly those within intergenerational household.1324    We know that 40 percent of family caregivers are living1325with their care recipient. That could be a grandparent taking1326care of a grandchild. It could be a son caring for his spouse1327or his wife, or his grandmother, or mother with a serious1328illness or a functional limitation.1329    The Chairman. Thank you. Ranking Member Gillibrand.1330    Senator Gillibrand. For Alison Barkoff. Today, we have1331highlighted how we can support older adults and people with1332disabilities so that they can live in their communities. One1333way to enhance supports and services for older adults is multi-1334sector plans for aging. These plans are state led cross-sector1335strategic planning resources that help states transform the1336infrastructure and coordination of services for older adults1337and their families.1338    Today I will reintroduce my Strategic Plan On Aging Act.1339The Strategic Plan for Aging Act creates a grant program under1340the older Americans Act to incentivize and support states to1341create their own multi-sector plans for aging and for people1342with disabilities. Professor Barkoff, could you speak to how a1343multi-sector plan for aging can improve supports and services1344for older adults? What benefits and of including direct input1345from older adults and people with disabilities in the1346development of these plans?1347    Dr. Barkoff. Thank you for the question and thank you for1348your leadership here. As we've talked about today, it takes a1349lot of different supports and services for people to age in1350place and stay in the community. That includes community-based1351services and affordable housing, and accessible transportation,1352and affordable healthcare.1353    Those services and supports cut across so many state and1354local agencies, sectors, providers, and types of advocates, and1355comprehensive and coordinated planning is absolutely critical,1356and that's why more than a dozen states have begun this1357comprehensive planning through multi-sector plans on aging. I1358so appreciate your bill and in your comments, you're1359highlighting that the experience of people with lived1360experience is critical.1361    They are best positioned to be able to say what works and1362doesn't work in the current system and where gaps are. It's1363also incredibly important and we're seeing more and more with1364states that people are including the disability community in1365those efforts. As we've heard today, the largest population of1366disabled people is older adults with disabilities, and the1367common needs and priorities cut across so many areas.1368    Finally, I'll just mention when I was at ACL, seeing the1369huge momentum, we worked on developing a strategic framework1370for a national plan on aging and we tried to model exactly what1371we were seeing in states bringing together agencies and1372departments with expertise, so, thank you again for1373reintroducing that act that I think will give a lot of momentum1374and resources to existing state efforts and really encourage1375that important aging and disability partnership.1376    Senator Gillibrand. Thank you, Alison. Emily, I want to ask1377about some of the challenges during the holidays that people1378with disabilities are often facing. First of all, accessibility1379for air travel. In 2013, 11,527 wheelchairs and scooters were1380mishandled by airlines. This mishandling can lead to costly1381repairs and leave wheelchair users without the technology they1382need to get around.1383    For many people, it's not just losing a chair, it's losing1384their independence. Chairs are extremely expensive. That's why1385I was disappointed to see the Department of Transportation was1386delaying the implementation of regulation that would address1387these harmful trends, so, can you discuss the importance of1388accessible transportation, especially accessible air travel and1389how delaying implementation of this regulation and impact will1390impact people with wheelchair users?1391    The second question I have is about web accessibility,1392because obviously when you're planning any time to go home, you1393use the internet to book your air travel, you use the internet1394to find hotels, you use the internet to do everything, and1395we've really not met our requirements of making the internet1396accessible at all. In 2022, this Committee released a report1397that found web accessibility failures throughout the Federal1398Government, including at agencies such as the Centers for1399Disease Control and Prevention in the Department of Veterans1400Affairs.1401    The VA's own reporting said approximately 90 percent of1402websites at the Department of Veterans Affairs were not fully1403accessible for people with disabilities as required by law, so,1404maybe just touch on these two things and anything else you want1405to bring up?1406    Ms. Ladau. Thank you, Senator Gillibrand. I am happy to1407talk about these issues. I want to first actually address the1408web accessibility part. This is very much intertwined with1409travel because you often need to book your travel through a1410website, and if that website is not accessible, it immediately1411precludes you from being able to book your travel1412independently, and this is an issue not just for people with1413disabilities, but for older Americans who may struggle to keep1414up with ever evolving technology.1415    Think of engaging with video content, think of watching a1416movie with captions, accessibility benefits, everybody. It just1417makes sense to implement accessibility and it makes the user1418experience easier for everyone, and when it comes to air1419travel, goodness knows, we need all of the improvements on1420experience we can get. I will say that I am one of the 11,000-1421plus people who has had my wheelchair damaged in the course of1422a given year.1423    I'm going to be very honest that it made it very difficult1424for me to go visit my grandmother before she passed away. She1425lived in Florida. I was not able to go see her because I was so1426afraid of my wheelchair breaking on an airplane that I instead1427chose not to make that trip because it was going to be so1428incredibly challenging knowing that my wheelchair had1429previously been broken.1430    When I flew across the United States from New York to1431Oregon, I found that my joystick had been completely sheared1432off when I landed and had to hold it together with duct tape1433and with zip ties, and I would just ask everyone to imagine if1434that was somebody's legs that were being held together with1435duct tape and zip ties.1436    All of that is to say that whether you are visiting a loved1437one, whether you are taking a holiday trip, whether you're a1438grandparent using a scooter who just wants to enjoy Disney1439World with their grandkids, you should be able to travel1440knowing that your mobility equipment will arrive intact, and1441this is an essential form of community living because it is1442indeed participating in the community.1443    It's not just the right thing to do, it also makes economic1444sense to keep people moving around the world safely. Thank you.1445    Senator Gillibrand. This question is for Jason. Thank you1446for discussing the Family Act in your opening statement, the1447Family Act would create a national family and medical paid1448leave program. Specifically, it would establish 12 weeks of1449paid leave for serious medical and family events, including the1450need to care for a loved one.1451    Can you go into further detail on why the Family Act is1452necessary? What kind of hard choices are American families1453forced to make when paid family leave is unavailable? Does the1454National Alliance for Caregiving have any caregiver stories1455that highlight those challenges?1456    Mr. Resendez. Absolutely. Thank you so much, Senator1457Gillibrand. First, I want to say that there are 35 million1458family caregivers who provide care while working at the same1459time, so, without paid leave, these millions of family1460caregivers face impossible choices between providing essential1461care for loved ones, including older adults with serious1462conditions like Alzheimer's or cancer, or maintaining their1463financial security, and according to our data, they often1464sacrifice both, leave jobs, deplete savings, and take on debt1465with long-term consequences for their own retirement security1466and economic stability.1467    In fact, half of all working caregivers report going in1468late, leaving early or taking time off to provide care. We1469heard from one such family caregiver, Marcy, a family caregiver1470in Kansas, who provides care for both her mother and also her1471grandson, who is ultimately forced to leave her job because of1472her caregiving responsibilities.1473    She told us, "They needed more time than what I had, and I1474couldn't take any more time off work. I was working 60 hours a1475week and coming home and doing everything too, to lose that1476income, it was a big hit." If we don't do more to help family1477caregivers balance both the care that they need to provide and1478the work they want to do, we're going to see more and more1479examples like Marcy's.1480    The Chairman. One, the Ranking Member and I would like to1481thank everyone for being here today and for the work you all do1482to support older Americans and the families who care for them.1483Aging in place is not only what many older Americans want, it's1484also better for their health and better for their families. The1485pressures on the sandwich generation are real and they'll grow1486heavier this time of year. Community-based support and OAA1487programs help lighten that burden and keep families strong. For148860 years, the OAA has been the backbone of critical services1489that promote independence and social connection for older1490adults.1491    That is why this Committee remains committed to working in1492a bipartisan way to re-authorize the OAA and strengthen1493programs that help seniors age in place. I look forward to1494continue to work with members on this Committee.1495    If any Senator has additional questions for the witnesses1496or statements to be added, the hearing record will be open1497until next Wednesday at 5:00 p.m.1498    The Chairman. I thank each of you.1499    [Whereupon, at 4:27 p.m., the hearing was adjourned.]1500=======================================================================15011502                                APPENDIX15031504=======================================================================15051506                      Prepared Witness