II 

115TH CONGRESS 

1ST SESSION S. 1606 

To authorize grants for the support of caregivers. 

IN THE SENATE OF THE UNITED STATES 

JULY 20, 2017 

Mr. BOOKER (for himself and Mr. FRANKEN) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To authorize grants for the support of caregivers. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘In-Home Caregiver 

5 Assessment Resources and Education Act’’ or the ‘‘In6 Home CARE Act’’. 

7 SEC. 2. FINDINGS. 

8 Congress finds the following: 

9 (1) More than 43,000,000 unpaid caregivers 

10 provide care for a chronically ill, disabled, or aged 

11 family member or friend during any given year. 


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1 (2) Sixty percent of unpaid caregivers are 

2 women. More than 37 percent of caregivers live with 

3 children or grandchildren who are under 18 years 

4 old. 

5 (3) Ethnic minority caregivers, particularly Af6 rican-American and Hispanic-American caregivers, 

7 experience greater strain and worse physical health 

8 than their counterparts. More than 50 percent of Af9 rican Americans are ‘‘sandwiched’’ between caring 

10 for an older person and a younger person under age 

11 18. 

12 (4) The needs of caregivers and care recipients 

13 vary by several factors such as race and ethnicity, 

14 age, social class, sexual orientation, geographical lo15 cation, gender, military or veteran status, relation16 ship between caregiver and care recipient, health 

17 status, and other factors. 

18 (5) Unpaid family caregivers spend an average 

19 of 24 hours per week caring for their loved ones, 

20 and about 23 percent of family caregivers provide 41 

21 or more hours of care per week. 

22 (6) Forty-nine percent of caregivers care for a 

23 parent. 

24 (7) Fourteen percent of caregivers provide care 

25 for a special needs child, including an estimated 


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1 16,800,000 caregivers who care for a special needs 

2 child under 18 years of age. 

3 (8) In 2016, the average caregiver for someone 

4 18 years or older spent $6,954 per year on out-of5 pocket caregiving expenses, which is nearly 20 per6 cent of the average annual income of caregivers. 

7 (9) Sixty percent of caregivers who provide care 

8 for an individual over the age of 18 are currently 

9 working or have worked while providing care. Three 

10 in five caregivers have had to make some modifica11 tions to their work schedule, from arriving late to 

12 work to leaving their job entirely. Almost half of em13 ployed caregivers have had to take time off from 

14 work. 

15 (10) Fifty-three percent of caregivers have ex16 perienced a decline in their health as a result of 

17 caregiving, which has affected their ability to provide 

18 care. Thirty-five percent of caregivers report having 

19 difficulty finding time for oneself, and 29 percent re20 port difficulty managing emotional and physical 

21 stress or balancing work and family responsibilities. 

22 (11) Forty-six percent of caregivers of adults 

23 perform medical or nursing tasks for patients with 

24 multiple physical and chronic conditions. Of these 

25 caregivers, 78 percent were in charge of managing 


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1 a patient’s medications, administering fluids, or ad2 ministering injections. 

3 (12) Nearly 20 percent of caregivers of adults 

4 who assisted with medication management and 33 

5 percent who assisted with changing dressings or 

6 bandages received no training about how to perform 

7 these tasks. 

8 (13) The vast majority of caregivers (84 per9 cent) indicated they need more support related to 

10 caregiving. 

11 (14) Home visiting programs are cost-effective 

12 and have been proven to improve outcomes for chil13 dren and parents in different domains ranging from 

14 child development to family violence. 

15 SEC. 3. PURPOSES. 

16 The purposes of this Act are— 

17 (1) to improve the ability of unpaid caregivers 

18 to care for individuals in the home; and 

19 (2) to increase opportunities for individuals who 

20 are in need of care to remain at home and reduce 

21 or postpone the need for such individuals to receive 

22 care at an institution or hospital. 


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1 SEC. 4. CAREGIVER GRANTS. 

2 Subpart IV of part D of title III of the Public Health 

3 Service Act (42 U.S.C. 255 et seq.) is amended by adding 

4 at the end the following: 

5 ‘‘SEC. 339A. CAREGIVER GRANTS. 

6 ‘‘(a) IN GENERAL.—The Secretary, acting through 

7 the Administrator of the Administration for Community 

8 Living, shall award 3-year grants, on a competitive basis, 

9 to eligible organizations to carry out home visiting pro10 grams for unpaid caregivers. 

11 ‘‘(b) DEFINITIONS.—In this section: 

12 ‘‘(1) CAREGIVER.—The term ‘caregiver’ means 

13 an unpaid family member, foster parent, or other 

14 unpaid adult who provides consistent in-home moni15 toring, management, supervision, or treatment of a 

16 child or adult with a special need, such as a disease, 

17 disability, or the frailties of old age. 

18 ‘‘(2) CAREGIVER ASSESSMENT.—The term 

19 ‘caregiver assessment’ means an assessment that in20 cludes talking directly to caregivers to better under21 stand their needs, problems, resources, and 

22 strengths. 

