II 

112TH CONGRESS 

1ST SESSION S. 1819 

To amend the Older Americans Act of 1965 to improve programs and services. 

IN THE SENATE OF THE UNITED STATES 

NOVEMBER 8, 2011 

Mr. KOHL (for himself and Ms. MIKULSKI) introduced the following bill; which 

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

Labor, and Pensions 

A BILL 

To amend the Older Americans Act of 1965 to improve 

programs and services. 

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 ‘‘Strengthening Services 

5 for America’s Seniors Act’’. 

6 SEC. 2. STANDARDIZED ASSESSMENT OF NEEDS OF FAMILY 

7 CAREGIVERS. 

8 (a) IN GENERAL.—Section 373 (42 U.S.C. 3030s– 

9 1) is amended— 


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1 (1) by redesignating subsections (b) through (g) 

2 as subsections (c) through (h), respectively; 

3 (2) in subsection (d), as so redesignated, by 

4 striking ‘‘subsection (b)’’ and inserting ‘‘subsection 

5 (c)’’; 

6 (3) in subsection (e), as so redesignated, by 

7 striking ‘‘subsection (b)’’ and inserting ‘‘subsection 

8 (c)’’; and 

9 (4) by inserting after subsection (a) the fol10 lowing: 

11 ‘‘(b) ASSESSMENT PROGRAM OF NEEDS OF FAMILY

12 CAREGIVERS.— 

13 ‘‘(1) IN GENERAL.—The Assistant Secretary 

14 may make grants to States to establish a program, 

15 in accordance with the program requirements de16 scribed in paragraph (5), to assess the needs of fam17 ily caregivers for targeted support services described 

18 in paragraph (5)(C). 

19 ‘‘(2) APPLICATION BY STATES.—Each State 

20 seeking a grant under this subsection shall submit 

21 an application to the Assistant Secretary at such 

22 time, in such manner, and containing such informa23 tion and assurances as the Assistant Secretary de24 termines appropriate. 


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1 ‘‘(3) GRANT AMOUNT.—The amount of a grant 

2 to a State under this subsection shall be determined 

3 according to such methodology as the Assistant Sec4 retary determines appropriate. 

5 ‘‘(4) PROGRAM ADMINISTRATION.—A State re6 ceiving a grant under this subsection may enter into 

7 an agreement with area agencies on aging in the 

8 State, or an Aging and Disability Resource Center 

9 in the State, to administer the program, using such 

10 grant funds. 

11 ‘‘(5) PROGRAM REQUIREMENTS.— 

12 ‘‘(A) STANDARDIZED ASSESSMENT.—As13 sessments under a program established under 

14 paragraph (1)— 

15 ‘‘(i) shall be conducted by social work16 ers, care managers, nurses, or other appro17 priate professionals; and 

18 ‘‘(ii)(I) shall be conducted with a 

19 standardized instrument to identify family 

20 caregiver needs; and 

21 ‘‘(II) in a State in which an area 

22 agency on aging or an Aging and Dis23 ability Resource Center is using such an 

24 instrument on the date of enactment of the 

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1 iors Act, may continue to be conducted 

2 with that instrument. 

3 ‘‘(B) QUESTIONNAIRE.— 

4 ‘‘(i) IN GENERAL.—Subject to clause 

5 (ii), assessments under a program estab6 lished as described in paragraph (1) shall 

7 include asking the family caregiver relevant 

8 questions in order to determine whether 

9 the family caregiver would benefit from 

10 any targeted support services described in 

11 subparagraph (C). 

12 ‘‘(ii) COMPLETION ON A VOLUNTARY

13 BASIS.—The answering of questions under 

14 clause (i) by a family caregiver shall be on 

15 a voluntary basis. 

16 ‘‘(iii) ADDRESSING DIVERSE CARE17 GIVER NEEDS AND PREFERENCES.—The 

18 questionnaire under this subparagraph 

19 shall be designed in a manner that ac20 counts for, and aims to ascertain, the vary21 ing needs and preferences of family care22 givers, based on the range of their capabili23 ties, caregiving experience, and other rel24 evant personal characteristics and cir25 cumstances. 