Statements15071508=======================================================================15091510                 U.S. Senate Special Committee on Aging15111512     "Aging in Place: The Impact of Community During the Holidays"15131514                            December 3, 202515151516                       Prepared Witness Testimony15171518                             John Offerdahl15191520    Chairman Scott, Ranking Member Gillibrand, and Members of1521the Committee - It is an honor to speak with you today about an1522issue affecting millions of older Americans: ensuring that1523seniors can age in place with dignity, safety, independence,1524and meaningful human connection. This is important every day of1525the year, but especially during the holiday season, when social1526isolation and food insecurity among older adults rise sharply.15271528Introduction15291530    As mentioned, my name is John Offerdahl. I became a proud1531resident of Broward County 40 years ago, when drafted by the1532Miami Dolphins in 1986. I spent my entire eight-year NFL career1533in South Florida, and for 36 of those 40 years, my wife Lynn1534and I have owned and operated regional restaurant chains, which1535we continue to run today. Throughout these decades, we have1536remained deeply involved in charitable work across South1537Florida-including through our Offerdahl's Hand-Off Foundation.15381539Background and COVID Experience15401541    Now you ask, how does an NFL linebacker become an Older1542American Act Home Delivered Meal service provider for the Area1543Agency on Aging of Broward County? Let me tell you the story!1544    The Hand-Off Meals for Seniors program was born during the1545onset of the COVID pandemic, when Miami Dolphins owner Stephen1546Ross reached out to several of his Miami Dolphins alumni1547players, who were also restaurateurs, to help produce & deliver1548$1MM of weekly emergency meals to families and seniors in the1549neighborhoods surrounding Hard Rock Stadium. With additional1550support from generous partners, we delivered more than one1551million meals across Broward County - many for homebound1552seniors.1553    In the years that followed, emergency COVID funding through1554the Area Agency on Aging of Broward County and the Florida1555Department of Elder Affairs, allowed us to continue this work.1556By 2022, our team had delivered hundreds of thousands of FRESH1557meals to vulnerable seniors & families who needed them most.1558    These experiences revealed a truth still urgent today:1559homebound seniors are a hidden population, often forgotten,1560isolated, and deeply in need of dependable nutrition and1561meaningful human contact.15621563A New Model for Home-Delivered Meals15641565    The success of this effort led the Area Agency on Aging of1566Broward County-under the leadership of current CEO, Charlotte1567Mather-Taylor-to rethink its 48-year Older American Act home-1568delivered meals program. Rather than awarding one contract to1569the lowest-cost frozen meal provider, the Agency on Aging1570awarded competitive contracts to multiple service providers.1571This ultimately offered variety and choice to Broward County1572homebound seniors.1573    Our foundation's program, Hand-Off Meals for Seniors, was1574selected in 2023 for a six-month pilot contract based on our1575proven ability to deliver fresh, restaurant-quality meals1576paired with compassionate, relationship-centered service.1577Seniors responded with overwhelming appreciation, and on1578January 1, 2024, our program was one of four service providers1579in Broward County awarded a five-year Older American Act Home1580Delivered Meals contract.1581    Today, Hand-Off Meals for Seniors is the leading service1582provider in Broward County delivering more than 4,500 fresh1583home-delivered meals and wellness visits every week to over 4501584homebound seniors across Broward County.15851586Why the Older Americans Act Matters15871588    Broward County reflects the future of our nation. Florida1589has one of the highest concentrations of seniors in America,1590and Broward's population of adults over 85 is projected to1591increase by 169% over the next 25 years.1592    Vulnerable, homebound seniors often live alone, without1593family, caregivers, transportation, or the ability to shop and1594cook making the need for support so huge that the Area Agency1595on Aging maintains a long waiting list underscoring the urgent1596need for strong, sustained investment in the Older Americans1597Act.The choice between aging in the community or entering1598institutional care often hinges on access to basic supports.1599    Allow me to highlight five "Basic Support" takeaways we1600have learned in Broward County for the Committee to consider:1601      1. Healthy competition among meal providers drives better1602quality, service and outcomes - Providers like us are food-1603centric-not large industrial frozen-meal brokers. Most meals we1604deliver offer FRESH salads, sandwiches, fruits, and vegetables1605vs institutionalized frozen tv meals. While FRESH ingredients &1606real time production are more expensive, local production in1607scattered restaurant locations across Broward County create1608decentralized pickup points that make the system efficient and1609sustainable.1610      2. Healthy competition among meal providers inspires1611innovation and efficiencies that mitigate costs - Providers can1612leverage a restaurant's purchasing power, fixed costs, and1613community commitment to provide high-quality meals at1614sustainable rates-discounting profits in service of the1615community-based mission.1616      3. Healthy competition among meal providers invigorates1617stronger public-private partnerships - Funding partnerships1618have expanded, supported by organizations like the Jim Moran1619Foundation, Community Foundation of Broward, Miami Dolphins1620Foundation, and Publix Charities to help cover the gap between1621public funds & the elevated costs of restaurant quality, FRESH1622meals.1623      4. Healthy competition among meal providers engages the1624soul - A meal in our model is never just a meal. Delivery1625drivers visit the same seniors each week, building trust and1626companionship. These visits are also the moments when someone1627notices memory decline, hazardous living conditions, or failing1628appliances.1629      5. Healthy competition among meal providers gives seniors1630the CHOICE! - Seniors retain personal for their choice of1631meals!16321633Conclusion16341635    This is the kind of improvement we all hope to see from1636government programs: invigorated partnerships, better outcomes,1637more choice, and an "age in place" option for seniors that will1638cost less and be more innovative, responsive and personal, than1639institutionalized care. Healthy competition among meal1640providers is good for the body & soul of our aging in place1641seniors. during the holidays and beyond!1642    At every level, this work is a public-private partnership-1643and the Older Americans Act is the backbone of the team. As1644Coach Shula taught us, "In life as in football. it takes a1645team."1646    Chairman Scott, Ranking Member Gillibrand, and Members of1647the Committee: aging in place is not merely a policy objective-1648it reflects who we are as a nation. The Hand-Off Meals for1649Seniors program demonstrates what becomes possible when FRESH,1650high-quality nutrition is paired with consistent human1651connection and allowed to compete for the body & soul of our1652senior.1653    I invite every member of this Committee to visit us in1654Broward County, meet our volunteers, talk with our seniors, and1655join my wife and me for one of our weekly meal deliveries. I1656give you my promise-you will be inspired!1657    Thank you for your time, your leadership, and your1658commitment to strengthening the golden years of America's older1659adults.16601661                 U.S. Senate Special Committee on Aging16621663     "Aging in Place: The Impact of Community During the Holidays"16641665                            December 3, 202516661667                       Prepared Witness Testimony16681669                             Jason Resendez16701671    Good afternoon, Chairman Scott, Ranking Member Gillibrand,1672and Members of the Committee:Thank you for the opportunity to1673testify about the role that family caregivers play in enabling1674older adults to age in place, in their community.1675    My name is Jason Resendez, and I am the President and CEO1676of the National Alliance for Caregiving, a national1677organization focused on transforming how our nation values its1678more than 63 million family caregivers.1679    For nearly 30 years, we've documented and amplified the1680experiences of family caregivers-their challenges, hardships,1681and joys-while measuring our country's progress in supporting1682their critical work.1683    We are living through a profound demographic shift. Every1684single day, roughly 10,000 Americans turn 65. Medical advances1685mean people are living longer than ever.\1\1686---------------------------------------------------------------------------1687    \1\ U.S. Department of Health and Human Services, Aging.1688Washington, D.C.: U.S. Department of Health and Human Services.1689Available at: https://www.hhs.gov/aging/index.html1690---------------------------------------------------------------------------1691    This is a tremendous achievement, but it also presents new1692challenges-challenges that largely fall on the shoulders of our1693country's family caregivers.1694    Today, these Americans make up the backbone of our nation's1695long-term services and support system.Family caregivers are our1696neighbors, our friends, and our family. They fill our schools,1697workplaces, and places of worship.1698    And as we head into the holidays, many Americans will be1699talking about caregiving issues with their family and friends.1700It has become a "kitchen table" issue.1701    For those caring for older relatives, you might hear1702someone talk about Dad's recent fall, his time spent in the1703hospital and then his discharge home where he suddenly needs1704someone to help him bathe, dress and prepare meals.1705    Change the name and the illness or health incident, but1706this is going on daily, across America, and family caregivers1707are the ones who step up and do the hard work - often on a1708moment's notice.17091710The Growing Need17111712    And their numbers are growing. According to new data from1713the National Alliance for Caregiving and AARP's landmark1714Caregiving in the US 2025 research, 63 million or one in four1715Americans is now a family caregiver-representing a nearly 501716percent increase since 2015.