Care. The Senate Aging Committee hearing is about one hour, 40 minutes. The Senate National committee on aging will come to order. As chairman, my top priority is keeping our promises to Older Americans and to americans with disabilities. We owe it to have the necessary information to decide when, where, and how to receive care as they age. That has motivated my advocacy, for example, for home and committeebased services. Every american wants to receive care. It has similarly motivated my work to ensure Nursing Homes are providing safe, quality care for all of their residents. We need to address the chronic underfunding and understaffing for the state agencies that conduct nursing home oversight so they can effectively protect the health and safety of residents. And this core mission of the aging committee brings us to todays topic, the topic of assisted living. And that landscape. It has been 20 years since this Committee Held a hearing on assisted living. With the dramatic growth of the assisted living industry in recent decades, it is long past time for congress to reexamine this model and ensure that it is meeting our nations needs. The best estimates reveal that nearly one million americans live in more than 30,000 assisted living facilities across our nation and that is almost certainly an undercount of that number. Assisted living facilities are state regulated residences that support assisted living while offering help with the activities with activities of daily living like bathing and Medication Management and they also often provide meaningful engagement and activities for their residents. Assisted living was first envisioned as a social model for residents who needed lower levels of support but today, People Living in assisted living facilities are older, require more care, and have Health Care Needs similar to that of those who reside in a nursing home and the needs of the assisted living population change. As those needs change, we need to know if assisted living facilities are meeting the needs of those residents or the needs of their families. One major issue i hear a lot about his cost. Assisted living facilities are widely unaffordable to the average american and their family. Recent survey found that 80 of older adults would be unable to afford four years in as assisted living facility. The average annual cost is 54,000 a year. But the costs can be substantially higher depending upon the location and the type of care that a resident requires. The more assistance and care a resident needs, the more they pay. In some cases, residents and their families dont know the total cost until they receive their monthly bill. These substantial costs and often hidden fees make it nearly impossible for older adults and their families to accurately budget for longterm care. In now, that is one of the reasons why im starting today im asking pennsylvanians and people across the country to share their stories and their bills with us. I want to hear from you about the true cost of assisted living and understand whether families have the information that they need to make difficult financial and Health Care Decisions. Im just going to hold up the website address for those who need it. You can go to aging. Senate. Gov assistedlivingbills, all one word, to share your stories. It is very important that we hear from people about their own experience as Family Members, as people who are paying the bill and also expecting the promises that are made when someone becomes a resident of an assisted living facility. It is only by hearing those stories, only by hearing about those experiences, can we bring the needed change that i know we all agree has to come. The assisted living industry is also facing the same workforce crisis that we see across other longterm settings care settings and other longterm care. We see it in child care and other parts of our health care and care landscape. Workers are struggling to support their own families because direct care workers are paid an average of just 15 an hour nationwide. Workers provide a higher level of care to support residents rowing needs, especially residents with dementia. But training requirements and worker support look very different in each state. As we will hear from our witnesses, these challenges make it harder for families to find the information that they need about assisted living facilities including how much it will cost, the quality of the services they receive, and how safe their Family Member will be. A recent Washington Post investigation found that since 2018, more than 2000 people have left assisted living facilities unsupervised and have been left unattended outside. Tragically, 98 of these 2000 incidents have resulted in the death of the resident. And those are just the cases that have been reported. The findings of the post investigation demonstrate how urgent it is that Congress Better understand this industry. Theres also been significant reporting by the New York Times and kfs in a series written before the end of last year. To help in our understanding, i have sent letters to three of the largest corporate owners of americas assisted living facilities. These letters request information about cost, workforce, safety, and availability of information about quality of services in assisted living facilities. I hope these letters i should say the response to the letters will improve transparency in the assisted living industry and help to inform policy solutions to address some of these concerns. As families are making difficult decisions about where to age, they deserve to know that their loved ones are safe. I think we can all agree on that. Assisted living providers making promises they cannot keep is a violation of trust. As we continue to