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1 ‘‘(C) TARGETED SUPPORT SERVICES DE2 SCRIBED.—The following targeted support serv3 ices are described in this subparagraph: 

4 ‘‘(i) Information and assistance (in5 cluding brochures and online resources for 

6 researching a disease or disability or for 

7 learning and managing a regular 

8 caregiving role, new technologies that can 

9 assist family caregivers, and practical as10 sistance for locating services). 

11 ‘‘(ii) Individual counseling (including 

12 advice and consultation sessions to bolster 

13 emotional support for the family caregiver 

14 to make well-informed decisions about how 

15 to cope with caregiver strain). 

16 ‘‘(iii) Support groups, including 

17 groups which provide help for family care18 givers to— 

19 ‘‘(I) locate a support group either 

20 locally or online to share experiences 

21 and reduce isolation; 

22 ‘‘(II) make well-informed 

23 caregiving decisions; and 

24 ‘‘(III) reduce isolation. 


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1 ‘‘(iv) Education and training (includ2 ing workshops and other resources avail3 able with information about stress manage4 ment, self-care to maintain good physical 

5 and mental health, understanding and 

6 communicating with individuals with de7 mentia, medication management, normal 

8 aging processes, change in disease and dis9 ability, the role of assistive technologies, 

10 and other relevant topics). 

11 ‘‘(v) Respite care and emergency 

12 back-up services (including short-term in13 home care services that gives the family 

14 caregiver a break from providing such 

15 care). 

16 ‘‘(vi) Chore services (such as house 

17 cleaning) to assist the individual receiving 

18 care. 

19 ‘‘(vii) Personal care (including outside 

20 help) to assist the individual receiving care. 

21 ‘‘(viii) Legal and financial planning 

22 and consultation (including advice and 

23 counseling regarding long-term care plan24 ning, estate planning, powers of attorney, 

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1 ployment leave advice, advance directives, 

2 and end-of-life care). 

3 ‘‘(ix) Transportation (including trans4 portation to medical appointments) to as5 sist the individual receiving care. 

6 ‘‘(x) Other targeted support services, 

7 as determined appropriate by the State 

8 agency and approved by the Assistant Sec9 retary. 

10 ‘‘(D) REFERRALS.—In the case where a 

11 questionnaire completed by a family caregiver 

12 under subparagraph (B) indicates that the fam13 ily caregiver would benefit from 1 or more of 

14 the targeted support services described in sub15 paragraph (C), the agency administering the 

16 program shall provide referrals to the family 

17 caregiver for State, local, and private-sector 

18 caregiver programs and other resources that 

19 provide such targeted support services to such 

20 caregivers. 

21 ‘‘(E) TARGETING AND TIMING OF ASSESS22 MENTS.—Assessments under the program es23 tablished under paragraph (1) may be con24 ducted— 


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1 ‘‘(i) when an individual who is being 

2 assisted by a family caregiver transitions 

3 from one care setting to another; 

4 ‘‘(ii) upon referral from a social work5 er, care manager, nurse, physician, or 

6 other appropriate professional; or 

7 ‘‘(iii) according to circumstances de8 termined by the State and approved by the 

9 Assistant Secretary. 

10 ‘‘(F) COORDINATION WITH OTHER ASSESS11 MENT.—Assessments under the program estab12 lished under paragraph (1) may be conducted 

13 separately or as part of, or in conjunction with, 

14 eligibility or other routine assessments of an in15 dividual who is being (or is going to be) as16 sisted by a family caregiver. 

17 ‘‘(G) FOLLOWUP SERVICES.—As the As18 sistant Secretary determines appropriate, a 

19 State with a program described in paragraph 

20 (1) shall conduct followup activities with care21 givers who have participated in an assessment 

22 to determine the status of the caregiver and 

23 whether services were provided. 

24 ‘‘(H) REPORTING REQUIREMENT.—Each 

25 State with a program described in paragraph 


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1 (1) shall periodically submit to the Assistant 

2 Secretary a report containing information on 

3 the number of caregivers assessed under the 

4 program, information on the number of refer5 rals made for targeted support services under 

6 the program (disaggregated by type of service), 

7 demographic information on caregivers assessed 

8 under the program, and other information re9 quired by the Assistant Secretary.’’. 