23 ‘‘(3) CHILD OR ADULT WITH A SPECIAL

24 NEED.—The term ‘child or adult with a special need’ 

25 means an individual for whom care or supervision is 

26 required to— 


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1 ‘‘(A) meet the basic needs of the indi2 vidual; 

3 ‘‘(B) prevent physical self-injury or injury 

4 to others; or 

5 ‘‘(C) avoid placement in an institutional 

6 facility. 

7 ‘‘(4) ELIGIBLE ORGANIZATION.—The term ‘eli8 gible organization’ means— 

9 ‘‘(A) a local government agency; 

10 ‘‘(B) a health care entity; or 

11 ‘‘(C) any other nonprofit or community or12 ganization, 

13 that has experience providing the services described 

14 in subsection (f). 

15 ‘‘(c) COORDINATION.—In carrying out this section, 

16 the Secretary shall coordinate with— 

17 ‘‘(1) the heads of the National Family Care18 giver Support Program of the Administration on 

19 Aging and other programs within the Department of 

20 Health and Human Services (such as the Lifespan 

21 Respite Care Program) and the Secretary of Vet22 erans Affairs, to ensure coordination of caregiver 

23 services for caregivers of children or adults with spe24 cial needs; and 


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1 ‘‘(2) the Administrator of the Centers for Medi2 care & Medicaid Services, to avoid duplicative serv3 ices and payments. 

4 ‘‘(d) APPLICATION.—An eligible organization that de5 sires a grant under this section shall submit an application 

6 at such time, in such manner, and containing such infor7 mation as the Secretary may require, including, at a min8 imum— 

9 ‘‘(1) an outreach plan that identifies how the el10 igible organization will ascertain which caregivers in 

11 the community— 

12 ‘‘(A) are most in need of support and edu13 cation, particularly caregivers who have had no 

14 training and provide complex chronic care ac15 tivities or perform medical or nursing tasks in 

16 addition to assisting with activities of daily liv17 ing; 

18 ‘‘(B) are caring for individuals who are at 

19 the greatest risk of needing institutional care; 

20 and 

21 ‘‘(C) desire to participate in the caregiver 

22 home visiting program; 

23 ‘‘(2) a description of the services that the eligi24 ble organization will provide directly using grant 

25 funds, and a description of the services that the eliVerDate Sep 11 2014 02:43 Jul 29, 2017 Jkt 069200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1606.IS S1606

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1 gible organization will use grant funds to provide 

2 through contracts or referrals; 

3 ‘‘(3) a description of how the eligible organiza4 tion will identify gaps in the services that caregivers 

5 and children or adults with a special need who re6 ceive care from a caregiver in the community are re7 ceiving; 

8 ‘‘(4) a description of how the eligible organiza9 tion can provide— 

10 ‘‘(A) an initial visit to caregivers in order 

11 to complete a caregiver assessment, including a 

12 description of the eligible organization’s exper13 tise in conducting caregiver assessments; 

14 ‘‘(B) education and training, based on evi15 dence-based models, to help the caregiver learn 

16 how to best care for a child or adult with a spe17 cial need, by an individual with expertise in the 

18 tasks for which the caregiver requires education 

19 and training, including education and training 

20 regarding, as applicable— 

21 ‘‘(i) medication management; 

22 ‘‘(ii) wound care; 

23 ‘‘(iii) nutrition and food preparation 

24 for special diets; 

25 ‘‘(iv) fall prevention; 


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1 ‘‘(v) management of depression, anx2 iety, stress, trauma, and other behavioral 

3 health conditions, including ways to mini4 mize negative mental health effects; 

5 ‘‘(vi) assistance with activities of daily 

6 living; 

7 ‘‘(vii) ways to engage other family 

8 members in providing care; 

9 ‘‘(viii) ways to identify and utilize 

10 available community resources; and 

11 ‘‘(ix) abuse and neglect prevention; 

12 and 

13 ‘‘(C) recommendations for home modifica14 tions or physical environmental changes that 

15 could improve the health or quality of life of a 

16 child or adult with a special need who is receiv17 ing care from a caregiver; 

18 ‘‘(5) a description of the eligible organization’s 

19 ability to provide, or refer caregivers to local re20 sources or appropriate programs of the Department 

21 of Health and Human Services or the Department 

22 of Veterans Affairs that will provide— 

23 ‘‘(A) physical and mental health care, in24 cluding home health care and long-term support 

25 services; 


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1 ‘‘(B) transportation; 

2 ‘‘(C) home modification services; 

3 ‘‘(D) respite care; 

4 ‘‘(E) adult day care; 

5 ‘‘(F) support groups; and 

6 ‘‘(G) legal assistance; 

7 ‘‘(6) a description of the eligible organization’s 

8 ability to coordinate with other State and commu9 nity-based agencies; 

10 ‘‘(7) a description of the eligible organization’s 

11 understanding of caregiver issues— 

12 ‘‘(A) across demographic groups, including 

13 age, gender, race and ethnicity, socioeconomic 

14 status, sexual orientation, military status, and 

15 geographical region; and 

16 ‘‘(B) including disabilities and chronic con17 ditions that affect the populations that the eli18 gible organization will serve; 

19 ‘‘(8) a description of the capacity of the eligible 

20 organization to engage caregivers, family members, 

21 and children or adults with a special need who re22 ceive care from a caregiver; and 

23 ‘‘(9) with respect to the population of caregivers 

24 to whom caregiver visits or services will be provided, 


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1 or for whom workers and volunteers will be recruited 

2 and trained, a description of— 

3 ‘‘(A) the population of caregivers; 

4 ‘‘(B) the extent and nature of the needs of 

5 that population; and 

6 ‘‘(C) existing caregiver services for that 

7 population, including the number of caregivers 

8 served and the extent of unmet need. 

