Transcripts For CSPAN2 Senior Health And Retirement Strategies 20180125

Senator collins good morning, the committee will come to order. For the next 12 years, 10,000 americans will turn 65 each day. Joinednth, i officially the club. Age, maine is ing most rapidly. They account for 94 of the 2016. Tion of the state in that is a 22 increase from the year 2010. No matter where in the country you live, when americans think of turning 65, we traditionally think of medicare and Social Security, as well be shown. Today, more than ever, there is an opportunity to plan for a brandnew chapter of life, as more americans are living longer. One out of four americans who lives to the age of 65 can expect to live in their 90s. 85 and older is the fastestgrowing segment of our population. For many seniors, this longevity needs an additional three decades followed what was once considered the age of retirement. We need to plan to age successfully and achieve a new chapter of continued growth in our lives. Makee same time, we must those all important decisions regarding medicare and Social Security. As i know from my own visit to ma Social Security office in , where everyone was extremely helpful, there are important decisions to make, and the program can be very complex to navigate. Is best to start considering options before that 65th birthday comes around. For example, the enrollment ,indow for medicare is limited there are penalties for late enrollment. Beginsck to sign up three months before the 65th birthday and extends for three months after. Sign up late, particularly for b, can lead to a hefty penalty. It can be confusing to navigate these hurdles. As well as to choose the right package to suit individual health care needs. Those who are collecting Social Security benefits when they turn to exceed five 65 are automatically enrolled in medicare. Americans are choosing to work longer as our Senate Aging Committee shows, in their annual report that was issued last year when we chose to look at americas aging workforce. For Many Americans working longer, that means delaying Social Security and then being able to collect much higher monthly benefits later. Whiches one know decision is best . What is the ultimo ultimate time to have Financial Stability in the long run . When should you be considering health care and reducing costs . Those are some of the s we will be examining today. We will also explore another issue. Why we have formulas to help guide us through the best medicare and Social Security decisions, there is no simple formula for healthy aging. If we were to create a checklist for healthy aging, what would it include . Are proven choices that one can make to maximize health and wellbeing. While genetics determine about 20 of longevity, lifestyle, and environment the other 80 . Staying physically active, eating well, conversing with friends, reading and engaging with books, doing something meaningful every day, and taking proactive steps to improving wellness, all contribute to healthy aging. Physical,e know social, and cognitive engagement is good for you. Few people realize that it remains critical at every lifestage. Especially in older adulthood. Even for those who face multiple chronic conditions and frailty, proactive actions can reverse this course and lead to a healthier future. That can be difficult in states like mine which are very rura and where people may feel isolated from one another. I would like to share with you the story of sandy a healthy 80yearold woman. One winter morning she stepped outside to take her dog out, she slipped and broke her leg. Once an active woman, she found herself unable to walk. , andwing surgery, rehab physical therapy, she was able to get around with a walker but stayed home for days at a time. Dumps, herwn in the daughter convince her to try a program called a matter of balance. It is a Hospital System based in maine. This program reduces fear of falling and improves balance. The program literally changed her life. Each week, she regained strength. She traded the walker for a cane , soon after she shut the cane too. Today she is a coach for that program. She is able to walk miles on hasand feels like she her life back. Her story shows that even after a fall, we have the capacity to get back up and age well. It also shows how important those programs can be in helping a senior regain his or her life. Today more and more americans have a chance to live to 100. The fastestgrowing age group and the states, the second fastestgrowing age group is 100 and older. Turning 65 once meant it was time to retire and slow down, today it is an opportunity to prepare for a lifetime ahead. A lifetime of living, learning, and loving. A lifetime of Financial Security , if the right decisions are made. Society, what and do we need to do to get there . What choices should we make . Useful we disseminate information to the senior population . I look for to our conversations about these important issues, and i am pleased to turn to senator case for his opening statement. Y senator casey i want to thank senator collins for the good work she has done and what has been a long week. Every day, 10,000 americans turning 65 in the United States of america, 10,000 people every day. That is a Staggering Number, today we will hear that people turning 65 race their own Staggering Number of decisions at that time in their life. They must be thinking about a range of issues, claiming Social Security, a also have to think about signing up for medicare, and getting what they need to stay healthy. These are not simple decisions. There is no onesizefitsall decision. That is what i hear from my constituents, in pennsylvania specifically, we hear about it day after day. Our office wrigley works with pennsylvanians who missed their window to signed up. Whoe is a woman with cancer did not know to sign up. There are people who have made an honest mistake, who did not know they needed to sign up for medicare. It could happen to anyone of us. Now they are paying higher premiums for the rest of their life. Maintenance0 and so are paying late enrollment for Medicare Part b. Almost 700,000 americans are on the hook for that late penalty. Aat is a 30 increase in persons income. That is outrageous. It is unacceptable, considering livingtirees are already under fixed incomes. Medicare is one of our Great Success stories, it is our sacred responsibility to make sure the people can make the most of the medicare benefits that they have earned. That is why i introduced the Medicare Beneficiary enrollment. Nd eligibility at it is a good thing we have an acronym. What that act does is make sure every american receives a notice before they turn 65 that explains went to sign up for medicare, and what can happen if you delay. For is the least we can do so Many Americans. This bill would also make sure fewer people experience a gap in health coverage. This change would up the parts of medicare law that has not been revisited since the program was created more than 50 years ago. Legislation, that it is bipartisan, it represents how congress should work. Hear about what is not working and most challenging for our constituents. We should Design Solutions to fix those problems. We should be able to pass these laws because they help the people that we serve. The people that deserve that kind of law. I look forward to todays hearing, i hope we can illuminate some of these problems. With the same problems that Susan Collins and i can work on. Thank you. Senator collins thank you very much. Turning to the after dark the comments of our witnesses, i do want to recognize and welcome member,committee senator jones from alabama. We have the opportunity to work very closely together the last releasing moreve of each other than you would probably like. You have joined this committee. I think you will find it to be a great committee. Sitting next to our most diligent member, if you follow her lead i am sure you will have a great experience. Welcome. Is thest witness today acting Deputy Commissioner for communications at the Social Security administration. He will discuss the spectrum of tools and Resources Available to rightmericans choose the retirement benefit for the individual need in the circumstances. Hear from the chief Strategy Officer and senior vice atsident of external affairs the National Council on aging. In her home state of arizona she helped launch the 2020 initiative that created the Arizona Division of adult services. Anld like to introduce adjunct clinical assistant professor of medicine at stanford university. She she is a Board Certified physician in geriatric meshes medicine. He promotes wellbeing through disease management and prevention. I will now turn to our Ranking Member to introduce our witness from pennsylvania. I want to start by congratulating ms. Hill, i am told you know have your seventh grandchild. Congratulations. That is a grandson . That is good news. We need some of that around