10 (b) STANDARDIZED ASSESSMENT OF NEEDS OF IN11 FORMAL CAREGIVERS.—Section 202 (42 U.S.C. 3012) is 

12 amended— 

13 (1) in subsection (b)(8)— 

14 (A) in subparagraph (D), by striking 

15 ‘‘and’’; 

16 (B) in subparagraph (E), inserting ‘‘and’’ 

17 after the semicolon at the end; and 

18 (C) by adding at the end the following: 

19 ‘‘(F) which may carry out the informal 

20 caregiver assessment program described in sub21 section (g);’’; and 

22 (2) by adding at the end the following: 

23 ‘‘(g) STANDARDIZED ASSESSMENT OF NEEDS OF IN24 FORMAL CAREGIVERS.— 


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1 ‘‘(1) IN GENERAL.—Aging and Disability Re2 source Centers implemented under subsection (b)(8) 

3 may carry out an assessment program with respect 

4 to informal caregivers and care recipients. Such as5 sessment program shall be modeled on the family 

6 caregiver assessment program established under sec7 tion 373(b). 

8 ‘‘(2) DEFINITIONS.—For purposes of an infor9 mal caregiver assessment carried out in accordance 

10 with paragraph (1), the following definitions shall 

11 apply: 

12 ‘‘(A) CARE RECIPIENT.—The term ‘care 

13 recipient’ means— 

14 ‘‘(i) an older individual; 

15 ‘‘(ii) an individual with a disability; or 

16 ‘‘(iii) an individual with a special 

17 need. 

18 ‘‘(B) INDIVIDUAL WITH A SPECIAL

19 NEED.—The term ‘individual with a special 

20 need’ means an individual who requires care or 

21 supervision to— 

22 ‘‘(i) meet the individual’s basic needs; 

23 ‘‘(ii) prevent physical self-injury or in24 jury to others; or 


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1 ‘‘(iii) avoid placement in an institu2 tional facility. 

3 ‘‘(C) INFORMAL CAREGIVER.— 

4 ‘‘(i) IN GENERAL.—Subject to clause 

5 (ii), the term ‘informal caregiver’ means an 

6 adult family member, or another indi7 vidual, who is an informal provider of in8 home and community care to a care recipi9 ent. 

10 ‘‘(ii) ALTERNATE DEFINITION.—A 

11 State that has a State law with an alter12 nate definition of the term ‘informal care13 giver’ for purposes of a program described 

14 in paragraph (1) may use that definition 

15 (with respect to caregivers for care recipi16 ents) for purposes of provisions of this Act 

17 that relate to that program, if such alter18 native definition is broader than the defini19 tion in clause (i), and subject to approval 

20 by the Assistant Secretary.’’. 

21 (c) CONFORMING AMENDMENT.—Section 631(b) (42 

22 U.S.C. 3057k–11(b)) is amended by striking ‘‘subsections 

23 (c), (d), and (e)’’ and inserting ‘‘subsections (d), (e), and 

24 (f)’’. 


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1 SEC. 3. ADVISORY COMMITTEE TO ASSESS, COORDINATE, 

2 AND IMPROVE LEGAL ASSISTANCE ACTIVI3 TIES. 

4 (a) IN GENERAL.—Title II of the Older Americans 

5 Act of 1965 is amended— 

6 (1) in section 215(j) (42 U.S.C. 3020e–1(j)), by 

7 striking ‘‘section 216’’ and inserting ‘‘section 217’’; 

8 (2) by redesignating section 216 (42 U.S.C. 

9 3020f) as section 217; and 

10 (3) by inserting after section 215 (42 U.S.C. 

11 3020e–1) the following: 

12 ‘‘SEC. 216. ADVISORY COMMITTEE TO ASSESS, COORDI13 NATE, AND IMPROVE LEGAL ASSISTANCE AC14 TIVITIES. 

15 ‘‘(a) ESTABLISHMENT.—There is established an Ad16 visory Committee to Assess, Coordinate, and Improve 

17 Legal Assistance Activities (referred to in this section as 

18 the ‘Committee’). 