\2\1717---------------------------------------------------------------------------1718    \2\ AARP and National Alliance for Caregiving, Caregiving in the US17192025. Washington, D.C.: AARP. July 2025. Available at: https://1720www.caregivingintheus.org1721---------------------------------------------------------------------------1722    That's 20 million additional caregivers in just one decade.1723    This surge directly mirrors our aging population and a1724critical reality: 70 percent of older Americans will need some1725form of long-term services and supports during their1726lifetime.\3\1727---------------------------------------------------------------------------1728    \3\ ACL Administration for Community Living, "How Much Care Will1729You Need?" Washington, D.C.: U.S. Department of Health and Human1730Services. Available at: https://acl.gov/ltc/basic-needs/how-much-care-1731will-you-need1732---------------------------------------------------------------------------1733    Understanding who provides this care is essential. Sixty-1734one percent of family caregivers are women and 38% are men,1735with an average age of 51. The vast majority-89%-care for1736relatives, most commonly a parent or parent-in-law (47%), and1737nearly half support someone age 75 or older. Twenty-nine1738percent are "sandwich generation" caregivers responsible for1739both young children and older adults, with African American and1740Latino American caregivers more likely to be in this dual1741role.\4\1742---------------------------------------------------------------------------1743    \4\ Op. cit.1744---------------------------------------------------------------------------1745    Often, this care occurs within intergenerational1746households-40% of caregivers live with their care recipient, a1747figure that rises among lower-income caregivers, men, and1748caregivers of color. The caregiver population reflects1749America's diversity: 61% are non-Hispanic white, 16% Latino1750American, 13% African American, and 6% Asian American/Native1751Hawaiian/Pacific Islander. One in five caregivers lives in a1752rural area, and nearly one-quarter are juggling care for1753multiple recipients simultaneously.1754    Across these demographics, caregiving now requires greater1755commitment-both in duration and intensity. Thirty percent of1756caregivers have been providing care for five or more years.1757They spend an average of 27 hours per week on caregiving1758duties, with nearly one in four putting in 40 or more hours-1759equivalent to a full-time job, and for 61%, this comes on top1760of paid employment.1761    Family caregivers deliver comprehensive, complex support1762that would otherwise require teams of paid professionals.1763Seventy percent monitor their loved ones' health conditions and1764adjust care accordingly. Nearly two-thirds communicate directly1765with healthcare providers, serving as the crucial link in care1766coordination.1767    More than half perform complex medical and nursing tasks1768such as administering medications, managing special diets, and1769providing wound care. Many provide around-the-clock support for1770the people they love. Yet only 22 percent of caregivers1771performing these complex medical tasks received any training.1772When training is provided, 96 percent feel it prepared them1773well highlighting both the gap and the opportunity.1774    As one caregiver, Maylia from California, shared: "I had to1775give up a prosperous career and took jobs to work around their1776schedule. I took a 90% pay cut and lived out of my savings,1777which has been depleted." She went on to say, "Being a1778caregiver is the hardest role... You are playing three or more1779roles: taking care of your family members, the house, yourself,1780your job."\5\1781---------------------------------------------------------------------------1782    \5\ Op cit. p. 36 and p.39.17831784---------------------------------------------------------------------------1785The Foundation of Our Healthcare System17861787    As Maylia's story makes clear, family caregivers are1788essential to healthcare delivery. They enable something1789Americans overwhelmingly desire: the ability to age and receive1790care at home, in their communities, surrounded by what's1791familiar and meaningful to them.1792    This matters for two fundamental reasons:1793    First, dignity and freedom. When people remain in their own1794homes, they maintain control over how and when they receive1795care, and importantly, who provides that care. These choices1796profoundly impact quality of life.1797    Second, basic economics. Annual nursing home costs average1798approximately $120,000, compared to roughly $44,000 for 301799hours of weekly home-based care at $30 an hour.\6\ Put simply,1800the cost of supporting one person in a nursing facility could1801support more than two people at home, and when family1802caregivers provide a substantial portion of this care-with1803appropriate support-the savings to Medicaid grow exponentially.1804---------------------------------------------------------------------------1805    \6\ Genworth Financial, Inc., Genworth and CareScout Release Cost1806of Care Survey Results for 2024. Richmond, VA: Genworth Financial,1807Inc.; March 2025. Available at: https://www.businesswire.com/news/home/180820250301584443/en/Genworth-and-CareScout-Release-Cost-of-Care-Survey-1809Results-for-2024.1810---------------------------------------------------------------------------1811    Congress recognized this reality nearly 25 years ago when1812it amended the Older Americans Act to create the National1813Family Caregiver Support Program. This program acknowledges1814that supporting the caregiver is inseparable from supporting1815the person receiving care. Yet funding has never matched the1816growing need even as caregiver numbers have surged by 201817million in a decade.1818    The Crisis of Strain1819    Despite their heroism and economic value, family caregivers1820face a growing crisis. Nearly two-thirds experience moderate or1821high emotional stress, 45 percent report physical strain, and1822nearly half have experienced at least one negative financial1823impact. One-third have stopped saving entirely. Nearly one in1824four report feeling alone, a figure that has increased since18252020.1826    Strikingly, 56 percent of caregivers felt they had no1827choice in taking on their role, with profound consequences:1828these caregivers experience nearly twice as many poor mental1829health days as those who felt they had a choice.1830    Over the past decade, National Alliance for Caregiving data1831show that family caregivers are struggling more-and for longer-1832than ever before. Black, Latino, rural, and other1833underrepresented communities - especially women -1834disproportionately bear these hardships.1835    The financial toll is particularly acute for these1836communities. African American and Latino American caregivers1837are significantly more likely to take on debt, use up savings,1838and be unable to afford basic expenses like food. Lower-income1839caregivers, those already least able to weather financial1840storms, are hit hardest, with 28 percent unable to afford basic1841expenses compared to eight percent of higher-income caregivers.1842    Seven in ten working-age caregivers balance employment with1843caregiving responsibilities. Half experience work disruptions-1844arriving late, leaving early, or taking time off. Working1845caregivers actually report feeling more isolated than non-1846working caregivers and face greater financial strain.1847    While access to caregiver-friendly workplace benefits has1848improved, salaried workers enjoy significantly better access1849than hourly workers creating an equity gap that policy must1850address.1851    This is where Older Americans Act programs become1852essential. The National Family Caregiver Support Program-a1853cornerstone of the OAA-provides the very services caregivers1854need most: respite care, counseling, training, and information1855services. Delivered through our national aging network of Area1856Agencies on Aging, these programs offer a lifeline to1857caregivers struggling to manage alone.1858    Dianne, a family caregiver from Green Bay, Wisconsin, put1859it this way: "The Older Americans Act helped me, the primary1860caregiver, have a few precious moments to myself to recharge.1861It provided relief to an already tight budget stretched thin1862with additional supply costs. I cannot imagine what other1863families are having to sacrifice in order to care for their1864loved ones."\7\1865---------------------------------------------------------------------------1866    \7\ National Alliance for Caregiving, Dianne's Story. Washington,1867D.C.: National Alliance for Caregiving; n.d. Available at:https://1868www.caregiving.org/care--stories/dianne-2/1869---------------------------------------------------------------------------18701871                 U.S. Senate Special Committee on Aging18721873     "Aging in Place: The Impact of Community During the Holidays"18741875                            December 3, 202518761877                       Prepared Witness Testimony18781879                             Alison Barkoff18801881    Good afternoon, Chairman Scott, Ranking Member Gillibrand,1882and Members of the Committee. Thank you for inviting me to1883participate in today's hearing.1884    My name is Alison Barkoff. I have more than 25 years'1885experience in disability, aging, and community living policy. I1886am the Hirsh Health Law and Policy Associate Professor and1887Program Director at George Washington University.\1\ I1888previously served as the Acting Assistant Secretary for Aging1889and Administrator of the Administration for Community Living1890and held leadership roles related to community living in the1891Centers for Medicare & Medicaid Services, Departments of Labor1892and Justice, and several non-profit organizations. I also bring1893my lived experience as a sibling of a brother with intellectual1894disabilities to my work.1895---------------------------------------------------------------------------1896    \1\ I am testifying in my individual capacity and not on behalf of1897the university.18981899---------------------------------------------------------------------------1900Preference for and Benefits of Community Living19011902    The vast majority of older adults and people with1903disabilities want to live in their own homes and communities1904instead of in nursing homes or other institutions.