9 ‘‘(e) PRIORITY.—In awarding grants under this sec10 tion, the Secretary shall give priority to eligible organiza11 tions that— 

12 ‘‘(1) the Secretary determines show the greatest 

13 likelihood of implementing or enhancing caregiver 

14 home visiting services that best meet the needs of 

15 the community; 

16 ‘‘(2) will allow caregivers to contact the eligible 

17 organization by phone, email, or 2-way interactive 

18 video for up to 6 months after home visits have 

19 ended, or to otherwise contact the organization at 

20 any time if a caregiver has questions or concerns; 

21 ‘‘(3) have a proven record of caregiver support; 

22 ‘‘(4) will use evidence-based programs; or 

23 ‘‘(5) will provide matching funds or can dem24 onstrate that the program funded by a grant under 


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1 this section will be sustainable after grant funds are 

2 no longer provided. 

3 ‘‘(f) AUTHORIZED ACTIVITIES.—An eligible organiza4 tion receiving a grant under this section shall use grant 

5 funds to— 

6 ‘‘(1) conduct an initial home visit for each care7 giver participating in the program, during which a 

8 representative from the eligible organization who has 

9 expertise in care management in the home and 

10 caregiving will perform a caregiver assessment and 

11 determine what follow-up services may benefit the 

12 caregiver and the child or adult with a special need 

13 who receives care from the caregiver; 

14 ‘‘(2) conduct home visits for the purpose of 

15 caregiver education and training; 

16 ‘‘(3) provide, or provide referrals for, the serv17 ices described in subsection (d)(5); 

18 ‘‘(4) provide an assessment and referral for 

19 physical and mental health services for the caregiver 

20 and for the child or adult with a special need who 

21 receives care from the caregiver, as needed; and 

22 ‘‘(5) carry out any other activities that are de23 scribed in the grant application submitted under 

24 subsection (d). 


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1 ‘‘(g) TECHNICAL ASSISTANCE CENTER.—The Sec2 retary shall establish, or contract to establish, a technical 

3 assistance center through which the Secretary shall— 

4 ‘‘(1) provide evidence-based models for pro5 grams funded by grants under this section; 

6 ‘‘(2) provide training for grantees; 

7 ‘‘(3) answer questions from grantees; and 

8 ‘‘(4) facilitate an exchange of information 

9 among grantees, and between grantees and other 

10 programs within the Department of Health and 

11 Human Services, including through use of the Tech12 nical Assistance Exchange of the Administration for 

13 Community Living, in order to maximize the use of 

14 existing resources and services for caregivers and to 

15 avoid the duplication of such services. 

16 ‘‘(h) EVALUATION.— 

17 ‘‘(1) IN GENERAL.—Not later than 2 years 

18 after the date of enactment of this section, and an19 nually thereafter, the Secretary shall evaluate the 

20 success of the grant program carried out under this 

21 section, based on criteria that the Secretary may de22 velop for such evaluation. 

23 ‘‘(2) OPTIONAL CONTENTS OF EVALUATION.— 

24 The evaluation described in paragraph (1) may in25 clude an evaluation of— 


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1 ‘‘(A) the extent to which children or adults 

2 with a special need who are cared for by a par3 ticipating caregiver have— 

4 ‘‘(i) a reduction in the potential num5 ber of hospitalizations; 

6 ‘‘(ii) a reduction in the potential num7 ber of institutionalizations; 

8 ‘‘(iii) cost reductions across the health 

9 care system; 

10 ‘‘(iv) improved connection to commu11 nity resources; 

12 ‘‘(v) improved care; and 

13 ‘‘(vi) improved quality of life (includ14 ing a reduction of stress and anxiety and 

15 improved relationships and mood); and 

16 ‘‘(B) the extent to which participating 

17 caregivers have improved quality of life (includ18 ing a reduction of stress and anxiety and im19 proved health, relationships, mood, and connec20 tion to community resources). 

21 ‘‘(i) REPORTS AND RECOMMENDATIONS.—Not later 

22 than 1 year before the expiration of the grants awarded 

23 under this section, the Secretary shall prepare and submit 

24 a report to Congress that includes recommendations, 


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1 based on the evaluation described in subsection (h), 

2 about— 

3 ‘‘(1) changes to the grant program under this 

4 section; 

5 ‘‘(2) the potential for expanding the number 

6 and scope of caregiver home visiting program grants 

7 distributed by the Secretary; and 

8 ‘‘(3) extending the length of the grant program. 

9 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There 

10 are authorized to be appropriated to carry out this section 

11 such sums as may be necessary.’’. 

Æ 


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