19 ‘‘(b) MEMBERSHIP.— 

20 ‘‘(1) COMPOSITION.—The Committee shall be 

21 composed of 9 members— 

22 ‘‘(A) with expertise with existing State 

23 legal assistance development programs carried 

24 out under section 731 and providers of State 

25 legal assistance under subtitle B of title III and 

26 title IV; and 


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1 ‘‘(B) of whom— 

2 ‘‘(i) 6 individuals shall be appointed 

3 by the Assistant Secretary— 

4 ‘‘(I) 1 of whom shall be a con5 sumer advocate; 

6 ‘‘(II) 1 of whom shall be a pro7 fessional advocate from a State agen8 cy or State Legal Services Developer; 

9 and 

10 ‘‘(III) 4 of whom shall be rep11 resentatives from collaborating organi12 zations under the National Legal Re13 source Center of the Administration; 

14 and 

15 ‘‘(ii) 3 individuals shall be appointed 

16 by the Comptroller General of the United 

17 States. 

18 ‘‘(2) DATE.—The appointments of the members 

19 of the Committee shall be made not later than 9 

20 months after the date of enactment of the Strength21 ening Services for America’s Seniors Act. 

22 ‘‘(3) PERIOD OF APPOINTMENT; VACANCIES.— 

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1 fect its powers, but shall be filled in the same man2 ner as the original appointment. 

3 ‘‘(4) CHAIRPERSON AND VICE CHAIRPERSON.— 

4 The Committee shall select a Chairperson and Vice 

5 Chairperson from among its members. 

6 ‘‘(c) INITIAL MEETING.—The Committee shall hold 

7 its first meeting not later than 9 months after the date 

8 of enactment of the Strengthening Services for America’s 

9 Seniors Act. 

10 ‘‘(d) DUTIES OF THE COMMITTEE.— 

11 ‘‘(1) DEFINITION.—In this subsection, the term 

12 ‘assistance activities’ includes— 

13 ‘‘(A) legal assistance made available to 

14 older individuals in social or economic need 

15 under this Act; 

16 ‘‘(B) activities of the National Legal Re17 source Center carried out under section 420(a); 

18 ‘‘(C) State legal assistance developer ac19 tivities carried out under section 731; and 

20 ‘‘(D) any other directly related activity or 

21 program as determined appropriate by the As22 sistant Secretary. 

23 ‘‘(2) STUDY.— 


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1 ‘‘(A) IN GENERAL.—The Committee shall 

2 design, implement, and analyze results of a 

3 study of— 

4 ‘‘(i) the extent to which State leader5 ship is provided through the State legal as6 sistance developer in States to enhance the 

7 coordination and effectiveness of legal as8 sistance activities across the State; 

9 ‘‘(ii) the extent to which— 

10 ‘‘(I) there is data collection and 

11 reporting of information by legal as12 sistance providers in States; 

13 ‘‘(II) there is uniform statewide 

14 reporting among States; and 

15 ‘‘(III) the value and impact of 

16 services provided is being captured at 

17 the State or local level; and 

18 ‘‘(iii) the mechanisms to organize and 

19 promote legal assistance development and 

20 services to best meet the needs of older in21 dividuals with greatest social and economic 

22 need. 

23 ‘‘(B) CONSIDERATIONS.—In carrying out 

24 subparagraph (A)(i), particular attention shall 

25 be given to— 


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1 ‘‘(i) State leadership on targeting lim2 ited legal resources to older individuals in 

3 greatest social and economic need; and 

4 ‘‘(ii) State leadership on establishing 

5 priority legal issue areas in accordance 

6 with section 307(a)(11)(E). 

7 ‘‘(3) RECOMMENDATIONS.—After completion 

8 and analysis of study results under paragraph (2), 

9 the Committee shall develop recommendations for 

10 the establishment of guidelines for— 

11 ‘‘(A) enhancing the leadership capacity of 

12 the State legal assistance developers to carry 

13 out statewide coordinated legal assistance serv14 ice delivery, with particular focus on enhancing 

15 leadership capacity to— 

16 ‘‘(i) target limited legal resources to 

17 older individuals in greatest social and eco18 nomic need; and 

19 ‘‘(ii) establish priority legal issue 

20 areas in accord with priorities set forth in 

21 section 307(a)(11)(E); 

22 ‘‘(B) developing a uniform national data 

23 collection system to be implemented in all 

24 States on legal assistance development and 

25 services; and 


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1 ‘‘(C) identifying mechanisms for organizing 

2 and promoting legal assistance activities to pro3 vide the highest quality, impact, and effective4 ness to older individuals with the greatest social 

5 and economic need. 