here. Of four volunteer years, she has worked weekly to and counsel pennsylvanians their families providing information to make the most of the medicare benefits. She will tell us how she came to this work and why it is so important to help people to understand medicare, she will also talk about some of the common questions she helps people with. As well as some of the missteps family make when they do not understand key information. I also want to recognize her granddaughter who is here with us. , thank you for being here with us and supporting your grandmother. You must be very proud of her, i hope you will be back here providing information before congress someday. Thank you for being here. We will nowins start with mr. Borland. Mr. Borland thank you. Members of the special committee, i am acting commissioner for communications and Social Security. Thank you for inviting me to provide information to help workers and their family members decide when to claim Social Security benefits and when to enroll in medicare. These decisions are important, we are mindful of our responsibility to provide information to help our claimants make informed choices. We believe workers need to be thinking about their decisions before they arrive at the field office. Outreach ise our important. The decision workers make help jumpstart Retirement Benefits are very important as they will affect them the rest of their lives. Thethis reason, even before individual applies for Social Security benefits or enroll in medicare, we provide objective information that they may use. We do this in a variety of ways, including our website, publications, outreach, and the Social Security statement. The Social Security statement in particular shows information on lifetime earnings, as well as estimates of future benefits families may receive on those earnings. Individuals may access their statement at any time through a Social Security accounts. We also currently mail statements to individuals aged 60 and older who are not receiving Social Security and do not have a my social streak out. Millionical 2017, 15. 6 my Social Security users access their sosa security statements nearly 46 million times. We mailed around 13. 5 million statements. In addition to basic benefit Information Company statement includes information on how work affects benefits, how a workers claiming decision affects survivor benefits, how to avoid medicare late enrollment in all these, and information on average life expectancy. Another viable research is our website. Each month, nearly 15 Million People visit us online to get the information they need to make informed decisions about their benefits. The website includes a retirement estimator which is a powerful and popular and accurate tool. It uses an individuals actual earnings information from our records and allows him or her to input a few pieces of information to receive an estimate of benefits. It returns benefit estimates aged 62 at the retirement age, an age 70, or any agent between. Our retirement estimator is one of governments highest rated websites. We recognize that not everyone chooses to use the internet. Our committed employees assist the public in a variety of ways, through facetoface interaction in our field offices, by telephone, including over the national 800 number, in response to online applications, and through the mail. We also have over 100 Public Affairs specialist who, along with our field office managers, participate in more than 6000 outreach events last fiscal year with an estimated audience of more than 3. 7 Million People. These range from small rural gettogethers in public libraries, Senior Centers, churches, and veterans organizations, to large gatherings like county fairs, state fairs, senior expos, and avoid meetings. Whether the attendance is is in the tens or thousands, Social Security employees helping americans better understand their benefits. We play a key role in citing people up for medicare, although the centers for medicare and medicare services, administers the Medicare Program and Social Security is responsible for enrollment. We provide information and medicare enrollment options for those of become eligible, whether or not they are already receiving Social Security benefits. We continue to strengthen our partnership with cms to improve communications with those nearing the medicare eligibility age of 65. We have updated the statements for older individuals to strengthen the message about when to apply for medicare and to make information more permanent. We have clarified language about late enrollment penalties in many publications to by establishing the Social Security and Medicare Programs, Congress Took action to provide seniors with benefits based on their earnings to sustain them throughout their retirement. As stewards of these programs, our job is to help workers make wellinformed decisions that are best for the individual circumstances. I thank you for the invitation to be here today and i look forward to answering any questions you may have. Sen. Collins thank you very much. Chairwoman collins and members of the committee, thank you for the opportunity to speak with you today on behalf of the National Council on aging. I am their chief strategy of the server and Senior Vice President for external affairs. We are the nations oldest aging advocacy organization. Life after 65 has changed dramatically since we started in 1950. Where retirement once met a few years of leisure with secure pensions, todays Older Americans have the gift and challenge of planning for 2030 years of life. You are prepared. If you are prepared, traditional retirement plans have traditionally disappeared and individual savings retirements have not caught up. Longer life brings new health challenges. Women face unique kernels. They begin hurdles, they begin retirement that is full of many, the pay gap, lowercase means less money saved. Women who choose to leave the workforce to be a parent or caregiver have fewer Social Security benefits buildup. Women of color face an even deeper disparity. Over 70 of older Hispanic Women and over 64 of older africanamerican women are economically vulnerable. We know there are proven costeffective ways to help americans navigate life after 65. With the help of thousands of partners, our Program Addresses to essential pillars of life passed 65, health and economic security. Health is essential to independence, but older adults are disproportionately affected by chronic conditions such as diabetes, arthritis, and heart disease. The good news is that chronic conditions can be prevented and managed. One example is the chronic disease selfmanagement program, available in community and online. It improves health and saves money. With help from congress, ncoa hopes to bring this to thousands of older adults. Falls are another Significant Health concern. The facts are alarming. , an older adult is treated in the emergency room for a fall. Adult19 minutes, an older dies from a fall. Medicare cause cost medicare 31 billion per year. They are preventable. Programs offers in committee such as a matter of balance and tai chi can reduce false by as much as 55 . Ncoa leads to National Initiatives to combat falls and ry september we set sponsor Fall Prevention awareness day to spotlight the issue. Thank you to senator collins and senator casey for sponsoring the 2017 senate resolution. Social isolation and loneliness are problem for millions. Older adults without adequate social interaction have a mortality risk comparable to smoking 15 cigarettes a day. In the community, Senior Centers are a beacon for older adults seeking social connections. They are a gateway to the nations aging network. Connecting seniors to support and fund and friendships. Ncoa runs the National Institute of Senior Centers to promote excellence and best practices. When it comes to health, we believe prevention should be a national priority. Investing in programs like these improve senior quality of life and saves money. Economic security is just as critical. Today, half of older adults living alone struggled to meet their monthly expenses. I want to share two ways that ncoa is working to change this. Thannefits access, less half of eligible seniors are enrolled in Public Benefits programs. We support local benefits counselors and offer benefits checkups, a free online benefit screening tool that has helped nearly 6. 