To amend the Older Americans Act of 1965 to establish a national family caregiver support program, and for other purposes.
IN THE SENATE OF THE UNITED STATES
March 24, 1999
Mr. GRASSLEY (for himself, Mr. BREAUX, Mr. SANTORUM, Mr. REED, Mrs. LINCOLN, Mr. BRYAN, Mr. DODD, Mr. KOHL, and Mr. REID) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions
To amend the Older Americans Act of 1965 to establish a national family caregiver support program, and for other purposes.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. FINDINGS.
Congress finds that--
(1) there is no Federal program to support family caregivers;
(2) most older individuals prefer to receive care in their homes, rather than in institutions;
(3)(A) more than 22,000,000 family caregivers actively care for aging or ailing older individuals in the United States;
(B) fewer than 2,000,000 older individuals receive care through nursing homes in the United States; and
(C) therefore, a large portion of the care provided for the Nation's older individuals is provided by family caregivers;
(4) nearly 75 percent of family caregivers are women, many of whom have other major responsibilities, such as young children or jobs;
(5) the loss in productivity of businesses due to necessary absences of caregiving employees ranges from $11,000,000,000 to $29,000,000,000 a year;
(6) family caregivers offer support that is worth billions of dollars;
(7) without the efforts of family caregivers, many additional older individuals would receive care services in a hospital or nursing home, a result that would be far more expensive for taxpayers than assisting family caregivers because--
(A) the Federal medicare and medicaid programs pay for a large portion of expenses associated with institutional care; and
(B) institutional care is more expensive than family caregiving;
(8) caregivers, on average, spend $2,000 per year for food, medication, and other expenses related to caregiving;
(9)(A) caregiving is physically demanding and emotionally draining to provide, with as many as 30 percent of caregivers reporting physical or mental health problems due to caregiving; and
(B) caregivers need resources that will support and help ease the overwhelming burden that the caregivers are expected to shoulder on a daily basis; and
(10) with millions of baby boomers set to retire in the near future, it is crucial to begin preparing today for what will be dramatically increased long-term care needs of older individuals.
SEC. 2. NATIONAL FAMILY CAREGIVER SUPPORT PROGRAM.
(a) ESTABLISHMENT OF PROGRAM- Part D of title III of the Older Americans Act of 1965 (42 U.S.C. 3030h et seq.) is amended to read as follows:
`PART D--NATIONAL FAMILY CAREGIVER SUPPORT PROGRAM
`Subpart 1--State Grant Program
`SEC. 341. PROGRAM AUTHORIZED.
`(a) IN GENERAL- The Assistant Secretary shall carry out a program for making grants to States with State plans approved under section 307, to pay for the Federal share of the cost of carrying out State programs, to enable eligible area agencies on aging to provide multifaceted systems of support services for family caregivers, and other caregivers, who are informal providers of in-home and community care to older individuals.
`(b) FAMILY CAREGIVER SUPPORT SERVICES- In providing services under this subpart, an area agency on aging shall provide support services, including providing--
`(1) information to eligible caregivers about available services;
`(2) assistance to eligible caregivers in gaining access to the services;
`(3) individual counseling, organization of support groups, and caregiver training to eligible caregivers to assist the caregivers in making decisions and solving problems relating to their caregiving roles;
`(4) respite care to enable eligible caregivers to be temporarily relieved from their caregiving responsibilities; and
`(5) supplemental services, on a limited basis, to complement the care provided by eligible caregivers.
`(c) ELIGIBILITY AND PRIORITY-
`(1) ELIGIBILITY- In order for a caregiver of an older individual to be eligible to receive services provided by a State program under this subpart, the State shall--
`(A) find that the caregiver is a caregiver described in subsection (a); and
`(B) determine that the older individual meets the condition specified in subparagraph (A)(i) or (B) of section 102(28).
`(2) PRIORITY- In providing the services, the State shall give priority for services to older individuals with greatest social need and older individuals with greatest economic need, consistent with the requirements of section 305(a)(2)(E), and their caregivers.
`(d) COORDINATION WITH SERVICE PROVIDERS- In carrying out this subpart, each area agency on aging shall coordinate the activities of the agency with the activities of other community agencies and voluntary organizations providing the types of services described in subsection (b).