6 ‘‘(4) REPORT.—Not later than 1 years after the 

7 date of the establishment of the Committee, the 

8 Committee shall submit to the President, Congress, 

9 and the Assistant Secretary a report that contains 

10 a detailed statement of the findings and conclusions 

11 of the Committee, together with the recommenda12 tions described in paragraph (3). 

13 ‘‘(e) DUTIES OF THE ASSISTANT SECRETARY.—Not 

14 later than 180 days after receiving the report described 

15 in subsection (d)(4), the Assistant Secretary shall issue 

16 regulations or guidance, taking into consideration the rec17 ommendations described in subsection (d)(3). 

18 ‘‘(f) POWERS.— 

19 ‘‘(1) INFORMATION FROM FEDERAL AGEN20 CIES.—The Committee may secure directly from any 

21 Federal department or agency such information as 

22 the Committee considers necessary to carry out the 

23 provisions of this section. Upon request of the Com24 mittee, the head of such department or agency shall 

25 furnish such information to the Committee. 


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1 ‘‘(2) POSTAL SERVICES.—The Committee may 

2 use the United States mails in the same manner and 

3 under the same conditions as other departments and 

4 agencies of the Federal Government. 

5 ‘‘(g) PERSONNEL AND ADMINISTRATION.— 

6 ‘‘(1) TRAVEL EXPENSES.—The members of the 

7 Committee shall not receive compensation for the 

8 performance of services for the Committee, but shall 

9 be allowed travel expenses, including per diem in lieu 

10 of subsistence, at rates authorized for employees of 

11 agencies under subchapter I of chapter 57 of title 5, 

12 United States Code, while away from their homes or 

13 regular places of business in the performance of 

14 services for the Committee. Notwithstanding section 

15 1342 of title 31, United States Code, the Secretary 

16 may accept the voluntary and uncompensated serv17 ices of members of the Committee. 

18 ‘‘(2) DETAIL OF GOVERNMENT EMPLOYEES.— 

19 Any Federal Government employee may be detailed 

20 to the Committee without reimbursement, and such 

21 detail shall be without interruption or loss of civil 

22 service status or privilege. 

23 ‘‘(3) ADMINISTRATIVE AND SUPPORT SERV24 ICES.—The Assistant Secretary shall provide admin25 istrative and support services to the Committee. 


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1 ‘‘(4) PROCUREMENT OF TEMPORARY AND

2 INTERMITTENT SERVICES.—The Chairman of the 

3 Committee may procure temporary and intermittent 

4 services under section 3109(b) of title 5, United 

5 States Code, at rates for individuals that do not ex6 ceed the daily equivalent of the annual rate of basic 

7 pay prescribed for level V of the Executive Schedule 

8 under section 5316 of such title. 

9 ‘‘(h) EXEMPTION FROM TERMINATION REQUIRE10 MENTS.—Section 14 of the Federal Advisory Committee 

11 Act shall not apply to the Committee.’’. 

12 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

13 217 of the Older Americans Act of 1965, as redesignated 

14 by subsection (a), is amended by adding at the end the 

15 following: 

16 ‘‘(d) ADVISORY COMMITTEE TO ASSESS, COORDI17 NATE, AND IMPROVE LEGAL ASSISTANCE ACTIVITIES.— 

18 There is authorized to be appropriated to carry out section 

19 216, $300,000 for fiscal year 2012.’’. 

20 SEC. 4. IMPROVING THE STATE LONG-TERM CARE OMBUDS21 MAN PROGRAMS. 

22 (a) NATIONAL OMBUDSMAN RESOURCE CENTER.— 

23 Section 202(a)(18)(B) of the Older Americans Act of 

24 1965 (42 U.S.C. 3012(a)(18)(B)) is amended by striking 

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1 serve and provide, for the funding of the National Om2 budsman Resource Center (which may include enabling 

3 the center to collaborate and participate with the Centers 

4 for Medicare & Medicaid Services in providing training for 

5 State survey agencies with an agreement in effect under 

6 section 1864 of the Social Security Act (42 U.S.C. 