5 Million People. Second is improving medicare. Anyone who has turned 65 can tell you how overwhelming it can be to understand and enroll. In making poor decisions can hurt you through higher costs, coverage gaps, and lifetime penalties. We support the bipartisan act introduced by senator casey which aims to simplify enrollment. Thank you for your leadership. Continued funding for low income benefits outreach enrollment and full funding for the Medicare State Health Insurance Assistance program are critical. They provide local counseling to medicare beneficiaries, their families, and caregivers. Help navigating life after 65 and that is why ncoa developed our own innovative approach called aging Mastery Program which we callamp. A fun programther that give seniors a pathway to age well, more than 10,000 seniors have graduated. In conclusion, aging well means making informed and deliberate choices. Ncoa offers tools and solution to help seniors do just that. We look forward to working with the committee to develop even more resources to help people navigate life after 65. Sen. Collins thank you. Madam chair, ranking and distinguished members, thank you for inviting and giving me the opportunity to discuss the challenges regarding this aging population in the United States. Educatorardcertified representing myself as a physician who has treated and managed and continues to treat thousands of senior americans. Today, the number of americans aged 65 and older is approximately 49 million, we are about 7000 dear attrition practicing in the United States and we need about 20,000 for the need we have. This aging population faces multiple challenges and i am giving my opinion about the challenge. Lack of fixed experience in geriatric medicine. Health care and Education System has not been designed to train enough senior care providers who can specifically manage seniors. As we age, our physiology changes and it is crucial to be managed by Health Care Providers who have been educated and trained in this field. In the u. S. , 80 of seniors have at least one chronic condition. 40 of the seniors take at least five medications, not taking into account over the counter supplements and herbal remedies. They see many different specialists and prescribed a number of different medications the reach which can result in over medication and drug cascade syndrome. Lack of scientific and research backed medical information regarding aging. Despite the fact that we lead in an era of advanced technology, with massive amounts of information on the subject of validity of much of the information is highly questionable. Or example, misleading Marketing Campaign at every corner are enticing seniors to take drastic measures such as taking unregulated vitamins and supplements and undergo harmful diet to live longer and healthier. This is regardless of the fact that the Scientific Data collected over many years indicates such overthecounter supplements and drastic diet are not contributing to Better Health and could even be detrimental to our health. The next challenge is the elderly are becoming more racially and ethnically diverse. In 2014, 15 of people 65 and older live in homes where a language other than english was spoken. We lack the resources to address the challenges of this growing ethnic and racial group. Next challenge, most important, we live in aging society, and transitional society, the elderly hold unexceptional status in the community. They are considered they are highly respected. In the u. S. , that is not true. Older adults are often forced out of the workforce and replaced by cheaper and on under skilled labor, they usually retire to solitude of their houses and become isolated and lonely. , they haveuence depression and Cognitive Impairment and later they will be institutionalized and set aside by society they built and the children they raised. They can be mistreated, cheated, and taken advantage of. Lack of infrastructure and resources are the next challenge , lack of appropriate resources and transportation, affordable housing, Senior Centers, organized and affordable social activities, and qualified health care centers. The next financial difficulty, a large number of seniors are living in poverty. Often they are faced with hard choices between paying their rent or mortgage, buying the many medications they cannot live without, or purchasing food. Too often they become not only financially, but physically dependent on their children, which are known as the sandwich generation. Robotic mentality is next, ieve in modern society, we more is considered better and this mentality tells us that for every single problem, there should exist a quick fix, even if there is no logic behind it. Modern medicine dictates that thing should be fixed with either medications or intervention, or procedure. In reality, the statistics do not support this. Medicare expenditure is the last challenge, the medicare system does not pay for medical Necessity Services which can have tremendous impact to physical and mental quality of life for older adults. Thank you for this opportunity and i will be happy to answer any questions and discuss how to fix this. Sen. Collins thank you. Mrs. Hill, welcome. Chairman colin, Ranking Member casey, and members of the committee. Thank you for this opportunity to testify today. It is an honor to be here. My name is sharon hill, i am 63yearold and a resident of vanderbilt, pennsylvania, i have two sons, and seven grandchildren. My youngest grandchild was born tuesday to my granddaughter august has joined me today. She is the volunteer with me at many of the Senior Centers i go to. I am a volunteer with the pennsylvania price program, nationally apprised is known as the state Health Insurance Assistance Program, ship. In addition to volunteering, i work cleaning my church, i care for my 89yearold father, and health care for my 92yearold neighbor who is blind. I have a disability myself and rely on the support of state and federal programs to remain active and engaged in my community. At a prize volunteer for four years and initially saw an advertisement in the local askingtimes newspaper for volunteers to help people with medicare issues. Medicareime, i was on because of a disability and had 67,000 been left with in medical bills after a cancer diagnosis. I recalled the difficult decisions my parents had to make about their Medicare Coverage. Both events were behind my interest in volunteering for the apprised program. Dobe a volunteer, i had to i had to attend many training sessions. At these sessions, i learned about the different parts of medicare, including Medicare Part a, b, c, d, and medigap. I learned about the programs that can help low income seniors and people with disabilities. This would be like medicare extra help, and even pennsylvania specific programs that help individuals who have high medical expenses. I was trained on how to use the Computer System and enter information into the medicare plan finder. Each year we received a Refresher Training to provide volunteers with any updated information that the Insurance Companies are offering. However, the more i learned, the ,ore i realized i did not know people have a lot to consider when signing up for medicare. And the decisions can be daunting. I wish i would have known about the resources sooner, because, if i had known about the program i am on now, mod, i would not have had the intense medical expenses i had earlier. It is because of my own experiences that i am passionate about the apprised program. It is the only place that older adults can go in person to get unbiased information. This helps them with their medicare decisions. As a volunteer, i give speeches and local Senior Centers and provide in person counseling sessions. Each counseling session is 6090 minutes long and, during medicare open enrollment season, we are very busy. Sometimes people come in with specific questions about their coverage and other times we are starting with the basics. It is common for people to make Medicare Coverage visit and based decisions based on the wellintentioned advice of friends, family, or other places. What i have learned during my time as a volunteer is that people do not have all the information they need to make the best decisions for their health care or financial needs. And making a bad decision when signing up for medicare can have unintended, lifelong consequences. When i see people with gaps in coverage, or seniors paying lifelong penalties, it is often because of misinformation. Knowledge is important in helping beneficiaries maximize their benefits and avoid the pitfalls of lifelong penalties. Thankfully, as in a prize volunteer, i am trained to help a prize volunteer, im pregnant people who have we liaison withsinformatio organizations to appeal a decision or screen people for programs that help cover the cost of their medication. Counselors not only provide information, they help beneficiaries navigate a complex is the answer as advocates. We find that, once people come for help, they come back each year to be sure they are coverage is right their coverage is right. Peoples lives are changing and they need to be educated or they will fall through the cracks. It is because of this, i tell everyone i meet about the program. Counselors do not make medicare decisions for beneficiaries. We instead provide them with information so they are able to make the best choices for themselves. I thank you for the opportunity to testify before the committee and i look forward