\2\ It allows1905them to remain with their families and friends, participate in1906community activities, work or volunteer, and age in place. With1907appropriate supports, people are generally happier and1908healthier in the community.\3\1909---------------------------------------------------------------------------1910    \2\ https://www.aarp.org/pri/topics/livable-communities/housing/19112024-home-community-preferences/1912    \3\ https://acl.gov/about-community-living1913---------------------------------------------------------------------------1914    Supporting an individual in the community costs a fraction1915of providing care in a nursing home or other institution.\4\ In1916addition, federal laws and the U.S. Supreme Court have1917recognized that people have a right to receive services in the1918most integrated setting appropriate to their needs.\5\1919---------------------------------------------------------------------------1920    \4\ https://acl.gov/about-community-living1921    \5\ See Olmstead v. L.C., 527 U.S. 581 (1999); https://1922archive.ada.gov/olmstead/olmstead--about.htm; https://www.ada.gov/1923topics/community-integration/1924---------------------------------------------------------------------------1925    There has been strong bipartisan support for policies,1926programs, and services that help older adults and people with1927disabilities live in the community and age in place, such as1928the Older Americans Act (OAA) programs and the Money Follows1929the Person program that helps people transition from nursing1930homes back to the community. The demand for community living is1931expanding exponentially, with more than 10,000 people turning193265 every day and a growing population of disabled people living1933longer (often with aging caregivers).\6\1934---------------------------------------------------------------------------1935    \6\ https://www.kiplinger.com/retirement/turning-65-key-things-to-1936know19371938Supporting Older Adults and People with Disabilities in the1939---------------------------------------------------------------------------1940Community19411942Medicaid-funded Home and Community-Based Services19431944    Many older adults and disabled people require assistance to1945live in their own homes and communities. Medicaid is the1946primary funder of these supports, known as Home and Community-1947Based Services (HCBS). HCBS include a wide range of services1948such as home care, senior day programs or disability employment1949supports, respite care, family caregiver supports, and1950accessible transportation. Neither private health insurance nor1951Medicare cover these services (despite many older adults1952mistakenly believing they do), few people have private long-1953term care insurance, and most people cannot afford to pay out-1954of-pocket.\7\1955---------------------------------------------------------------------------1956    \7\ https://www.kff.org/medicaid/issue-brief/10-things-about-long-1957term-services-and-supports-ltss/1958---------------------------------------------------------------------------1959    Medicaid is a state-federal partnership, and states design1960their own Medicaid systems within federal law and guidelines.1961States must provide nursing home and other institutional1962services to people who are eligible because they are1963"mandatory" services under Medicaid law. In contrast, HCBS are1964"optional," meaning that states are permitted to cap enrollment1965in their HCBS programs. Currently there are over 600,000 people1966on waiting lists for HCBS.\8\ A top policy priority for the1967aging and disability communities is to reverse this1968"institutional bias" in Medicaid and put HCBS on equal footing1969with institutional care.1970---------------------------------------------------------------------------1971    \8\ https://www.kff.org/medicaid/a-look-at-waiting-lists-for-1972medicaid-home-and-community-based-services-from-2016-to-2025/1973---------------------------------------------------------------------------1974    Despite the optional nature of HCBS, states have expanded1975their investments in HCBS over time, with increased funding,1976new authorities and "rebalancing" funding from nursing homes1977and other institutional settings to HCBS programs to better1978match people's preferences. Nationally, 65 percent of state1979Medicaid long-term care spending goes towards HCBS,\9\ but the1980percentage varies significantly both by state and by aging and1981disability sub-populations.\10\ Continuing efforts to expand1982HCBS is essential to helping people remain in their community1983and age in place, particularly in light of the growing demand1984and need. Yet reductions in federal Medicaid funding to states1985could put optional services, like HCBS programs, at risk for1986cuts.\11\1987---------------------------------------------------------------------------1988    \9\ https://www.medicaid.gov/medicaid/long-term-services-supports/1989downloads/ltss-rebalancing-brief-2022.pdf1990    \10\ https://aspe.hhs.gov/sites/default/files/documents/1991ad7cf66fb2a7ae1a0bd91b288363fc71/rebalancing-ltss-medicaid-enrolled-1992brief.pdf1993    \11\  https://geigergibson.publichealth.gwu.edu/history-repeats-1994faced-medicaid-cuts-states-reduced-support-older-adults-and-disabled-1995people1996---------------------------------------------------------------------------1997Older Americans Act ProgramsThe OAA funds a range of community-1998based services to help older adults, including older adults1999with disabilities, age in place, maintain their health, and2000engage in their communities. This includes personal care2001services, respite, transportation, family caregiver supports,2002and senior nutrition programs. OAA programs support one in five2003Americans over 60.\12\2004---------------------------------------------------------------------------2005    \12\ https://www.advancingstates.org/sites/default/files/2024-oaa-2006roi-infographic-national.pdf2007---------------------------------------------------------------------------2008    OAA programs complement, but do not duplicate, other2009programs like Medicaid HCBS. OAA programs often serve2010individuals who are not yet eligible for Medicaid due to their2011level of need or financial situation or who are on HCBS waiting2012lists in their state. OAA programs also provide services that2013other programs do not cover, like family caregiver supports or2014meals.2015    OAA programs are cost effective. For example, one year of2016home delivered meals costs less than one day in the hospital.2017They also save hundreds of millions of dollars annually to2018other programs like Medicare and Medicaid by preventing2019unnecessary emergency room, hospital, and nursing home2020admissions; OAA programs led to nearly two million extra days2021living in the community instead of in hospitals or nursing2022homes. Every dollar invested in OAA generates $3.39 in2023community value and taxpayer savings.\13\2024---------------------------------------------------------------------------2025    \13\ https://www.advancingstates.org/sites/default/files/2024-oaa-2026roi-infographic-national.pdf2027---------------------------------------------------------------------------2028    As the population of older adults continues to quickly2029grow, the demand for OAA-funded services has outpaced their2030capacity. Many programs already have long waiting lists,2031including one in three Meals on Wheels Providers.\14\ In2032addition, the demand on OAA programs is expected to increase as2033federal funding to other programs that older adults rely upon,2034like Medicaid and the Supplemental Nutrition Assistance Program2035(SNAP), decrease.2036---------------------------------------------------------------------------2037    \14\ https://www.mealsonwheelsamerica.org/news/meals-on-wheels-2038america-calls-for-donations-this-giving-tuesday-and-all-giving-season-2039long-to-ensure-no-senior-is-left-hungry-and-alone-during-the-holidays/2040---------------------------------------------------------------------------2041    The OAA has long had bipartisan support. In the 118th2042Congress, the Senate passed bipartisan legislation to2043reauthorize the OAA and strengthen its programs.2044Reauthorization of the OAA and increased investment in its2045programs is a top priority for the aging community and an2046important step to supporting older adults to age in place.20472048Independent Living and Other Disability Programs20492050    Independent living programs, authorized and funded under2051the Rehabilitation Act, help support disabled people of all2052ages to live, work, and participate in their communities. Local2053Centers on Independent Living (CILs) provide a wide range of2054supports, including assistance to people at risk of entering or2055transitioning from institutions to the community, training on2056independent living skills, transportation, and assistance with2057finding a job or housing.\15\ Other programs funded under the2058Developmental Disabilities Act, including State Councils on2059Developmental Disabilities,\16\ Protection and Advocacy2060Systems,\17\ and University Centers on Excellence in2061Developmental Disabilities,\18\ help people with intellectual2062and developmental disabilities and their families in accessing2063community-based services. As with OAA programs, demand outpaces2064growing need; continued investment in these programs is2065essential to supporting the growing population of disabled2066people, including those aging with and into disability.2067---------------------------------------------------------------------------2068    \15\ https://acl.gov/sites/default/files/programs/2023-12/CIL--2069FactSheet--2023.508.pdf2070    \16\ https://acl.gov/sites/default/files/programs/2023-12/2071DDCouncils--FactSheet.508.pdf2072    \17\ https://acl.gov/sites/default/files/2025-03/protection-2073advocacy-factsheet-acl.pdf2074    \18\ https://acl.gov/sites/default/files/programs/2023-12/UCEDD--2075FactSheet--2023.508.pdf2076---------------------------------------------------------------------------2077Affordable Accessible Housing20782079    For many older adults and disabled people, the lack of2080affordable, accessible housing is a barrier to community2081living. A recent AARP report found that housing affordability2082and accessibility are a significant challenge for nearly half2083of older adults.\19\ Less than five percent of housing stock is2084accessible.\20\ Many older adults and disabled people pay more2085than one-third of their income on housing, often requiring them2086to spend less on food or needed medical care and placing them2087at risk of homelessness.