increase the quality of the continuum of longterm care for older adults, it is time we prioritize efforts to improve the assisted living care option. If we say if we, as a nation, are the greatest country in the world, then we have to have the best, not second, not third, the best longterm care in the world, and we are not there yet. Older adults and people with disabilities who call assisted living facilities home we have to remember this is their home, their residence, where they live, where their families come to see them if those older adults and people with disabilities are calling those facilities home, they should have quality Affordable Care so i look forward to hearing from our Witnesses Today and i will turn to Ranking Member for his opening statement. Thank you, chairman casey. In 2050, that you think the problem is bad now one in four americans will be 65 years of age or older. With an aging population that we know is coming at us, thank goodness we have hearings like this to highlight what you are going to do about it. Sometimes, the market doesnt do the job. I do want to say that ideally, these things are crafted through the market and probably with states leading the way. I say that for one big reason i am on the budget committee. The biggest thing that challenges this place is how you would add something even further to the list of things you want to do when we are now borrowing a trillion dollars every six months instead of annually, and that has just changed over the last five years so we have to be careful. But it still has nothing to do with a problem or an issue that is out there and this is about highlighting who can do it best and how you get there. Chronic workforce shortage, when i traveled and visited all 92 counties in indiana, precovid, that was the number one issue, and it is about double now the number of jobs in my own state. I think it is close to 130,000. It was 65,000. And caregivers, a large percentage of them, that assistance is given by independent contractors. You know, Small Business owners. We need to figure out how to enable that and make it easier, how you actually have your curriculums in various states and School Systems that show the full spectrum of what jobs are out there and where the needs are. Senator kaine and i introduced the jobs act here which allows students to use federal pell grants for high quality, shortterm jobtraining programs. That is a good federal program. It is increasing the flexibility of how you can use it. Other senators and i introduced the train more nurses act which reviews all nursing Grant Programs to find ways of increasing nursing pathways. Happy to hear some things do work well here. That path, by unanimous consent last night in the u. S. Senate now, we got to get it over to the house to do the same thing. The federal government should make it easier for people to enter the Health Care Workforce and for families to take care of their loved ones. By making sure that it is energizing the people that may be interested in it, in the places they will be doing the heavy lifting. Right now, for instance, the Biden Administration is saying one thing and actually doing another. And i come from the world of Small Business. Independent contractors, retailers, individuals that make their living out of may be running a Small Business. The independent contractor rule that is out there, which would make that more difficult, could eliminate many of the existing caregiver jobs for that reason, so you got to make sure you are not wanting to do something and then working at a cross purpose through another agency that will make it even more difficult. Unlike Nursing Homes that are regulated by both federal and state agencies, assisted living facilities are primarily regulated by states to increase safety and transparency. Indiana requires staffing ratios, dementia training, and maintains a website that discloses reports in enforcement actions. States in assisted living facilities are working to find creative ways to use existing resources to assist seniors. Indiana is using a combination of state and federal tools to provide more affordable assisted living to hoosiers. As a result, indiana has c inaffordability and quality improve. However, there is always more work to be done. Some of my colleagues may be tempted to call for a shift towards increased federal involvement in regulations. I would say be careful. Help us get best practices out there. Help us have an environment to get it done where its normally done more effectively, more affordably, at lower levels of government. I believe that states are best positioned to meet that growing need. I am glad we here at the federal level, the big microphone that has to highlight the issues, that is what were doing here today. Thank you to all the panelists for being here and i am interested to see what we can come up with. Thank you, mr. Chairman. Turned to our witness introductions. I am grateful for the time and the work that goes into an appearance by our witnesses. Our first witness this morning is patty from gainesville, virginia. Her first husband, john whitney, had mentioned and lived in an assisted living facility at the end of his life. She will share some of her and her husbands experiences where she supported him and assisted in an assisted living setting. We are grateful you are here today. Thank you. Our second witness is dr. Jennifer kraft morgan. Dr. Morgan is from georgia. Dr. Morgan is a professor and director of the Gerontology Institute at Georgia State university. She studies issues related to longterm care dementia in the Health Care Workforce. Thanks for being with us today, doctor. Our third witness is dr. Julie simpkins. I will turn to Ranking Member braun for that introduction. She