to answering any of your questions. Sen. Collins thank you very much, mrs. Hill. You just gave a compelling case for why it would be a mistake to implement the administrations proposal to eliminate altogether h. I. P program and i am pleased to say that has been rejected by the Appropriations Committee on which i serve. If anyone needs further proof, i am quoting your testimony. [laughter] doctor, i want to start with you, you gave a compelling statistic about the number of seniors, more than 40 , who take at least five prescription medications, plus over the counter supplements and herbal remedies. Obviously can lead to over medication, but also something that i understand is called drug testing syndrome. Effects resultde in another prescription for the senior. I met last year with a position in maine who was doing house calls on seniors. The first thing he has them do is bring out all the Prescription Drugs and overthecounter remedies they are taking. In every case, he has been able to reduce the number. It was extraordinary. He did before and after pictures of the number of bottles of pills and it was incredible. Elaborate a little bit more for me on why this problem exists and why there is not better coordination among all of the specialists that a patient may be seen. That is a great point, thank you. I believe it is the biggest problem for older adults, exactly as you say, over medication. The first reason, which i think is part of the when we come to the conclusion that for everyone turning 65, i like to decide if the package about the benefit of medicare, we should give them basic information to be careful about pharmacies in the future because, as we age, the risk of chronic disease is higher and more chance to get medication. One of the reasons is because the way that we train students, the way we train doctors, we have 16,000 physicians being trained in medical schools in the u. S. The way we train them, i have been training the same way, we become we want to not disappoint our patients. , thathey have a problem is why i said about robotic mentality, quickfix, there should be a medication to fix a problem. We forget sometimes to discuss pros and cons of treatment intervention. Talk about side effects. As we discussed the physiology changing and as we age, this is not happening when we are in the decade,s, 30s, every our physiology changes and we are more susceptible to adverse reactions. One thing is happening, the patient did and dr. , they are expecting, finally i will get the medication, and when they come out from the office with the medication, they take it and there is no followup because one of the big problems we do not explain therapeutic endpoint for medication. I give you the medication because i want you to reach a therapeutic endpoint, if you do not, we need to stop. I cannot take how many times i have been in Public Places and discuss this topic and a lot of people, they said i take 18 kinds of medication and i do not know why. Just because the doctor prescribed it for me and i keep asking the pharmacy to refill it. Patients do not know. The physicians do not follow that. We have programs encouraging doctors and hospitals to do medication reconciliation, which is going through the list to make sure they are taking all of this medication or not. We should have another conversation, we should really go at one point and tell the patients that, you have to come every visit when you get your annual wellness with your doctor, to review all the medications, and if you are not a candidate to continue the medication, dont. Many times i have 90yearold eat, theyot able to give a high dosage of cholesterol medication, it is preventing a stroke in five and 10 years, i am decorating, what am i treating for . Why am i giving cholesterol medication to someone not able to take a sip of water . I am glad i have the opportunity. Many times i have cost this patients whose only prognosis is less than six months or two weeks, they are crushing vitamins and some and supplements and applesauce and they cannot swallow them. Why . This needs to be changed and we need to bring Public Education as to all the people, when they start turning to medicare to have the information, you need to discuss about the medication. And go to medical school and train your doctors, it is ok if you tell your patient that, may be a strategy of watching weight is the best strategy rather than jumping to prescribing other medications. Sen. Collins thank you, very much for that thorough answer. I have many more questions but i will save them for the next round. Senator casey . Sen. Casey thank you. Sharon, i will start with you, i hope you do not mind i usually first name. We are formal but you are from pennsylvania, we can be informal. Thank you for your testimony. Probably the first time you ever testified and you not only did it well but you are begot action, senator collins is already working on something based upon what you said. A great country, right . Yes it is. Sen. Casey i was struck by a lot of what you said. In particular, one line jumped out. You said that, in your testimony, people have a lot to consider when signing up for medicare. And the decisions can be daunting. That is a pretty good summation. These are difficult decisions. We are hoping we can pass the nies act to ben prevent mistakes. On you elaborate more engaging with people trying to and these decisions need for clear and easy Accessible Information to make those decisions. Tell us more about that. One of the funniest things we run into are when couples come. To do that medicare. Agree onk they have to a plan for each of them. When they find they can each get their own plan, they think you have given them another piece of candy because they are happy about that. So they do not have to limit somebodys medical information, because somebody else needs more pharmaceuticals. A lot of the things, when you come in, sometimes the date they do not want any pharmaceutical Party Insurance part d interest because they do not take medications, you have to ask mike to them they have to put something in there because if you ever do get medication, you will pay a lifelong penalty on top of your medication. Andthere is decisions western pennsylvania, we have to factions going on. Two actions going on, the you mark, youc and high have to walk people through that this tension. Distinction. Do you want this or that . Or this hospital you used to go to does not handle this company anymore so we need to get you which do you want to choose . And make that decision. It is not as simple as going in and saying, i am 65, just give me something to use. Because a year of the wrong program can leave you in a lot of medical distress. And bills. Sen. Casey the word navigate you and others have used, it is what someription of are up against. In the remaining time in this ask, sharon, i want to you said in your testimony knowledge is important to avoid the pitfalls of lifelong penalties, the reality for a lot of people is their pain penalties. Constituent Service People hear about this all the time across pennsylvania. I know you have seen it up close. Can you share why it is important for seniors to have access to, not just information, but unbiased information provided by a counselor . Certainly. If someone comes in to one of our training sessions and say, i got this letter and it says i have a penalty. Your heart just sinks because you know there will be a problem. ,hey end up being in a pickle more like somebody in a canoe without a paddle. Sometimes, when people say penalty, they think i own my 10 and i am done. What they find out is it is a lot more than 10. It is every day for the rest of their life. Ito not think that part of is emphasized enough in the information we have right now. It is listed as a penalty. It needs to say, longterm, so they know. Also, the problem with the prescription penalties is that, if they are not taking medication, they do not see a need for prescription plan. All of a sudden, tenures later, they 10 years later, they are taking a hard medication and now they have hard medication medicine, which is expensive heart medication medicine, which is expensive, and lifelong penalties on top of it and it becomes frustrating. The best we can do, when we have someone like that come to us, is to try to backtrack to see if we the so security, medicare Social Security, medicare, the persons hr department, where was there a breakdown in the information so that sometimes we can go back and see if we can get maybe a lower penalty. Or, on rare occasions, no penalty. But it is a long process. And the diff and a difficult one people find themselves in, and it is very sad. Sen. Casey thank you very much for that, that is the real life of it. Sen. Collins thank you. You, ande, all of thank you for being here. I noticed you were taking notes. That was my first question. Important to is get her feedback because she is on the front lines interacting