\21\ As a result, these populations2088comprise the majority of people experiencing or at risk of2089homelessness, with older adults being the quickest growing2090homeless population.\22\ Supporting community living and aging2091in place will require increased investments in affordable,2092accessible housing; cuts to housing programs could force people2093into more expensive nursing homes and other institutional2094settings or into homelessness.2095---------------------------------------------------------------------------2096    \19\ https://press.aarp.org/2024-12-10-New-AARP-Report-Majority-2097Adults-50-plus-Age-Place-Policies-Communities-Catch-Up2098    \20\ https://www.housingwire.com/articles/less-than-5-of-american-2099homes-are-accessible-for-the-disabled-elderly/2100    \21\ https://aspe.hhs.gov/sites/default/files/documents/21019ac2d2a7e8c360b4e75932b96f59a20b/addressing-older-adult-2102homelessness.pdf2103    \22\ https://endhomelessness.org/blog/paint-by-numbers-older-2104americans-and-homelessness/21052106---------------------------------------------------------------------------2107Multisector Plans to Support Community Living21082109    Supporting older adults and people with disabilities to2110live in the community and age in place requires coordination2111across systems, ensuring access to community-services,2112affordable housing, accessible transportation, affordable2113healthcare, and more. More than a dozen states have begun this2114type of comprehensive planning - bringing together relevant2115state and local agencies, community leaders, businesses, and2116stakeholders - through a process to develop Multisector Plans2117for Aging.\23\ Several states have explicitly included2118disability in their planning efforts, recognizing the2119significant number of people aging with and into disability and2120the many common priorities between the communities. The2121Strategic Plan for Aging Act, introduced by Ranking Member2122Gillibrand, would help support states to develop and implement2123Multisector Plans for Aging and Aging with Disabilities,2124providing momentum to the important work already happening in2125states and encouraging the important partnerships between aging2126and disability in this effort to support community living.2127---------------------------------------------------------------------------2128    \23\ https://multisectorplanforaging.org/21292130The Role of the Administration for Community Living in2131---------------------------------------------------------------------------2132Supporting Community Living21332134    The Administration for Community Living (ACL) plays a2135critical role in helping older adults and people with2136disabilities live and participate in their own communities and2137age in place. ACL is the only federal agency focused on2138community living, elevating the issue and ensuring that older2139adults and disabled people are considered in federal policies2140across the Department of Health and Human Services (HHS) and2141the federal government.2142    ACL funds and implements a wide range of aging and2143disability programs that support community living, including2144those under the OAA, Rehabilitation Act, and Developmental2145Disabilities Act discussed above.\24\ACL has also launched2146numerous initiatives to address barriers and increase2147opportunities for community living for both older adults and2148disabled people, including efforts to support family2149caregivers,\25\ strengthen the direct care workforce,\26\ and2150expand affordable, accessible housing.\27\2151---------------------------------------------------------------------------2152    \24\ https://acl.gov/programs/aging-and-disability-networks2153    \25\ https://acl.gov/ncsc2154    \26\ https://acl.gov/DCWcenter2155    \27\ https://acl.gov/HousingAndServices2156---------------------------------------------------------------------------2157    ACL has been impacted by HHS' proposed reorganization and2158reductions in force. ACL has lost almost half of its staff over2159this calendar year, threatening its ability to fully implement,2160oversee, and support its aging and disability programs.2161Consistent with the bipartisan support that ACL has enjoyed,2162Congress should ensure that ACL is sufficiently resourced to2163fulfil its statutory mandates, support its programs, and2164continue its important coordination role across HHS and the2165federal government.2166    Thank you for this opportunity to testify about the2167importance of community living and what it takes to make that a2168reality for the millions of older adults and people with2169disabilities in this country. I'm happy to answer your2170questions.21712172                 U.S. Senate Special Committee on Aging21732174     "Aging in Place: The Impact of Community During the Holidays"21752176                            December 3, 202521772178                       Prepared Witness Testimony21792180                              Emily Ladau21812182    Chairman Scott, Ranking Member Gillibrand, and2183distinguished Committee members, I am honored to testify on2184this auspicious day, as December 3rd is the International Day2185of Persons with Disabilities.2186    I am a proud disability advocate, and my mission is to2187harness the power of storytelling as a tool to expand2188accessibility and inclusion for all. As a 34-year-old, my story2189may seem out of place at a hearing about aging in place, but2190the disability perspective is especially pertinent to today's2191focus on the impact of community. I want to emphasize that more2192than 1 in 4 adults in the United States have a disability\1\2193and of this group, 43.9% are adults aged 65 or older.\2\ For2194those who are not yet disabled, there is a significant2195likelihood of aging into having a disability. Neither a2196person's age nor disability status should ever be a barrier to2197being among loved ones in our homes and communities.2198---------------------------------------------------------------------------2199    \1\ Centers for Disease Control and Prevention. Disability Impacts2200All of Us Infographic. Accessed November 26, 2025.https://www.cdc.gov/2201disability-and-health/articles-documents/disability-impacts-all-of-us-2202infographic.html.2203    \2\ Centers for Disease Control and Prevention, National Center on2204Birth Defects and Developmental Disabilities, Division of Human2205Development and Disability. Disability and Health Data System (DHDS)2206Data. Acessed November 26, 2025. https://dhds.cdc.gov2207---------------------------------------------------------------------------2208    When I was a teenager, my parents and I took a trip to2209Florida to visit my grandparents for a holiday celebration. At2210the time, my grandpa was in the midst of an extended hospital2211stay, but his doctor permitted him to come home for a few hours2212to join us for a holiday meal. As my family was cooking, I sat2213with my grandpa while he opened the day's mail. He began to2214weep over the simple act of being able to do a task in his own2215home. It's the only time I ever saw him cry. As I look back on2216this moment, I realize just how strongly it underscores the2217immense importance of being home-and not just for the holidays.2218    I was born with my physical disability, so I know well the2219essential nature of supports and services that empower me to2220thrive at home and in my community, and how fortunate I am to2221have had access to them throughout my life. When my mom-who has2222the same disability as me-was born in 1961, a family member2223suggested my grandparents place her in an institution. Thirty2224years later, when I was born, no one made this suggestion to my2225parents. Instead, following my stay in the neonatal intensive2226care unit, a public health nurse connected my mom with2227resources to ensure I'd receive the care I needed.2228    Because of this, I was able to have regular physical,2229occupational, and speech therapy starting at just a few months2230old. By the time I began kindergarten, I was approved for2231ongoing home and community-based services, or HCBS, thanks to2232the New York State Care at Home Medicaid Waiver.2233    Medicaid provided me access not only to vital therapeutic2234services, but also to home modifications that enabled me to2235function as independently as possible in my family's home.2236Medicaid also assisted in the acquisition of durable medical2237equipment, such as my power wheelchair. As you can see by the2238fact that I am here today, my wheelchair gives me freedom to be2239out and about in the community.2240    Unfortunately, the Medicaid asset limit, which has been a2241mere $2,000 for over 35 years, became prohibitive to my future2242career and relationship goals. In my early 30s, I found myself2243at an inflection point. I wanted to forge ahead in my career2244and build a life with my partner, but I was trapped in an2245inflexible system that imposes caps and penalties on people in2246exchange for access to life-sustaining services, so, with2247family support, which most people cannot afford, I took a risk2248and decided not to reapply for Medicaid.2249    That said, what I am sharing is not a success story about2250transitioning off Medicaid, as this choice has meant foregoing2251needed care, such as in-home physical therapy multiple times2252per week, which I can only access through the Medicaid program.2253The story here is that HCBS provided by Medicaid were what set2254me up for success.2255    This past October, I married the love of my life. My2256husband and I are now seeking a community to call home near our2257families in New Jersey. We're searching for somewhere2258accessible for my physical needs at this stage of our lives as2259well as for our future needs so we can safely age in place.2260This search has proven arduous in a housing market where2261accessible homes are nearly nonexistent.2262    Our experiences are a stark reminder that the stakes of2263today's hearing are much higher than heartwarming tales of2264being home for the holidays. Without access to HCBS and without2265efforts to prioritize housing and communities that work for2266everyone, people with disabilities and older adults will all2267too easily be pushed out of our homes and communities and into2268institutionalized settings-denied opportunities for everything2269from education and employment to recreation and socialization.2270    But we won't be the only ones missing out. Our friends,2271families, colleagues, and neighbors will miss out on all we can2272contribute to our communities both socially and economically.2273This isn't just about making treasured holiday memories with2274loved ones, although that's a beautiful part of the human2275experience. It's