is the copresident of management systems. She has been in the longterm care arena for nearly 30 years. She focuses on affordable assisted living and she advocates for both providers and Older Americans. She leads on several state and National Associations including the Indiana HealthCare Association board of directors and the National Center for assisted living board of directors. Thank you for testifying here today. Thank you, Ranking Member braun. Our fourth and final witness is richard. He is the executive director of the longterm Care Community coalition. This coalition works to provide families with unbiased information about Nursing Homes, assisted living facilities, and other longterm care settings. Thanks for being with us today, and we will turn to our first witness, patty. Patty good morning, chairman casey, Ranking Member braun, and members of the Senate Special committee on aging. My name is patty. Thank you for allowing me to share this testimony of my experience with assisted living for my husband, john whitney, during his journey through the middle stage of dementia. I will focus on my experiences and observations that i believe are most relevant to your national focus. In 2013, my husband was diagnosed with dementia. Although this dementia is similar to alzheimers, it manifests itself a bit differently and it is important that caregivers be informed and trained appropriately to ensure the comfort, safety, and security of their patients. Some key systems, a loss of sense of smell, rem sleep behavior disorder, which causes individuals to violently act out dreams, often falling out of bed , visual hallucinations, marked fluctuations in attention and alertness, and gastrointestinal issues including severe constipation. All of which my husband experienced. Loss of memory often occurs much later in this disease process. I took several free courses on caregiving for individuals with dementia including a Virtual Reality dementia experience. Which helped me to understand the challenges that people with this disorder face, and most importantly, why they become fearful and combative. I mentioned this to provide a basis for my ability to recognize problems with care as i saw it. These same courses offered for prevention for the rational set reasonable costs. In june of 2017, when my husbands disease was progressing more rapidly, i moved to virginia to be mere family. I cared for him alone at home until january 26, 2018, when he attempted to strangle me in my bed. The state determined that john should be placed in a longterm care facility. I found him a room in an assisted living facility in virginia that specialize in memory care. He moved in the first week of march in 2018. I provided the Management Team with johns history, his diagnosis, and disease progression. The following is a list of issues that i observed in the memory care unit during my daily visits with john. Poor facility design. There were blocks of rooms built around a large central room for Group Activities and tv. The central room was extremely loud and high levels of noise can easily agitate dementia patients. Activity stations were set up for residents. One of these had various lengths of pvc pipe, not kidding, some longer than a baseball bat. These were weapons in waiting and you can guess what happened. There was no quiet area for the residents other than their rooms. The hallways and the room blocks were isolated, making it difficult for staff to monitor. There were many incidents that i witnessed when there was no staff around. I will share one that i feel was very important. A woman fell by tripping on a raised area on the floor where the rug abutted the hard flooring. Nobody saw her fall. I found her bloody and staggering down a hallway. A company knowledgeable about Dementia Care would not design it facility this way. They would certainly understand that people with a mentor have problems with balance. And understand there were video cameras in place but they only used them for reviewing incidents after the fact. They were understaffed. Too many patients were assigned to each caregiver. In the morning, each caregiver needed to give their assigned residence, get them up and dressed and ready for breakfast. Everybody ate at the same time, putting additional pressure on the staff. They only gave residents a shower when necessary as they were always pressed for time. They needed extra time to spend on residents stages of dementia as they required help to move from their bed to a wheelchair and be hand fed. After lunch, the caregivers would place most of the residents in chairs in the main room while they worked getting the advanced stage patients back into their beds. Every day after lunch, my husband urgently needed to empty his bowels. Several times while i was there, i tried to help him but it was difficult for me as i had a broken arm at the time. I could not find anybody so i did the best i could and often when i was not there, he soiled himself while waiting for help. I once believe i saved a man life mans life. I was off the main activity area and i heard someone crying for help. I ran into the hallway and found an old man on the floor, trying to protect himself from being beaten with his own came by another resident. I called for help, quickly moving closer and redirecting the attackers attention. I kept him as the while calmly calling for assistance, trying not to further agitate him. It took several minutes before a staff number finally heard me and came to help. Night was no better as staff levels were lower as allowed by state regulations. They placed residents who had trouble sleeping in front of a tv while they dealt with other residents. Inadequate staff training. Most of their caregiver staff were trained as nurse