with seniors and talking with them. To me, the first step is the awareness and education. But we are providing is enough information to make an intelligent decision, then we are missing out on providing that educational piece. My first question was to you, a couple of things, thank you for having the online Social Security account that people can gather information. Through about outreach telephone, facetoface, field office, committee gatherings where you go to the community to talk with individuals, libraries and rural communities. To what extent do you coordinate with the states . In nevada, we have a division aging services that does a lot of outreach and education, working with people like mrs. Hill in my state. How do you correlate with them to make sure we are leveraging the Additional Resources to get the educational information out while getting feedback on what we should be putting out there to make sure our seniors have the most Important Information they need . Thank you for the question, senator. I was listening to mrs. Hill speak and thinking how fortunate we are to have people like her who are dedicating a portion of ther lives to helping Social Security administration. Help them be more effective in ensuring seniors have access to health care. I can tell you from personal specialistshat our do many many referrals to the state Health Insurance Systems Program a Assistance Program ,ecause, as Social Security what we are responsible for enrolling people in medicare, for explaining the consequences of not taking part d, explaining the consequence of not taking part d, not enrolling in a Prescription Drug plan, we can only go so far. We are not in a position to witht oaks with folks selecting a plan, what planet is best for them and what medication, that is not a part of what we do, we can explain why you should coordinate part b, perhaps if you happen employerprovided Health Insurance plan, but we will not our role is not to help you choose a plan. I will say thousands of referrals to the state Insurance Programs we do every single week. I can talk later about some of the work we are doing with ncoa and cms to improve access. Are there Additional Resources we can help you obtain to make sure you are doing a better job, or more interaction at the state level with individuals on the front line . Is there more we can help you with that you could be doing . I think we have strong coalitions. For example, with the National Council on aging, every year, we when we send out our low Income Subsidy notices out to those who may be eligible for a premiums, pain part d we provide that broken down by zip code to ncoa who provides it to the ships, so they can do specific outreach. And know where people are know what their service demand volume will be. We have strong partnerships and we can always strengthen those partnerships. My concern is i am running out of time so i will wait until the next round, that First Contact is so important. If we lose people by passing them off, we should probably figure out how to stop that opportunity where we lose people in that gap. The First Contact to meet is the key and how do we keep them involved, instead of passing them to the next state agency. Do you have any comments . That is why it is so important that the senate bill senator casey has introduced is all about consumer education. Really alerting people that the deadline is coming. Although turning 65 is a great opportunity there are responsibility and individual has to take. It is critical, and we have done this for decades, not only working with the federal agencies, but also working with other communitybased organizations across the country in communities and no individuals and no individuals who need extra help. We run benefit Enrollment Centers where we trained volunteers, Staff Members at local organizations to walk people through, sometimes complicated federal programs. We found a need for both. A need for education from the federal agencies directly into their mailbox or facebook, because the majority of seniors are on facebook everyday. How are committed getting to seniors in a way they want to be through federal agency avenues and also funding and supporting local communitybased organizations to do the oneonone training. Warren . Lins senator sen. Warren thank you for holding this hearing. It is very important. You have come up with good things for us to talk about. Todays ago Congress Passed a shortterm budget that will keep the government open for another three weeks. I believe we need to look beyond the bare minimum and stop lurking from crisis to crisis to keep the lights on. This is a moment for us to focus on our core values and choose carefully about what we invest in. I with members of this committee believe the government should invest in our seniors. That starts with making sure the Social Security Administration Offices are fully funded so that seniors can get their hardearned sosa security checks when they sosa security checks when they turn 65 and enroll in medicare. Ssa has actually a budget for staff and other resources. Can you say a word about what Social Security and ministries in does administration does with the money . I would be happy to. We have over 1200 field opposites across the country and dedicate over 56 of our entire budget to staff. That is people who work in field offices. Sen. Warren can you say a word about what they do . I would be happy to. On any given day, someone walking into the field office may be coming to file a retirement claim or combination retirement and medicare claim, they may come into file for disability benefits or get a replacement Social Security card , if they are already receiving benefits, disability benefits, they may be reporting wages which impacts their benefit amounts. We are doing Program Integrity reviews to make sure people are still eligible for benefits on a continuing basis so that we do not create overpayments. Somethingo this is that is less understood we are providing a tremendous amount of information and counseling in a way. People have lots of questions about Social Security. Our frontline staff is very knowledgeable and well trained. They interact with the public everyday to make sure they are making informed decisions. Sen. Warren that is powerful and important, people have lives and you make sure they get what they are entitled to. It is clear to me that the Social Security an illustration that administrations work is important in the field opposites make sure americans get the benefits they are entitled to. Cuts to the Social Security Administration Budget in recent years have resulted in staff shortages, field office closures, and longer wait times. Despite years of underfunding, Senate Appropriators have proposed a more than 400 million cut to the Social Security Administration Budget for this year. That is nearly 4 of your budget. Can you say a brief word about how those cuts would affect seniors applying for benefits . I would like to say that at the Social Security immigration, we believe administration, that if we received the 2018 president s fiscal budget, we think we could handle the priorities. How does budget impact the service we provide . For every 100 million, that will buy you a hundred 26,000 retirement 826,000 retirement claims, educating the claim, and making the payment adjudicating the claim, and making the payment and by you 51,000 disability hearings. Sen. Warren let me multiply that by four. 200,000 hearings for americans trying to get disability benefits. And more than 3 million claims process for Retirement Benefits for seniors. Is that right . That sounds right. Sen. Warren thank you. Social security and medicare are contracts we make with each other. Americans have paid into Social Security and medicare on the understanding that the government would be a good steward of their money and that they would have the protection available when they need it. The government cannot be a good steward of Social Security and medicare if it does not have the money to run the Social Security offices. This one should be easy. We should increase the funding for Social Security and ministrys and so you Social Security administration so you had the resources to make sure the seniors get the benefits they have earned. Sen. Collins thank you. Senator jones. You. Or jones thank a couple of things. I was especially struck by testimony, given these challengesabout the women of color and hispanic , that is 70 , 60 because of the pay gap. If it had been worked on year ago years ago, that would not have been a problem but we are where we are. I know that we have to be concerned with budgets for medicare and Social Security. Is there something that can be done from federal policies, knowing that these women have often no choice, very little choice, they are either caregivers, dropout to raise children, this contributes to society in so many other ways. Is there anything you can suggest from a federal policy