7 1395aa) or, in the case of States without such an agency, 

8 work with the Administrator for the Centers for Medicare 

9 & Medicaid Services to improve the investigative processes 

10 used by the center to address complaints by residents of 

11 long-term care facilities)— 

12 ‘‘(i) for fiscal year 2012, not less than 

13 $2,000,000; and 

14 ‘‘(ii) for each subsequent fiscal year, 

15 not less than the sum of— 

16 ‘‘(I) $100,000; and 

17 ‘‘(II) the amount made available 

18 under this subparagraph for the fiscal 

19 year preceding the year for which the 

20 sum is determined;’’. 

21 (b) FUNCTIONS OF PROGRAM.— 

22 (1) PRIVATE AND UNIMPEDED ACCESS TO OM23 BUDSMAN SERVICES.—Section 712(b)(1)(A) of the 

24 Older Americans Act of 1965 (42 U.S.C. 


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1 3058g(b)(1)(A)) is amended by striking ‘‘access’’ 

2 and inserting ‘‘private and unimpeded access’’. 

3 (2) OMBUDSMAN DEVELOPMENT OF RESIDENT

4 AND FAMILY COUNCILS.—Section 712(a)(3)(H)(iii) 

5 of such Act (42 U.S.C. 3058g(a)(3)(H)(iii)) is 

6 amended by striking ‘‘provide technical support for’’ 

7 and inserting ‘‘actively encourage and assist in’’. 

8 (3) LOCAL ENTITY DEVELOPMENT OF RESI9 DENT AND FAMILY COUNCILS.—Section 

10 712(a)(5)(B)(vi) of such Act (42 U.S.C. 

11 3058g(a)(5)(B)(vi)) is amended by striking ‘‘sup12 port’’ and inserting ‘‘actively encourage and assist 

13 in’’. 

14 (c) OMBUDSMAN AUTHORITY WITH RESPECT TO

15 HIPAA.—Section 712(b) of the Older Americans Act of 

16 1965 (42 U.S.C. 3058g(b)) is amended— 

17 (1) in paragraph (1)(B)(i) by striking ‘‘the 

18 medical and social records of a’’ and inserting ‘‘all 

19 records concerning a’’; and 

20 (2) by adding at the end the following: 

21 ‘‘(3) For purposes of section 264(c) of the Health In22 surance Portability and Accountability Act of 1996 (in23 cluding regulations issued under that section) (42 U.S.C. 

24 1320d–2 note), the Ombudsman and a representative of 

25 the Office shall be considered a ‘health oversight agency,’ 


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1 so that release of residents’ individually identifiable health 

2 information to the Ombudsman or representative is not 

3 precluded in cases in which the requirements of clause (i) 

4 or (ii) of paragraph (1)(B) are otherwise met.’’. 

5 (d) DISCLOSURE AND CONFIDENTIALITY.—Section 

6 712(d) of the Older Americans Act of 1965 (42 U.S.C. 

7 3058g(d)) is amended— 

8 (1) in paragraph (1), by striking ‘‘files’’ and in9 serting ‘‘information’’; and 

10 (2) in paragraph (2)— 

11 (A) in the paragraph heading, by striking 

12 ‘‘IDENTITY OF COMPLAINANT OR RESIDENT’’ 

13 and inserting ‘‘PROCEDURES’’; 

14 (B) in subparagraph (A)— 

15 (i) by striking ‘‘files or records’’ the 

16 first place it appears and inserting ‘‘infor17 mation (including files or records)’’; and 

18 (ii) by striking ‘‘disclose’’ and all that 

19 follows and inserting ‘‘disclose such infor20 mation);’’; 

21 (C) in subparagraph (B)— 

22 (i) in the matter preceding clause (i), 

23 by striking ‘‘files or records’’ and inserting 

24 ‘‘information’’; and 


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1 (ii) in clause (iii), by striking the pe2 riod and inserting ‘‘; and’’; and 

3 (D) by adding at the end the following: 

4 ‘‘(C) require that the Ombudsman and 

5 each representative of the Office hold in strict 

6 confidence all communications with individuals 

7 seeking assistance under this Act, and take all 

8 reasonable steps to safeguard the confidentiality 

9 of information provided to the Ombudsman or 

10 a representative of the Office under this title by 

11 a complainant or resident.’’. 

Æ 


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