also about fostering a country where all of us2276can grow older assured by the notion that we will always have a2277place to call home.2278    Thank you.22792280=======================================================================22812282                        Questions for the Record22832284=======================================================================22852286                 U.S. Senate Special Committee on Aging22872288     "Aging in Place: The Impact of Community During the Holidays"22892290                            December 3, 202522912292                        Questions for the Record22932294                             Alison Barkoff22952296                        Senator Raphael Warnock22972298    Question:22992300    More than 47,000 older adults and individuals with2301disabilities in Georgia rely on Medicaid Home and Community-2302Based Services (HCBS) for critical personal care assistance,2303meal delivery, and employment support. On July 4, 2025,2304President Trump signed the One Big Beautiful Bill Act (OBBB)2305into law, which cut nearly $1 trillion in Medicaid funding for2306the next several years.2307    How will cuts to Medicaid from OBBB affect Georgians'2308access to HCBS?23092310    Response:23112312    As I discussed in my written testimony, the Congressional2313Budget Office has estimated that OBBB will lead to over $9002314billion in reduced federal Medicaid funding to states over the2315next 10 years. This is the largest cut to Medicaid in the2316program's 60 years history.2317    States must have balanced budgets. To navigate reduced2318federal Medicaid funding, states will either have to find new2319funding - from new taxes or taking funding from another program2320like education - or make cuts to their Medicaid spending.2321Optional services under Medicaid are at highest risk for cuts.2322Under Medicaid law, institutional services like nursing home2323care are mandatory, but HCBS are optional.2324    History has shown that when states have funding shortfalls2325in their Medicaid programs, HCBS are among the first to be cut.2326I, together with researchers from University of California and2327UMass Boston, examined state behavior during the Great2328Recession in the 2010s. We found that every single state made2329cuts to their HCBS programs in response to Medicaid budget2330shortfalls. The full article is available here, and a table of2331state-by-state cuts is here.2332    Cuts to HCBS can happen in different ways. States might2333eliminate HCBS programs or reduce the number of HCBS "waiver2334slots," leading to even longer waiting lists. They might cut2335the hours or types of services available in an HCBS program. Or2336states may reduce HCBS provider reimbursement rates, which are2337already so low that they are limiting access to HCBS. KFF has2338recently published a report on ways that states may manage2339their HCBS spending in response to OBBB. All of these types of2340cuts will hurt people with disabilities, older adults and their2341families; these cuts could force people unnecessarily into2342institutions and/or force families to take on even more care to2343fill these gaps.2344    On a personal level, I am very concerned about cuts to2345Georgia's HCBS programs. My adult brother with intellectual2346disabilities is on Georgia's COMP Waiver. His waiver provides2347him supports to live independently in an apartment with a2348roommate, with a job coach that supports him at his job at the2349Georgia Aquarium, and with supports and transportation to2350participate in community activities. Our parents are in their235180's and would be unable to take on additional care if his2352waiver supports are cut. Many families across Georgia are in2353similar situations.23542355    Question:23562357    How will Georgians' access to these services compare to2358individuals in states like Louisiana that have expanded2359Medicaid?23602361    Response:23622363    It is difficult to compare the impacts of OBBB on HCBS2364access between Medicaid-expansion and non-expansion states. All2365states will face significant cuts to their federal Medicaid2366funding, regardless of whether they have expanded Medicaid. For2367non-expansion states like Georgia, the biggest impacts will2368likely be from new limits on provider taxes, a strategy2369virtually all states (including Georgia) use to finance their2370share of Medicaid costs. In addition, Georgia may also be2371impacted by OBBB's new limits on the use of state directed2372payments to increase provider rates, limiting state strategies2373for addressing low reimbursement rates for HCBS providers. The2374Center for Law and Social Policy has recently released a2375publication about the impact of Medicaid cuts in non-expansion2376states, with state-level information. The publication is2377available here.2378    As discussed in my previous answer, because all states will2379face reductions in federal Medicaid funding, optional services2380like HCBS are at risk of being cut to address those shortfalls.2381Georgia already has approximately 7,300 people on its waiting2382list for HCBS waivers. It is facing a direct care workforce2383crisis due to low wages, and Georgia is still implementing a2384settlement agreement with the U.S. Department of Justice to2385expand access to HCBS in its developmental disabilities and2386mental health systems to address its historical overreliance on2387institutional care and underinvestment in HCBS. Cuts to HCBS2388would undermine the efforts in that settlement, would place2389people at risk of unnecessary institutionalization, and worsen2390the long HCBS waiting list and workforce challenges.23912392    Question:23932394    The Trump administration cut the workforce at the2395Administration for Community Living (ACL) by nearly half on2396April 1, 2025 and proposes to dissolve the agency. Given your2397prior experience as the Acting Assistant Secretary for Aging2398and Administrator of the ACL, how will cuts to ACL's workforce2399affect its important mission of serving older Americans and2400individuals with disabilities?24012402    Response:24032404    ACL is the only federal agency focused on community living2405for older adults and people with disabilities. Not only does2406ACL fund, oversee and support important community living2407programs like those funded under the Older Americans Act,2408Developmental Disabilities Act, and more, but it plays a2409critical role in coordinating across HHS and the federal2410government to ensure that the unique needs of older adults and2411disabled people are considered in federal policy.2412    ACL has been significantly impacted by the reductions in2413force that have occurred at HHS. Nearly half of the staff is2414gone, with the termination of the entire teams that work on2415policy and evaluation, grants and budget, communications and2416external affairs, as well as all regional staff. The2417termination of staff has had significant impacts on ACL's2418ability to get funding out to ACL grantees in a timely manner,2419forcing grantees like Meals on Wheels providers and Protection2420and Advocacy Systems to reduce services due to delays in2421receiving funding following the passage of the Continuing2422Resolutions in March 2025 and again this November 2025. The2423elimination of the policy team has meant that there are no2424staff remaining to continue ACL's important work with other HHS2425agencies on policies that impact people with disabilities and2426older adults, particularly policies related to HCBS issued and2427implemented by the Centers for Medicare and Medicaid Services2428(CMS), and the elimination of all regional staff has meant that2429there are no staff in the field to provide technical assistance2430to grantees and to coordinate responses in emergencies like2431natural disasters.2432    Not only has ACL been impacted by termination of staff, but2433HHS has proposed to eliminate ACL as its own agency and move it2434as a sub-agency into the Administration for Children and2435Families. This will further hinder ACL's ability to fulfill its2436role coordinating aging and disability policy across HHS and2437with other federal agencies.2438    In May, I testified at a hearing led by Senators Welch and2439Baldwin entitled "Trump's Destruction of HHS: Mass Firings,2440Reorganizations, and the Human Harm Caused." In my testimony, I2441discussed the devastating harms caused by the termination of2442staff, reorganization, and cuts proposed in the President's2443Budget. Senator Welch's press release is here, with a link to a2444video of my testimony. I also am attaching a copy of my written2445testimony. In addition, I recently published an article in the2446Public Policy and Aging Report, a peer-reviewed publication of2447the Gerontological Society of America, entitled "How the2448reorganization, staff terminations, and proposed program cuts2449at the U.S. Department of Health and Human Services will impact2450older adults and disabled people," with a focus on the impacts2451at ACL. I also am attaching a copy of that article here.24522453       Alison Barkoff - Attachment for "Questions for the Record"24542455Attachment 1: Alison Barkoff written testimony from May 21,24562025 Senate Democratic Spotlight Hearing, "Trump's Destruction2457of HHS: Mass Firings, Reorganization, and the Human Harm2458Caused."2459[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]24602461       Alison Barkoff - Attachment for "Questions for the Record"24622463Attachment 2: Alison Barkoff. "How the Reorganization, Staff2464Terminations and Proposed Program Cuts at the U.S. Department2465of Health and Human Services Will Impact Older Adults and2466Disabled People." Public Policy and Aging Report (Fall 2025).2467[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]24682469                 U.S. Senate Special Committee on Aging24702471     "Aging in Place: The Impact of Community During the Holidays"24722473                            December 3, 202524742475                        Questions for the Record24762477                              Emily Ladau24782479                        Senator Raphael Warnock24802481    Question:24822483    More than one in four adults live with a disability in the2484United States. Employees with disabilities at the Department of2485Health and Human Services (HHS), including Centers for Disease2486Control and Prevention (CDC) workers in Georgia, are facing2487unjust and haphazard policies that rescind reasonable2488accommodations (RA) and create obstacles for reapplication.2489    As a disability rights advocate, why is teleworking an2490important part of providing RAs?2491    How can