`(e) QUALITY STANDARDS AND MECHANISMS AND ACCOUNTABILITY-
`(1) QUALITY STANDARDS AND MECHANISMS- The State shall establish standards and mechanisms designed to assure the quality of services provided with assistance made available under this subpart.
`(2) DATA AND RECORDS- The State shall collect data and maintain records relating to the State program in a standardized format specified by the Assistant Secretary. The State shall furnish the records to the Assistant Secretary, at such time as the Assistant Secretary may require, in order to enable the Assistant Secretary to monitor State program administration and compliance, and to evaluate and compare the effectiveness of the State programs.
`(3) REPORTS- The State shall prepare and submit to the Assistant Secretary reports on the data and records required under paragraph (2), including information on the services funded under this subpart, and standards and mechanisms by which the quality of the services shall be assured.
`(f) AVAILABILITY OF FUNDS-
`(1) IN GENERAL- A State shall use the portion of the State allotment under section 304 that is from amounts appropriated under section 303(d) to carry out the State program under this subpart.
`(2) USE OF FUNDS FOR ADMINISTRATION OF AREA PLANS- Amounts made available to a State to carry out the State program under this subpart may be used, in addition to amounts available in accordance with section 303(c)(1), for costs of administration of area plans.
`(3) FEDERAL SHARE-
`(A) IN GENERAL- Notwithstanding section 304(d)(1)(D), the Federal share of the cost of carrying out a State program under this subpart shall be 75 percent.
`(B) NON-FEDERAL SHARE- The non-Federal share of the costs shall be provided from State and local sources.
`SEC. 342. MAINTENANCE OF EFFORT.
`Funds made available under this subpart shall supplement, and not supplant, any Federal, State, or local funds expended by a State or unit of general purpose local government (including an area agency on aging) to provide services described in section 341(b).
`Subpart 2--National Innovation Programs
`SEC. 346. INNOVATION GRANT PROGRAM.
`(a) IN GENERAL- The Assistant Secretary shall carry out a program for making grants to appropriate entities on a competitive basis to foster the development and testing of new approaches to--
`(1) sustaining the efforts of family caregivers and other informal caregivers of older individuals; and
`(2) serving the needs of particular groups of caregivers of older individuals, including minority caregivers and distant caregivers.
`(b) EVALUATION AND DISSEMINATION OF RESULTS- The Assistant Secretary shall provide for evaluation of the effectiveness of programs and activities funded with grants made under this section, and for dissemination to States of descriptions and evaluations of the programs and activities, to enable States to incorporate successful approaches into their individual State programs under this part.
`(c) AVAILABILITY OF FUNDS-
`(1) IN GENERAL- The Assistant Secretary shall reserve not more than 10 percent of the amount appropriated under section 303(d) for a fiscal year to carry out the program of the Assistant Secretary under this section.
`(2) NATIVE AMERICAN PROGRAMS AND ACTIVITIES- Twenty percent of the amount reserved under paragraph (1) shall be available for programs and activities under this section for caregivers serving Indians and Native Hawaiians, as defined in section 625.
`SEC. 347. ACTIVITIES OF NATIONAL SIGNIFICANCE.
`(a) IN GENERAL- The Assistant Secretary shall, directly or by grant or contract, carry out activities of national significance to promote quality and continuous improvement in the support services provided to family caregivers and other informal caregivers of older individuals, through program evaluation, training, technical assistance, and research.
`(b) AVAILABILITY OF FUNDS- The Assistant Secretary shall reserve not more than 2 percent of the amount appropriated under section 303(d) to carry out the activities under this section.'.
SEC. 3. AUTHORIZATION OF APPROPRIATIONS; ALLOTMENTS.
(a) AUTHORIZATION OF APPROPRIATIONS- Section 303(d) of the Older Americans Act of 1965 (42 U.S.C. 3023(d)) is amended to read as follows:
`(d) There are authorized to be appropriated $125,000,000 for fiscal year 2000, and such sums as may be necessary for each of fiscal years 2001 through 2004, to carry out part D (relating to the national family caregiver support program).'.