standpoint that may help level the Playing Field for those taking on significant important , you can they are jobs ask anyone one of them, they are probably more challenging than anyone sitting up here right now. Anything we can do to level the Playing Field so that those people can not be punished for doing their duties . Senator jones, i wish we could have another hearing on the subject. The data is overwhelming. It is bigger than the pay gap, a wealth disparity issue. It impacts girls and women throughout their lifetimes. From a federal policy level, it goes to how we educate women, how we ensure employment rules and regulars and are followed. Followed. Ions are by reinforcing the aging sector and looking at all the Human Services that affect seniors, you will impact women in a terrific way. As we look at the data in the programs we administer, we run the National Institute on Senior Centers and look at thousands of Senior Citizens across the country and daily activities and find out that more than 75 of people who go to Senior Centers on a daily basis are women. We look at the benefits checkup, a free Online System where you simply go on and put a few data entries about your zip code, female, male, and we found out that millions of people we serve, the majority in the system are women. It are checking the benefits or their spouse or children. Because aging disproportionally impact women, anything we can do to reinforce these systems are incredible. The gentleman to my right could not say it but any federal funding cuts to the Social Security Immigration Administration will have a disproportionate impact on women because, as i hear from my partners across the country running nonprofits, running units on aging, their systems are overwhelmed and overburdened. Although we appreciate the federal laws put in place 50 years ago, they have not been reformed in decades. I welcome the opportunity to work with the committee to figure out a way to leverage these parents we have gained over the decades. Also, how we reinforce the connections between federal, state, local organizations doing great work. Senator jones thank you for that. I would respectfully suggest that may be a good topic for this committee at some point in the future. Thank you for that. Doctor, i understand and can relate to the challenges faced over the last year or so. We are fortunate in birmingham to have a fair amount of Resources Available. Alabama also has a very rural population. Delivery health care in alabama is challenge in itself. Do you have suggestions of what we can do that may address the challenges specifically to our rural segments of this country . Thank you, it is a great question. One of the Biggest Challenges we discuss, especially in our area. One of the models that has been utilize, thet we resources we have for rural areas. For example, we have a lot of things in Technology Today we can use, telemedicine, medicare approves reimbursement for telemedicine. One of the suggestions is to expand geriatric consultations for this area, we have a wonderful primary care decision, but the problem is that the patient needs a Second Opinion because they are frail, they had a lot of geriatric syndromes, but there is not an expert to help them. ,ome sort of Satellite Program telemedicine, virtual care, these models, in a lot of areas a are already using and are helpful. That, weest more in have one physician taking care of the patient but always have a backup. One of the issues we have, it goes more towards the government is reimbursement. For this model. It does not make a satisfactory for the health or system to invest more money. Solution,e a better there will be an encouragement for medical centers to expand the program, which will be crucial. Huge benefits for all. As he mentioned, many of the aging population is living in rural areas. It is not only about alabama. We can have this service and expertise for them to have a Second Opinion and help them through that your help them through that. Senator jones telemedicine leads to another issue and rule access, the access to broadband. That is something we will work on. Thank you. I appreciate the opportunity. Sen. Collins that is a great leadin to my next question. It is wonderful that the Social Security administration has toolsped so many online that can help seniors. The fact is that in a state like mine, there are large sections of the state that do not have access to Broadband Services on the internet. And there are also seniors who do not have computers in their homes. And are not familiar with it. Finally, i would suggest that there are seniors who are much more comfortable with a facetoface interaction. Then they are going down to their local library and trying to figure out how to access Social Security information online. Office closed in rumford, maine which created a hardship for People Living in that community, because the nearest Social Security office was in lewiston. In the winter, it is quite a drive for seniors to make. They were just uncomfortable. What can you tell us about how Social Security is trying to reach rural seniors who may not have computers at all . Again, i think your Online Services are excellent. But they do not reach everybody. Thank you, senator collins. You are right. We have to make sure that we have the services and can deliver them to all americans, whether they live in urban or rural areas, whether they had internet access, Broadband Access, or not. We have a longstanding commitment to our field office structure. We had 1200 offices around the country, including many in rural areas. Small cities and towns across america. We have our 800 number. That is a lifeline for many people in rule america that have Service Delivery needs or questions for Social Security. We do not stop there. The part of the agency i represent, we are responsible for outreach, we are responsible for communicating with the public. Any of you who live in rural areas or have lived en route areas know that in rural areas, no the weekly and monthly newspapers are a lifeline, the radio is a lifeline in rural communities. Our Public Affairs specialist work with local media, many of our Public Affairs specialist have weekly radio shows where they talk about Social Security benefits, they talk about when to claim benefits, they talk about medicare enrollment, and the importance of enrolling in medicare before you are 65. We are using some of the more traditional means of communications to ensure that we reach Rural America. But we are not stopping there. You mentioned libraries. Not all seniors are comfortable using a computer at the library, but many are. That is why we have the ssa express program where we partner with libraries to provide one click access to our online information and services. Sen. Collins thank you. My next question is for the chavez. Nd ms. Doctor, i was intrigued in your written testimony by your phrase that we live in an antiaging society. Because i think this is the key issue. In addressing isolation, in addressing how we treat our seniors. In keeping them engaged. I would like both of you to address that issue. What advice do you have for Older Americans and their families so that we can counter this pervasive antiaging thatng in our society sometimes leads to our seniors being devalued or pushed aside . , will start with you doctor because he lived in two different countries, you lived you were trained in a ron and live in the united iran and live in the United States, do you see differences in those societies and in general please comment. And i would like to hear from you, mr. Chavez as well mrs. Chavez as well. Why older adults in this country, they do not have access to medical, nutritional supplements, all of the things we have here, why are they doing better . These people, when they migrate to the United States, they will get worse. They have depression. I see it everyday. I practice in california with a lot of immigrants. Why will this change . It is mentality. We are up says about you we are obsessed about youth. Welways criticizing teach our children that there is something wrong with aging. Or aging is a germ we have to avoid. When i go to every place shopping, i see the sign of antiaging supplements and amazed me nervous because it tells my son, four years old, your dad is aging. There is something wrong with him. Aging. Ld stop, fighting when they tried to do Public Education, it says we have seminaries about fighting agent. There is no fighting aging. It is Like Fighting nature, the solar system. We cannot. We need to adapt to aging, it is a process. If you start the culture, change the dialogue in the community, in society, about aging, we can accept aging. That is why i have an educated phd patient that, when he comes to me and asked for depression treatment and says when i apply for a job, i have to dye my hair and i do not reveal my age because i have more experience and they will not pay me. And they tell