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106TH CONGRESS

1ST SESSION S. 707

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, Mr. REID, Ms. MIKULSKI,

and Mr. WYDEN) 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 establish

a national family caregiver support program, and for

other purposes.

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

3 SECTION 1. FINDINGS.

4 Congress finds that—

5 (1) there is no Federal program to support

6 family caregivers;

7 (2) most older individuals and persons with

8 mental retardation and related developmental dis9 abilities (as defined in section 102 of the Develop-
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1 mental Disabilities Assistance and Bill of Rights Act

2 (42 U.S.C. 6000) (referred to in this section as ‘‘de3 velopmental disabilities’’)) prefer to receive care in

4 their homes, rather than in institutions;

5 (3)(A) more than 22,000,000 family caregivers

6 actively care for aging or ailing older individuals in

7 the United States;

8 (B) fewer than 2,000,000 older individuals re9 ceive care through nursing homes in the United

10 States; and

11 (C) therefore, a large portion of the care pro12 vided for the Nation’s older individuals is provided

13 by family caregivers;

14 (4)(A) there are an estimated 3,170,000 per15 sons with mental retardation and related develop16 mental disabilities in the United States;

17 (B) 1,890,000 of individuals with mental retar18 dation and related developmental disabilities live

19 with family caregivers;

20 (C) 479,862 of individuals with mental retarda21 tion and related developmental disabilities who are

22 living at home receive care from caregivers who are

23 60 years old or older; and

24 (D) like services for the elderly population, a

25 large portion of supports and care for persons with
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1 mental retardation and related developmental dis2 abilities is provided by family caregivers;

3 (5) nearly 75 percent of family caregivers are

4 women, many of whom have other major responsibil5 ities, such as young children or jobs;

6 (6) the loss in productivity of businesses due to

7 necessary absences of caregiving employees ranges

8 from $11,000,000,000 to $29,000,000,000 a year;

9 (7) family caregivers offer support that is worth

10 billions of dollars;

11 (8) without the efforts of family caregivers,

12 many additional older individuals, and persons with

13 mental retardation and related developmental dis14 abilities, would receive care services in a hospital,

15 State facility, intermediate care facility for the men16 tally retarded, or nursing home, or would receive, al17 though less costly, home and community-based waiv18 er services under section 1915(c) of the Social Secu19 rity Act (42 U.S.C. 1396n(c)), such a result being

20 far more expensive for taxpayers than assisting fam21 ily caregivers since—

22 (A) the Federal medicare and medicaid

23 programs pay for a large portion of expenses

24 associated with such institutional care; and
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1 (B) such institutional care is more expen2 sive than family caregiving;

3 (9) caregivers, on average, spend $2,000 per

4 year for food, medication, and other expenses related

5 to caregiving;

6 (10)(A) caregiving is physically demanding and

7 emotionally draining to provide, with as many as 30

8 percent of caregivers reporting physical or mental

9 health problems due to caregiving; and

10 (B) caregivers need resources that will support

11 and help ease the overwhelming burden that the

12 caregivers are expected to shoulder on a daily basis;

13 and

14 (11) with millions of baby boomers set to retire

15 in the near future, it is crucial to begin preparing

16 today for what will be dramatically increased long17 term care needs of older individuals.

18 SEC. 2. NATIONAL FAMILY CAREGIVER SUPPORT PRO19 GRAM.

20 (a) ESTABLISHMENT OF PROGRAM.—Part D of title

21 III of the Older Americans Act of 1965 (42 U.S.C. 3030h

22 et seq.) is amended to read as follows:
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1 ‘‘PART D—NATIONAL FAMILY CAREGIVER

2 SUPPORT PROGRAM

3 ‘‘Subpart 1—State Grant Program

4 ‘‘SEC. 341. PROGRAM AUTHORIZED.

5 ‘‘(a) IN GENERAL.—The Assistant Secretary shall

6 carry out a program for making grants to States with

7 State plans approved under section 307, to pay for the

8 Federal share of the cost of carrying out State programs,

9 to enable eligible area agencies on aging to provide multi10 faceted systems of support services for family caregivers,

11 and other caregivers, who are informal providers of in12 home and community care to older individuals.

