S. HRG. 112–804 SENIOR HUNGER AND THE OLDER AMERICANS ACT HEARING BEFORE THE SUBCOMMITTEE ON PRIMARY HEALTH AND AGING OF THE COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS UNITED STATES SENATE ONE HUNDRED TWELFTH CONGRESS FIRST SESSION ON EXAMINING SENIOR HUNGER AND THE ‘‘OLDER AMERICANS ACT’’ JUNE 21, 2011 Printed for the use of the Committee on Health, Education, Labor, and Pensions ( Available via the World Wide Web: http://www.gpo.gov/fdsys/ U.S. GOVERNMENT PRINTING OFFICE 82–326 PDF WASHINGTON : 2013 For sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800 Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001 COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS TOM HARKIN, Iowa, Chairman BARBARA A. MIKULSKI, Maryland MICHAEL B. ENZI, Wyoming JEFF BINGAMAN, New Mexico LAMAR ALEXANDER, Tennessee PATTY MURRAY, Washington RICHARD BURR, North Carolina BERNARD SANDERS (I), Vermont JOHNNY ISAKSON, Georgia ROBERT P. CASEY, JR., Pennsylvania RAND PAUL, Kentucky KAY R. HAGAN, North Carolina ORRIN G. HATCH, Utah JEFF MERKLEY, Oregon JOHN MCCAIN, Arizona AL FRANKEN, Minnesota PAT ROBERTS, Kansas MICHAEL F. BENNET, Colorado LISA MURKOWSKI, Alaska SHELDON WHITEHOUSE, Rhode Island MARK KIRK, Illinois RICHARD BLUMENTHAL, Connecticut PAMELA SMITH, Staff Director LAUREN MCFERRAN, Deputy Staff Director FRANK MACCHIAROLA, Republican Staff Director and Chief Counsel SUBCOMMITTEE ON PRIMARY HEALTH AND AGING BERNARD SANDERS, Vermont BARBARA A. MIKULSKI, Maryland RAND PAUL, Kentucky JEFF BINGAMAN, New Mexico RICHARD BURR, North Carolina ROBERT P. CASEY, JR., Pennsylvania JOHNNY ISAKSON, Georgia KAY R. HAGAN, North Carolina ORRIN G. HATCH, Utah JEFF MERKLEY, Oregon LISA MURKOWSKI, Alaska SHELDON WHITEHOUSE, Rhode Island MICHAEL B. ENZI, Wyoming (ex officio) TOM HARKIN, Iowa (ex officio) ASHLEY CARSON COTTINGHAM, Staff Director PETER J. FOTOS, Minority Staff Director (II) CONTENTS STATEMENTS TUESDAY, JUNE 21, 2011 Page COMMITTEE MEMBERS Sanders, Hon. Bernard, Chairman, Subcommittee on Primary Health, and Aging, opening statement .................................................................................... 1 Paul, Hon. Rand, a U.S. Senator from the State of Kentucky ............................. 3 Franken, Hon. Al, a U.S. Senator from the State of Minnesota .......................... 5 Hagan, Hon. Kay R., a U.S. Senator from North Carolina .................................. 49 WITNESS—PANEL I Greenlee, Kathy, Assistant Secretary, Administration on Aging, U.S. Depart- ment of Health and Human Services, Washington, DC ................................... 6 Prepared statement .......................................................................................... 8 WITNESSES—PANEL II Blancato, Robert, Executive Director, National Association of Nutrition and Aging Services Program, Washington, DC ......................................................... 18 Prepared statement .......................................................................................... 20 Gordon, Kenneth E., Executive Director, Area Agency on Aging for North- eastern Vermont, St. Johnsbury, VT .................................................................. 25 Prepared statement .......................................................................................... 27 Brown, Kay E., Director, Education, Workforce and Income Security, Govern- ment Accountability Office, Washington, DC .................................................... 29 Prepared statement .......................................................................................... 31 Koren, Mary Jane, M.D., M.P.H., Vice President, Picker/Commonwealth Fund Long-Term Quality Improvement Program, The Commonwealth Fund, New York, NY ............................................................................................................... 38 Prepared statement .......................................................................................... 39 ADDITIONAL MATERIAL Statements, articles, publications, letters, etc.: AARP ................................................................................................................. 53 Feeding America ............................................................................................... 55 The Gerontological Society of America ........................................................... 60 Hunger Free Vermont ...................................................................................... 60 Meals on Wheels Association of America ....................................................... 62 An Overview of Senior Hunger in the United States, James P. Ziliak & Craig Gundersen ....................................................................................... 