me because i aged, i am not innovative, who says aging people are not innovative. Many studies show our social skills improve as we age. We have many a study, not in the United States, in germany, the m w, they havent bmw, they have a study older labor versus younger labor, older in the production of the bmw, they are more productive with less mistakes. When we change the dialogue where older people do not feel frustrated, fewer of aging, when do not focusange, on negative things and stay on positive. And then we can have change. One comment, i have the same problem with my students to encourage them to work in aging fields. When we look at the media, a teacher of the doctors or nurses are heroes in the tv series. They are all bodybuilders. This is a picture of my students see. When i asked them to come in a nursing home, they say i do not like to come here, it smells very bad and i have to take care of old people. The people went to medicine because they have a passionate passion to help people. We are changing. We need to change Public Education media. I am sorry i am over i enjoy sitting next to a doctor who is clearly passionate about this subject. A few decades ago, people would look at me and say i was too young. I used to wear a button that said, aging. If it is not your issue, it will be. In my culture, seniors are the epicenter of our universe. I would say three major things that we tell people to think about. Think about your financial plan. For women, even more important. Start thinking about it now, even for young women and men in college. Start putting away for retirement. The benefitsand that are coming to you at that point in time. There are ways of leveraging those benefits. Second, engage in healthy behaviors. Scientists will tell you that the things you do a your 20s and 30s can actually have a great impact on what you will do in your 60s and 70s. My father is 89 years old and does 200 pushups a day. No one could tell him aging is a bad thing. So start doing great things right now both mentally and physically. Third, stay active and engaged in your community. Find a passion, something you are excited about that gets you up every day. I will tell you that the number one reason seniors are able to get over a fall or able to get through chronic disease is that they have Something Else they are focused on every day. I encourage everybody to always think through. Just as we say in our aging Mastery Program, what are you grateful for . Because every day is a gift. How are you going to use that gift of time for the Better Things in life . Sen. Collins thank you very much. I would like to start with something for the record. Matters,sent on two two letters. The first letter was organized by the medicare rights center. It is from more than 75 organizations urging congress to packed and act. To pass an act. The second is from the former administrators of the Medicare Program from democrat and republican administrations that support the bill. So i asked to submit both letters to the record. Without objection. Thank you. I also want to express support to statements made today, the first by our chair with regard to the cuts the administration would propose or have proposed with regard to the socalled chip program that allows us to have programs like the prize apprise program. I appreciate you saying that here today and i certainly support that. Social call for administration, we want to make sure those kinds of cuts do not become the norm and do everything that we can to prevent the cuts. I will go there with mr. Borland. You have been asked a couple times today about the work your and we should cite efforts you have already undertaken and will continue to undertake, all of the outreach you do. We appreciate that. Maybe a last two questions. I will make a statement. I hope if you think you need more resources, you or someone in your agency would tell us. I know that in every , sometimes people are instructed to not say much, to not advocate for more resources. I do not know if that is the case here and i do not want to make that charge, but i hope that if you need more resources, you would come to the congress and express that. I know what it is like to criticize agencies. For two terms i was nsylvanias auditor jennet general. I kicked the hell out of agencies that were and the agencies did a lot of audits that criticized how state agencies works. I also tried to couple the criticism and critique with recommendations for how to how to improve the work that you do. Sometimes that comes down to money. Sometimes you cannot fix a problem without the resources. You can be efficient and effective, i get that. But sometimes you need to ask for more dollars. If they ask you to do that, to not do that, i do not want to get you in trouble. But i hope that you would come to us or to the appropriators when you need more resources. Mr. Borland, here is a question. How does the Social Security administration make sure that people are prepared to sign up for medicare . And if you want to reiterate some of what you have said, it bears repeating. What initiatives or partnerships are underway right now at the Social Security administration to strengthen the communications you want to take and to prevent the misinformation that sometimes leads people to make decisions or failed to make a decision that can hurt them down the road . Thank you. Let me talk first about some of the efforts we currently make. I certainly talked and made a pitch for my Social Security accounts. For americans who do not have that account are missing out on an opportunity to learn an awful lot about the benefits that they might become entitled to in the future, including Retirement Benefits but also survivors benefits for their families, disability benefits, and that a care. As i mentioned earlier and medicare. We mailed a Social Security statement with an insert to everyone 60 years and older every year until they claim benefits, Social Security benefits. In that insert, prominently is a reminder. Make sure you sign up for medicare three months before your 61st 65th birthday. That notice goes out at age 60, 60 1, 62. It is a message that bears repeating. That is a primary way that we communicate to individuals who are not receiving social that they needts to sign up for medicare at 65. More importantly, i want to talk about some things we are working on and literally just three weeks ago i sat down along with my counterparts from Social Security from policy, communications, the people that run our 800number across the folks from cms. We think there are great opportunities for strengthening the agency and preventing and tosary handoffs increasingly serve the public at the first point of contact. I appreciate that. I know i am over time. I will wrap up with the point you made, even if you are making all of those efforts but there is a gap because of lack of Broadband Access and highspeed internet, that is one of the many reasons we have to get an infrastructure bill or something that would focus on broadband. Many have worked on these issues for years but we have not gotten to the point where Rural America has the kind of conductivity it deserves. Something in the order of 39 of the people live in Rural America have no highspeed internet. 39 of all of the People Living in Rural America. So if there was ever a time to push for it, now is the time. Thank you very much. Sen. Collins thank you. Senator jill grant, welcome. As the number of individuals eligible claim Social Security is rising, it is more important than ever that we ensure the administration is fully funded and capable of providing the surgeon sues the services. Mr. Borland, can you tell us what steps you are taking to keep up with the growing demand for services and how ssa will ensure the quality will not decline as it serves so many individuals . And can you tell us about some of the issues around claiming benefits that seem to confuse people the most . Thank you. I would be happy to. Men we first talk let first talk about some of the areas where people have a lot of questions when they come into our offices. Importanthe most information that we provide is the basis basic fact that the longer you wait to claim benefits, the higher your benefits will be for the rest of your life. Arounds some confusion early retirement age, full retirement age, the impact of delayed retirement credits at age 70. The basic message we deliver to every person that asks us, whether it is over the internet or in a field office is, the longer you wait, the higher your benefit account will be for the rest of your life. That is a point of confusion. Others include that your benefits are based on your 35 highest years of earnings. Many people think it is your highest three. Is your highest 35 years of earnings. If you have 30 years of earnings, or 33 years of earnings, you are going to have zeros instead of an earning amount in those years. It may encourage people to work a few more