13 ‘‘(b) FAMILY CAREGIVER SUPPORT SERVICES.—In

14 providing services under this subpart, an area agency on

15 aging shall provide support services, including providing—

16 ‘‘(1) information to eligible caregivers about

17 available services;

18 ‘‘(2) assistance to eligible caregivers in gaining

19 access to the services;

20 ‘‘(3) individual counseling, organization of sup21 port groups, and caregiver training to eligible care22 givers to assist the caregivers in making decisions

23 and solving problems relating to their caregiving

24 roles;
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1 ‘‘(4) respite care to enable eligible caregivers to

2 be temporarily relieved from their caregiving respon3 sibilities; and

4 ‘‘(5) supplemental services, on a limited basis,

5 to complement the care provided by eligible care6 givers.

7 ‘‘(c) ELIGIBILITY AND PRIORITY.—

8 ‘‘(1) ELIGIBILITY.—In order for a caregiver of

9 an older individual to be eligible to receive services

10 provided by a State program under this subpart, the

11 State shall—

12 ‘‘(A) find that the caregiver is a caregiver

13 described in subsection (a); and

14 ‘‘(B) determine that the older individual

15 meets the condition specified in subparagraph

16 (A)(i) or (B) of section 102(28).

17 ‘‘(2) PRIORITY.—In providing the services, the

18 State shall give priority for services to older individ19 uals with greatest social need, older individuals with

20 greatest economic need, and older individuals pro21 viding care and supports to persons with mental re22 tardation and related developmental disabilities (as

23 defined in section 102 of the Developmental Disabil24 ities Assistance and Bill of Rights Act (42 U.S.C.

25 6000) (referred to in this part as ‘‘developmental
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1 disabilities’’)) consistent with the requirements of

2 section 305(a)(2)(E), and their caregivers.

3 ‘‘(d) COORDINATION WITH SERVICE PROVIDERS.—

4 In carrying out this subpart, each area agency on aging

5 shall coordinate the activities of the agency with the activi6 ties of other community agencies and voluntary organiza7 tions providing the types of services described in sub8 section (b).

9 ‘‘(e) QUALITY STANDARDS AND MECHANISMS AND

10 ACCOUNTABILITY.—

11 ‘‘(1) QUALITY STANDARDS AND MECHANISMS.—

12 The State shall establish standards and mechanisms

13 designed to assure the quality of services provided

14 with assistance made available under this subpart.

15 ‘‘(2) DATA AND RECORDS.—The State shall col16 lect data and maintain records relating to the State

17 program in a standardized format specified by the

18 Assistant Secretary. The State shall furnish the

19 records to the Assistant Secretary, at such time as

20 the Assistant Secretary may require, in order to en21 able the Assistant Secretary to monitor State pro22 gram administration and compliance, and to evalu23 ate and compare the effectiveness of the State pro24 grams.
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1 ‘‘(3) REPORTS.—The State shall prepare and

2 submit to the Assistant Secretary reports on the

3 data and records required under paragraph (2), in4 cluding information on the services funded under

5 this subpart, and standards and mechanisms by

6 which the quality of the services shall be assured.

7 ‘‘(f) AVAILABILITY OF FUNDS.—

8 ‘‘(1) IN GENERAL.—A State shall use the por9 tion of the State allotment under section 304 that

10 is from amounts appropriated under section 303(d)

11 to carry out the State program under this subpart.

12 ‘‘(2) USE OF FUNDS FOR ADMINISTRATION OF

13 AREA PLANS.—Amounts made available to a State to

14 carry out the State program under this subpart may

15 be used, in addition to amounts available in accord16 ance with section 303(c)(1), for costs of administra17 tion of area plans.

18 ‘‘(3) FEDERAL SHARE.—

19 ‘‘(A) IN GENERAL.—Notwithstanding sec20 tion 304(d)(1)(D), the Federal share of the cost

21 of carrying out a State program under this sub22 part shall be 75 percent.

23 ‘‘(B) NON-FEDERAL SHARE.—The non24 Federal share of the costs shall be provided

25 from State and local sources.
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1 ‘‘SEC. 342. MAINTENANCE OF EFFORT.

2 ‘‘Funds made available under this subpart shall sup3 plement, and not supplant, any Federal, State, or local

4 funds expended by a State or unit of general purpose local

5 government (including an area agency on aging) to provide

6 services described in section 341(b).