(b) ALLOTMENTS TO STATES- Section 304(a)(1) of the Older Americans Act of 1965 (42 U.S.C. 3024(a)(1)) is amended in the first sentence--
(1) in the matter preceding subparagraph (A), by inserting `, and remaining after reservations of funds made under sections 346 and 347,' after `from the sums appropriated under section 303 for each fiscal year'; and
(2) in subparagraphs (A), (B), and (C), by striking `sum appropriated' and inserting `remaining sums'.
SEC. 4. AVAILABILITY OF FUNDS FOR REALLOTMENT.
Section 304(b) of the Older Americans Act of 1965 (42 U.S.C. 3024(b)) is amended in the first sentence by striking `part B or C' and inserting `part B or C, or subpart 1 of part D,'.
SEC. 5. CONFORMING AMENDMENTS.
(a) RELOCATION OF PROVISIONS CONCERNING IN-HOME SERVICES FOR FRAIL OLDER INDIVIDUALS- Section 321 of the Older Americans Act of 1965 (42 U.S.C. 3030d) is amended--
(1) in subsection (a)(5), by striking `including' and all that follows and inserting `including--
`(A) client assessment, case management services, and development and coordination of community services;
`(B) in-home services for frail older individuals (including supportive activities for older individuals with Alzheimer's disease and related disorders with neurological and organic brain dysfunction) and for the families of the individuals;
`(C) supportive activities to meet the special needs of caregivers, including caretakers who provide in-home services to frail older individuals; and
`(D) in-home services and other community services, including shopping, escort, reader, and letterwriting services, and provision of home-delivered meals and transportation, to assist older individuals to live independently in a home environment;'; and
(2) by adding at the end the following:
`(c) In this section, the term `in-home services' includes--
`(1) homemaker and home health aide services;
`(2) visiting and telephone reassurance;
`(3) chore maintenance;
`(4) in-home respite care for families, and adult day care as a respite service for families;
`(5) minor modification of homes that is necessary to help older individuals remain at home and that is not available under other programs, except that not more than $150 per client may be expended under this part for the modification;
`(6) personal care services; and
`(7) other in-home services as defined--
`(A) by the State agency in the State plan submitted in accordance with section 307; and
`(B) by the area agency on aging in the area plan submitted in accordance with section 306.'.
(b) REPEAL OF PART G- Part G (relating to supportive activities for caretakers who provide in-home services to frail older individuals) of title III of the Older Americans Act of 1965 (42 U.S.C. 3030p et seq.) is repealed.
(c) OTHER CONFORMING AMENDMENTS-
(1) Section 303 of the Older Americans Act of 1965 (42 U.S.C. 3023) is amended by striking subsection (g).
(2) Section 304(a) of the Older Americans Act of 1965 (42 U.S.C. 3024(a)) is amended--
(A) in paragraph (1)--
(i) in the first sentence, by striking `Subject to paragraphs (2) and (3)' and inserting `Subject to paragraph (2),'; and
(ii) in the last sentence, by striking `For the purposes of paragraph (3) and the exception' and inserting `For the purposes of the exception'; and
(B) by striking paragraph (3).
(3) Section 306(a)(2) of the Older Americans Act of 1965 (42 U.S.C. 3026(a)(2)) is amended by striking subparagraph (B) and inserting the following:
`(B) in-home services (as defined in section 321);'.
(4) Section 307(a) of the Older Americans Act of 1965 (42 U.S.C. 3027(a)) is amended--
(A) in paragraph (10), by striking `section 342' and inserting `section 321';
(B) in paragraph (27), by striking `in-home services under section 341' and inserting `in-home services under section 321';
(C) by striking paragraph (40); and
(D) in paragraph (44), by inserting `(as defined in section 321)' after `in-home services'.
(5) Section 422(b)(11)(A)(ii)(III) of the Older Americans Act of 1965 (42 U.S.C. 3035a(b)(11)(A)(ii)(III)) is amended by striking `part D' and inserting `part B'.
(6) Section 429F(a)(2) of the Older Americans Act of 1965 (42 U.S.C. 3035n(a)(2)) is amended by striking `section 342' and inserting `section 321'.
SEC. 6. EFFECTIVE DATE.
The amendments made by this Act take effect on October 1, 1999.