years, to fill in those zeros and potentially boost their benefits amounts for the rest of their lives. It in 2007, counselors provided onetoone counseling to 130,000 individuals and help more than 3000 educational presentations across new york. Heard many new yorkers that ship is essential for them to get access to benefits. Miss chavez could you explain to us the importance of ship counselors the on to the 1800 number . Absolutely. We are a very big supporter of the ship program. We know it is going to take many different points of contact with the seniors to ensure they understand their benefits. We administer the benefit access through a grant through the federal government. We physically put town slurs in the field to assist seniors. But there are we physically put counselors in the field to assist seniors. With people like mrs. Hale who are doing Community Interventions and interviews and discussions with seniors. We also work closely with other federal state agencies to ensure we are getting the latest information. One of the things we have gotten feedback on is because we run one of the Largest Online benefit access tools, which is free to the public, and we updated consistently to ensure that the ship counselors and benefit counselors across the country have access at their computer, not only to the federal benefits that the seniors might be eligible for, but also at the state level and also sometimes the municipality level. So what you will see here today is this ecosystem have built between federal partners, state agencies, volunteers, and National Nonprofits who are serving the seniors. And ecosystem is critical we would not be able to do this work without the support of congress. And would you please submit an analysis of the impact of enrollment errors . I know there is a number of people who make mistakes and rolling and for almost 700 paidands americans, they late fee enrollment penalties. When people make mistakes, how do we fix them . And what are your best recommendations to fix that to limit that . Thank you. Thank you for the second round. This is part of the discussion i wanted to get into. I echo my colleagues on the concerns with the cuts to Social Security. I so appreciate your comments on this. I was fortunate enough to be raised by incredible parents, grandparents, and greatgrandparents. Not only were they every day in our lives, i saw what happened to them as they aged. I have a mexicanamerican grandmother who work for entire life as a sales clerk. Her retirement was Social Security. That pay gap had an impact on the type of retirement she had later in life. That is why i know, looking at the statistics, the beneficiaries of that money that they count on, they work so hard like my grandmother. Borland, i appreciate the position you are in, but i also know talking with some of your employees that within my state, and the interaction i have seen in my state and the benefits of having those offices open and the interaction between state and local, there are so many beneficiaries of Social Security that are out there and aging and they are going to need those offices over. So i do not support cuts to Social Security and never will. There are ways to address this issue but it does not start with harming all of the people who rely on this and who worked so hard in their lives. So i thank you for that. I appreciate the conversation today, and i also have Italian American grandparents. Dr. , i can tell you are a good doctor. I had an italian grandfather who loved to play golf and smoke cigars. Becameot older, he familiar with his doctor. He was always in the Doctors Office within eight or pain. Ache or pain. Finally the doctor looked at him and said, you are just getting old. This is about lifestyle and how you eat. So would you please, we have not nutritionalhis, food and healthy food have an impact on your health. I think we need to learn at an early age, but at the same time, as you age, this has an impact on your health. Dr. , please talk a little bit about that. Certainly. Whenever i talk about healthy lifestyle, i add my Italian Culture because they talk and that is the best exercise for the brain. So whenever i have an elderly complain about isolation, i say, live like an italian. Talk. It is about nutrition. One of thing one challenge we have for a lot of patients, they a magicys looking for formula. They ask, what is the best vitamin and supplement i can take. This is part of the education we can provide for them. Nutrition is at the beginning of the healthy lifestyle. 80 of our longevity depends on it. This should be a good they need a balanced diet. Obsess about the diets, sometimes people come in who have to take lots of fibers, lots of that stumbles. I wrote an article several years ago that too much fiber can be harmful. Fat can be helpful for the elderly. But everything in moderation, not exaggeration. That is why it is important that , firstthe older people of all they do not need to take extra supplements. If they eat a healthy, balanced diet it is enough for them. One of the things we do not educate them, in the majority of our Health Centers we do not have educated nutritionists in senior care to come and talk to them and review their diet. A lot of these seniors are living on some of the programs. One thing is only that they dont eat. The other thing is a lack of companionship. They have programs like meals on wheels. When i do house visits i see all of the food in the refrigerator and nobody touched it. Because they do not have the feeling to eat. Is one of the biggest problems. A lot of things happen for us because we prescribed too much medication. They do not feel like eating food. In Senior Centers is to make a good presentation for your food, to make them motivated and engaged. Them become motivated. But definitely nutrition is a major thing. Thank you for this great panel and this great discussion today. Sen. Collins thank you. I want to thank all of the great witnesses for your testimony today, and more important for the work you are doing to assist the Older Americans who are navigating what can often be a confusing maze of information to help our society recognize and value our seniors, and to assist the Older Americans in living healthier lives. Dr. , we really need you in maine. California has funny of specialists. We are the oldest state in the nation by median age and we have a real shortage of physicians who are trained in geriatrics. So i am serious. If you really, really want to make a difference, i am positive that i can get you a good job in the state of maine. [laughter] sen. Collins it is a real problem. In states with aging populations, there are not people who have the kind of training that you have and that you discussed. This problem is only going to become more severe as our population continues to age. When the Fastest Growing population is 75 or older, the future is scary. I am really concerned about having the workforce that is that has trained an expert to help us adjust and ensure we live good, healthy lives for people as long as possible. When you think about how much our world has changed in the 1953, thatrs, since is the year that Color Television first started appearing. Gas cost . 20 a gallon. Iphones or heard of computers being while widely available. The needtalking about for people to talk more facetoface. This is a major obstacle to people having conversations. I cant live without it, and it is a major obstacle. And you cant probably see from there, but my 92yearold father in his world war ii uniform is my screensaver. But we need to do so much more to adjust to the new reality that we are in. That has been one of the purposes of this hearing today. So i thank you all so much for helping us to better understand. He world that we are living in i also want to think our staff for their hard work. Committee members will have until february 2 two summit a agital two submit individual question. So you might be getting some inquiries. I would like to thank you for this hearing and the good work by your staff and our staff. I want to thank our witnesses and a special tribute to sharon, she did such a great job and is from pennsylvania. We have a special place in our heart in fayette county. I am grateful for that and especially because we are dealing with such a difficult issue. 65 are facing a Staggering Number of decisions. They are complex decisions that will have lifelong consequences. It is our responsibility to provide people with information to make the best decisions possible. It ist information that easy to access and understand, people are being punished for honest mistakes and that is unacceptable. We have a lot of work to do this year on these issues. The bennysn pass act. I look forward to continuing to work on these issues. Sen. Collins thank you. Senator cortez matz, do you have anything to add . Thank you, this hearing is now adjourned. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org]