7 ‘‘Subpart 2—National Innovation Programs

8 ‘‘SEC. 346. INNOVATION GRANT PROGRAM.

9 ‘‘(a) IN GENERAL.—The Assistant Secretary shall

10 carry out a program for making grants to appropriate en11 tities on a competitive basis to foster the development and

12 testing of new approaches to—

13 ‘‘(1) sustaining the efforts of family caregivers

14 and other informal caregivers of older individuals;

15 ‘‘(2) serving the needs of particular groups of

16 caregivers of older individuals, including minority

17 caregivers and distant caregivers; and

18 ‘‘(3) linking family support programs with the

19 State entity or agency that administers or funds

20 programs for persons with mental retardation or re21 lated developmental disabilities and their families.

22 ‘‘(b) EVALUATION AND DISSEMINATION OF RE23 SULTS.—The Assistant Secretary shall provide for evalua24 tion of the effectiveness of programs and activities funded

25 with grants made under this section, and for dissemina26 tion to States of descriptions and evaluations of the pro-
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1 grams and activities, to enable States to incorporate suc2 cessful approaches into their individual State programs

3 under this part.

4 ‘‘(c) AVAILABILITY OF FUNDS.—

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

6 shall reserve not more than 10 percent of the

7 amount appropriated under section 303(d) for a fis8 cal year to carry out the program of the Assistant

9 Secretary under this section.

10 ‘‘(2) NATIVE AMERICAN PROGRAMS AND AC11 TIVITIES.—Twenty percent of the amount reserved

12 under paragraph (1) shall be available for programs

13 and activities under this section for caregivers serv14 ing Indians and Native Hawaiians, as defined in sec15 tion 625.

16 ‘‘SEC. 347. ACTIVITIES OF NATIONAL SIGNIFICANCE.

17 ‘‘(a) IN GENERAL.—The Assistant Secretary shall,

18 directly or by grant or contract, carry out activities of na19 tional significance to promote quality and continuous im20 provement in the support services provided to family care21 givers and other informal caregivers of older individuals,

22 through program evaluation, training, technical assist23 ance, and research.

24 ‘‘(b) AVAILABILITY OF FUNDS.—The Assistant Sec25 retary shall reserve not more than 2 percent of the amount
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1 appropriated under section 303(d) to carry out the activi2 ties under this section.’’.

3 SEC. 3. AUTHORIZATION OF APPROPRIATIONS; ALLOT4 MENTS.

5 (a) AUTHORIZATION OF APPROPRIATIONS.—Section

6 303(d) of the Older Americans Act of 1965 (42 U.S.C.

7 3023(d)) is amended to read as follows:

8 ‘‘(d) There are authorized to be appropriated

9 $125,000,000 for fiscal year 2000, and such sums as may

10 be necessary for each of fiscal years 2001 through 2004,

11 to carry out part D (relating to the national family care12 giver support program).’’.

13 (b) ALLOTMENTS TO STATES.—Section 304(a)(1) of

14 the Older Americans Act of 1965 (42 U.S.C. 3024(a)(1))

15 is amended in the first sentence—

16 (1) in the matter preceding subparagraph (A),

17 by inserting ‘‘, and remaining after reservations of

18 funds made under sections 346 and 347,’’ after

19 ‘‘from the sums appropriated under section 303 for

20 each fiscal year’’; and

21 (2) in subparagraphs (A), (B), and (C), by

22 striking ‘‘sum appropriated’’ and inserting ‘‘remain23 ing sums’’.
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1 SEC. 4. AVAILABILITY OF FUNDS FOR REALLOTMENT.

2 Section 304(b) of the Older Americans Act of 1965

3 (42 U.S.C. 3024(b)) is amended in the first sentence by

4 striking ‘‘part B or C’’ and inserting ‘‘part B or C, or

5 subpart 1 of part D,’’.

6 SEC. 5. CONFORMING AMENDMENTS.

7 (a) RELOCATION OF PROVISIONS CONCERNING IN8 HOME SERVICES FOR FRAIL OLDER INDIVIDUALS.—Sec9 tion 321 of the Older Americans Act of 1965 (42 U.S.C.