Congress protect the rights of employees with2492disabilities against unjust accommodation policies?24932494    Response:24952496    Thank you, Senator Warnock, for inquiring about these2497essential topics. First, I'd like to address the value of2498teleworking as a reasonable accommodation. I've been2499teleworking in some capacity since 2013, well before it became2500a more standard practice because of the COVID-19 pandemic. As a2501physically disabled woman who did not yet have my driver's2502license after I graduated college-because I needed more2503intensive adapted lessons and an adapted vehicle-I worked2504remotely starting with the first full-time job I had. This2505reasonable accommodation proved to be essential as I began to2506build a career in disability advocacy and communications,2507allowing me to work from an environment that was fully2508accessible for me (my home) so I could deliver my best work.2509    In the face of the devastation of the COVID-19 pandemic, it2510was heartening to see how employers and employees alike2511benefitted from implementing telework policies. It opened up2512flexible and safe work opportunities, creating pathways to2513employment for disabled people who could not previously sustain2514jobs for any number of reasons, such as being immunocompromised2515or having a chronic condition. As employers now continue to try2516to shift back to in-person work, I urge them to keep in mind2517that telework is not a barrier, but a boon for workplaces.2518    Regarding accommodation policies more broadly, I urge2519Congress to recognize that reasonable accommodations are not2520"special treatment" and to better understand the purpose that2521they serve in the workplace. While some policymakers may2522believe that reasonable accommodations are simply part of2523"diversity, equity, and inclusion" initiatives that they are2524insistent upon shutting down, the reality is that disability2525does not choose political sides. Anyone can acquire a2526disability at any time due to an accident or onset of an2527illness, regardless of their views. As such, all employees2528should always have access to reasonable accommodations. Beyond2529that, reasonable accommodations are tools that empower2530employees to fulfill their duties, maximizing workplace2531productivity and overall success. There should not be a culture2532of fear around requesting reasonable accommodations, nor should2533the request process be a cumbersome waste of time, as this is2534only to the detriment of progress in the sphere.2535======================================================================25362537                       Statements for the Record25382539=======================================================================25402541                 U.S. Senate Special Committee on Aging25422543     "Aging in Place: The Impact of Community During the Holidays"25442545                            December 3, 202525462547                       Statements for the Record25482549                        Statements from Alabama2550[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]25512552                 U.S. Senate Special Committee on Aging25532554     "Aging in Place: The Impact of Community During the Holidays"25552556                            December 3, 202525572558                       Statements for the Record25592560                         Statements from Alaska2561[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]25622563U.S. Senate Special Committee on Aging25642565     "Aging in Place: The Impact of Community During the Holidays"25662567                            December 3, 202525682569                       Statements for the Record25702571                        Statements from Arizona2572[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]25732574                 U.S. Senate Special Committee on Aging25752576     "Aging in Place: The Impact of Community During the Holidays"25772578                            December 3, 202525792580                       Statements for the Record25812582                        Statements from Arkansas2583[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]25842585                 U.S. Senate Special Committee on Aging25862587     "Aging in Place: The Impact of Community During the Holidays"25882589                            December 3, 202525902591                       Statements for the Record25922593                       Statements from California2594[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]25952596                 U.S. Senate Special Committee on Aging25972598     "Aging in Place: The Impact of Community During the Holidays"25992600                            December 3, 202526012602                       Statements for the Record26032604                        Statements from Colorado2605[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]26062607                 U.S. Senate Special Committee on Aging26082609     "Aging in Place: The Impact of Community During the Holidays"26102611                            December 3, 202526122613                       Statements for the Record26142615                      Statements from Connecticut2616[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]26172618                 U.S. Senate Special Committee on Aging26192620     "Aging in Place: The Impact of Community During the Holidays"26212622                            December 3, 202526232624                       Statements for the Record26252626                        Statements from Delaware2627[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]26282629                 U.S. Senate Special Committee on Aging26302631     "Aging in Place: The Impact of Community During the Holidays"26322633                            December 3, 202526342635                       Statements for the Record26362637                  Statements from District of Columbia2638[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]26392640                  U.S. Senate Special Committee on Aging26412642     "Aging in Place: The Impact of Community During the Holidays"26432644                            December 3, 202526452646                       Statements for the Record26472648                        Statements from Florida2649[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]26502651                 U.S. Senate Special Committee on Aging26522653     "Aging in Place: The Impact of Community During the Holidays"26542655                            December 3, 202526562657                       Statements for the Record26582659                        Statements from Georgia2660[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]26612662                 U.S. Senate Special Committee on Aging26632664     "Aging in Place: The Impact of Community During the Holidays"26652666                            December 3, 202526672668                       Statements for the Record26692670                         Statements from Hawaii2671[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]26722673                 U.S. Senate Special Committee on Aging26742675     "Aging in Place: The Impact of Community During the Holidays"26762677                            December 3, 202526782679                       Statements for the Record26802681                         Statements from Idaho2682[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]26832684                 U.S. Senate Special Committee on Aging26852686     "Aging in Place: The Impact of Community During the Holidays"26872688                            December 3, 202526892690                       Statements for the Record26912692                        Statements from Illinois2693[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]26942695                 U.S. Senate Special Committee on Aging26962697     "Aging in Place: The Impact of Community During the Holidays"26982699                            December 3, 202527002701                       Statements for the Record27022703                        Statements from Indiana2704[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]27052706                 U.S. Senate Special Committee on Aging27072708     "Aging in Place: The Impact of Community During the Holidays"27092710                            December 3, 202527112712                       Statements for the Record27132714                          Statements from Iowa2715[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]27162717                 U.S. Senate Special Committee on Aging27182719     "Aging in Place: The Impact of Community During the Holidays"27202721                            December 3, 202527222723                       Statements for the Record27242725                         Statements from Kansas2726[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]27272728                 U.S. Senate Special Committee on Aging27292730     "Aging in Place: The Impact of Community During the Holidays"27312732                            December 3, 202527332734                       Statements for the Record27352736                        Statements from Kentucky2737[GRAPHIC] [TIFF OMITTED] T2922.13127382739                 U.S. Senate Special Committee on Aging27402741     "Aging in Place: The Impact of Community During the Holidays"27422743                            December 3, 202527442745                       Statements for the Record27462747                       Statements from Louisiana2748[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]2749                 U.S. Senate Special Committee on Aging27502751     "Aging in Place: The Impact of Community During the Holidays"27522753                            December 3, 202527542755                       Statements for the Record27562757                         Statements from Maine2758[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]27592760                   U.S. Senate Special Committee on Aging27612762     "Aging in Place: The Impact of Community During the Holidays"27632764                            December 3, 202527652766                       Statements for the Record27672768                        Statements from Maryland2769[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]27702771                 U.S. Senate Special Committee on Aging27722773     "Aging in Place: The Impact of Community During the Holidays"27742775                            December 3, 202527762777                       Statements for the Record27782779                     Statements from Massachusetts2780[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]27812782                 U.S. Senate Special Committee on Aging27832784     "Aging in Place: The Impact of