70 Jeff Gordon, Inc., letter .................................................................................... 72 (III) SENIOR HUNGER AND THE OLDER AMERICANS ACT TUESDAY, JUNE 21, 2011 U.S. SENATE, SUBCOMMITTEE ON PRIMARY HEALTH AND AGING, COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS, Washington, DC. The subcommittee met, pursuant to notice, at 10:02 a.m. in Room 430, Dirksen Office Building, Hon. Bernard Sanders, chairman of the subcommittee, presiding. Present: Senators Sanders, Hagan, Franken, and Paul. OPENING STATEMENT OF SENATOR SANDERS Senator SANDERS. Good morning and welcome to a hearing of the Committee on Health, Education, Labor, and Pensions Sub- committee on Primary Health and Aging. Today’s hearing is ad- dressing a very important issue and I want to thank everybody for being here, especially our panelists. I don’t have to tell anybody in this room that our country today faces some enormously serious problems, and one of them is that, in a time of severe recession, high unemployment, and increased poverty, how do we make certain that all of our people, especially the most vulnerable, those unable to take care of themselves, are able to maintain at least a minimal standard of living. In my view, the problem that we are discussing today, food secu- rity among seniors, is both a moral issue and it is a financial issue. So we’re going to be going over both of those aspects of the problem this morning. From a moral perspective, it is clear to me that in this great Nation no one should go hungry, especially those who are old and frail and unable to take care of themselves. From a fi- nancial perspective, what is also clear—and we will hear testimony about this this morning from our panelists—is that investing in senior nutrition and in well-designed senior programs in general saves money. Let me repeat that: Saves money for the government, because when we do that, when we make sure that our seniors have adequate nutrition, among other things, at the end of the day those seniors are not going to be ending up in a emergency room, those seniors are not going to be ending up in a hospital when they should not be in a hospital, and in many cases they’re not going to be ending up in a nursing home. I think one of the main points that I want to make this morning and we’ll pursue with our panelists, is that investing in seniors, making sure that seniors have the nutrition that they need, is not (1) 2 only the right and moral thing to do; it is the financially smart thing to do. Today the situation in our country with regard to hunger among seniors is not anything that we should be proud of and is some- thing that must be significantly improved. As the baby boom gen- eration transitions into their senior years, an ever-expanding num- ber of our Nation’s seniors grapple with issues of food insecurity and malnutrition. In fact, the hunger rates for lower income sen- iors have more than doubled in recent years. In the wake of the recession, there is a growing demand for both home-delivered and congregate meal programs, and there is evi- dence indicating that some of our poorest and most functionally limited seniors are simply not getting the nutrition they need. Sometimes here on Capitol Hill, in this beautiful room, it is hard to imagine that right now all over this country there are hundreds of thousands, if not millions, of seniors sitting alone, perhaps suf- fering from one or another degree of dementia, confused about the medications they are taking, not able to prepare the food that they need in order to take care of themselves. But that is a reality that is going on in our country and a reality that we as Americans have got to address. It is estimated today that 5 million seniors face the threat of hunger, 3 million seniors are at risk of hunger, and 1 million sen- iors go hungry because they cannot afford to buy food. But in some cases it’s not just money. In some cases it’s having the transpor- tation to get to the store. In some cases it’s the ability to think through, when you’re 85 or 90 and alone, what kind of food you need and how you purchase it. This issue is important again not only from a moral perspective, but from a financial one as well. Persistent hunger and malnutri- tion leads to multiple chronic diseases, resulting in extended hos- pital stays and premature nursing home placements. There are some studies out. They’re not quite sure about what percentages of seniors today who are in nursing homes, and might not need to be in that expensive care, if they had good nutrition and somebody visiting them on a regular basis. That seems to me to be pretty dumb, not a good way to spend Federal money. Medicaid is paying for 70