10 3030d) is amended—

11 (1) in subsection (a)(5), by striking ‘‘including’’

12 and all that follows and inserting ‘‘including—

13 ‘‘(A) client assessment, case management

14 services, and development and coordination of

15 community services;

16 ‘‘(B) in-home services for frail older indi17 viduals (including supportive activities for older

18 individuals with Alzheimer’s disease and related

19 disorders with neurological and organic brain

20 dysfunction) and for the families of the individ21 uals;

22 ‘‘(C) supportive activities to meet the spe23 cial needs of caregivers, including caretakers

24 who provide in-home services to frail older indi25 viduals; and
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1 ‘‘(D) in-home services and other commu2 nity services, including shopping, escort, reader,

3 and letterwriting services, and provision of

4 home-delivered meals and transportation, to as5 sist older individuals to live independently in a

6 home environment;’’; and

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

8 ‘‘(c) In this section, the term ‘in-home services’

9 includes—

10 ‘‘(1) homemaker and home health aide services;

11 ‘‘(2) visiting and telephone reassurance;

12 ‘‘(3) chore maintenance;

13 ‘‘(4) in-home respite care for families, and adult

14 day care as a respite service for families;

15 ‘‘(5) minor modification of homes that is nec16 essary to help older individuals remain at home and

17 that is not available under other programs, except

18 that not more than $150 per client may be expended

19 under this part for the modification;

20 ‘‘(6) personal care services; and

21 ‘‘(7) other in-home services as defined—

22 ‘‘(A) by the State agency in the State plan

23 submitted in accordance with section 307; and
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1 ‘‘(B) by the area agency on aging in the

2 area plan submitted in accordance with section

3 306.’’.

4 (b) REPEAL OF PART G.—Part G (relating to sup5 portive activities for caretakers who provide in-home serv6 ices to frail older individuals) of title III of the Older

7 Americans Act of 1965 (42 U.S.C. 3030p et seq.) is re8 pealed.

9 (c) OTHER CONFORMING AMENDMENTS.—

10 (1) Section 303 of the Older Americans Act of

11 1965 (42 U.S.C. 3023) is amended by striking sub12 section (g).

13 (2) Section 304(a) of the Older Americans Act

14 of 1965 (42 U.S.C. 3024(a)) is amended—

15 (A) in paragraph (1)—

16 (i) in the first sentence, by striking

17 ‘‘Subject to paragraphs (2) and (3)’’ and

18 inserting ‘‘Subject to paragraph (2),’’; and

19 (ii) in the last sentence, by striking

20 ‘‘For the purposes of paragraph (3) and

21 the exception’’ and inserting ‘‘For the pur22 poses of the exception’’; and

23 (B) by striking paragraph (3).

24 (3) Section 306(a)(2) of the Older Americans

25 Act of 1965 (42 U.S.C. 3026(a)(2)) is amended by
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1 striking subparagraph (B) and inserting the fol2 lowing:

3 ‘‘(B) in-home services (as defined in sec4 tion 321);’’.

5 (4) Section 307(a) of the Older Americans Act

6 of 1965 (42 U.S.C. 3027(a)) is amended—

7 (A) in paragraph (10), by striking ‘‘section

8 342’’ and inserting ‘‘section 321’’;

9 (B) in paragraph (27), by striking ‘‘in10 home services under section 341’’ and inserting

11 ‘‘in-home services under section 321’’;

12 (C) by striking paragraph (40); and

13 (D) in paragraph (44), by inserting ‘‘(as

14 defined in section 321)’’ after ‘‘in-home serv15 ices’’.

16 (5) Section 422(b)(11)(A)(ii)(III) of the Older

17 Americans Act of 1965 (42 U.S.C.

18 3035a(b)(11)(A)(ii)(III)) is amended by striking

19 ‘‘part D’’ and inserting ‘‘part B’’.

20 (6) Section 429F(a)(2) of the Older Americans

21 Act of 1965 (42 U.S.C. 3035n(a)(2)) is amended by

22 striking ‘‘section 342’’ and inserting ‘‘section 321’’.
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1 SEC. 6. EFFECTIVE DATE.

2 The amendments made by this Act take effect on Oc3 tober 1, 1999.

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