Community During the Holidays"27852786                            December 3, 202527872788                       Statements for the Record27892790                        Statements from Michigan2791[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]27922793                 U.S. Senate Special Committee on Aging27942795     "Aging in Place: The Impact of Community During the Holidays"27962797                            December 3, 202527982799                       Statements for the Record2800[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]28012802                       Statements from Minnesota2803[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]28042805                 U.S. Senate Special Committee on Aging28062807     "Aging in Place: The Impact of Community During the Holidays"28082809                            December 3, 202528102811                       Statements for the Record28122813                      Statements from Mississippi2814[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]28152816                 U.S. Senate Special Committee on Aging28172818     "Aging in Place: The Impact of Community During the Holidays"28192820                            December 3, 202528212822                       Statements for the Record28232824                        Statements from Missouri2825[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]28262827                 U.S. Senate Special Committee on Aging28282829     "Aging in Place: The Impact of Community During the Holidays"28302831                            December 3, 202528322833                       Statements for the Record28342835                        Statements from Montana2836[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]2837                 U.S. Senate Special Committee on Aging28382839     "Aging in Place: The Impact of Community During the Holidays"28402841                            December 3, 202528422843                       Statements for the Record28442845                       Statements from Newbraska2846[GRAPHIC] [TIFF OMITTED] T2922.18528472848                 U.S. Senate Special Committee on Aging28492850     "Aging in Place: The Impact of Community During the Holidays"28512852                            December 3, 202528532854                       Statements for the Record28552856                         Statements from Nevada2857[GRAPHIC] [TIFF OMITTED] T2922.18628582859                 U.S. Senate Special Committee on Aging28602861     "Aging in Place: The Impact of Community During the Holidays"28622863                            December 3, 202528642865                       Statements for the Record28662867                     Statements from New Hampshire2868[GRAPHIC] [TIFF OMITTED] T2922.18728692870                 U.S. Senate Special Committee on Aging28712872     "Aging in Place: The Impact of Community During the Holidays"28732874                            December 3, 202528752876                       Statements for the Record28772878                       Statements from New Jersey2879[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]28802881                 U.S. Senate Special Committee on Aging28822883     "Aging in Place: The Impact of Community During the Holidays"28842885                            December 3, 202528862887                       Statements for the Record28882889                       Statements from New Mexico2890[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]28912892                 U.S. Senate Special Committee on Aging28932894     "Aging in Place: The Impact of Community During the Holidays"28952896                            December 3, 202528972898                       Statements for the Record28992900                        Statements from New York2901[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]29022903                 U.S. Senate Special Committee on Aging29042905     "Aging in Place: The Impact of Community During the Holidays"29062907                            December 3, 202529082909                       Statements for the Record29102911                     Statements from North Carolina2912[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]29132914                 U.S. Senate Special Committee on Aging29152916     "Aging in Place: The Impact of Community During the Holidays"29172918                            December 3, 202529192920                       Statements for the Record29212922                          Statements from Ohio2923[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]29242925                 U.S. Senate Special Committee on Aging29262927     "Aging in Place: The Impact of Community During the Holidays"29282929                            December 3, 202529302931                       Statements for the Record29322933                        Statements from Oklahoma2934[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]29352936                 U.S. Senate Special Committee on Aging29372938     "Aging in Place: The Impact of Community During the Holidays"29392940                            December 3, 202529412942                       Statements for the Record29432944                         Statements from Oregon2945[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]29462947                 U.S. Senate Special Committee on Aging29482949     "Aging in Place: The Impact of Community During the Holidays"29502951                            December 3, 202529522953                       Statements for the Record29542955                      Statements from Pennsylvania2956[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]29572958                 U.S. Senate Special Committee on Aging29592960     "Aging in Place: The Impact of Community During the Holidays"29612962                            December 3, 202529632964                       Statements for the Record29652966                      Statements from Rhode Island2967[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]29682969                 U.S. Senate Special Committee on Aging29702971     "Aging in Place: The Impact of Community During the Holidays"29722973                            December 3, 202529742975                       Statements for the Record29762977                     Statements from South Carolina2978[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]29792980                 U.S. Senate Special Committee on Aging29812982     "Aging in Place: The Impact of Community During the Holidays"29832984                            December 3, 202529852986                       Statements for the Record29872988                      Statements from South Dakota2989[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]29902991                   U.S. Senate Special Committee on Aging29922993     "Aging in Place: The Impact of Community During the Holidays"29942995                            December 3, 202529962997                       Statements for the Record29982999                       Statements from Tennessee3000[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]30013002                 U.S. Senate Special Committee on Aging30033004     "Aging in Place: The Impact of Community During the Holidays"30053006                            December 3, 202530073008                       Statements for the Record30093010                         Statements from Texas3011[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]30123013                 U.S. Senate Special Committee on Aging30143015     "Aging in Place: The Impact of Community During the Holidays"30163017                            December 3, 202530183019                       Statements for the Record30203021                          Statements from Utah3022[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]30233024                 U.S. Senate Special Committee on Aging30253026     "Aging in Place: The Impact of Community During the Holidays"30273028                            December 3, 202530293030                       Statements for the Record30313032                        Statements from Vermont3033[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]30343035                 U.S. Senate Special Committee on Aging30363037     "Aging in Place: The Impact of Community During the Holidays"30383039                            December 3, 202530403041                       Statements for the Record30423043                        Statements from Virginia3044[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]30453046                 U.S. Senate Special Committee on Aging30473048     "Aging in Place: The Impact of Community During the Holidays"30493050                            December 3, 202530513052                       Statements for the Record30533054                       Statements from Washington3055[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]30563057                 U.S. Senate Special Committee on Aging30583059     "Aging in Place: The Impact of Community During the Holidays"30603061                            December 3, 202530623063                       Statements for the Record30643065                     Statements from West Virginia3066[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]30673068                 U.S. Senate Special Committee on Aging30693070     "Aging in Place: The Impact of Community During the Holidays"30713072                            December 3, 202530733074                       Statements for the Record30753076                       Statements from Wisconsin3077[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]30783079                 U.S. Senate Special Committee on Aging30803081     "Aging in Place: The Impact of Community During the Holidays"30823083                            December 3, 202530843085                       Statements for the Record30863087                        Statements from Wyoming3088[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]30893090                    U.S. Senate Special Committee on Aging30913092     "Aging in Place: The Impact of Community During the Holidays"30933094                            December 3, 202530953096                       Statements for the Record30973098        Statements from Organizations, Nonprofits, and Providers3099[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]31003101                 U.S. Senate Special Committee on Aging31023103     "Aging in Place: The Impact of Community During the Holidays"31043105                            December 3, 202531063107                       Statements for the Record31083109                         Additional Statements3110[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]31113112                                 [all]