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[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 707 Introduced in Senate (IS)]

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.

    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 and persons with mental 
        retardation and related developmental disabilities (as defined 
        in section 102 of the Developmental Disabilities Assistance and 
        Bill of Rights Act (42 U.S.C. 6000) (referred to in this 
        section as ``developmental disabilities'')) 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)(A) there are an estimated 3,170,000 persons with mental 
        retardation and related developmental disabilities in the 
        United States;
            (B) 1,890,000 of individuals with mental retardation and 
        related developmental disabilities live with family caregivers;
            (C) 479,862 of individuals with mental retardation and 
        related developmental disabilities who are living at home 
        receive care from caregivers who are 60 years old or older; and
            (D) like services for the elderly population, a large 
        portion of supports and care for persons with mental 
        retardation and related developmental disabilities is provided 
        by family caregivers;
            (5) nearly 75 percent of family caregivers are women, many 
        of whom have other major responsibilities, such as young 
        children or jobs;
            (6) 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;
            (7) family caregivers offer support that is worth billions 
        of dollars;
            (8) without the efforts of family caregivers, many 
        additional older individuals, and persons with mental 
        retardation and related developmental disabilities, would 
        receive care services in a hospital, State facility, 
        intermediate care facility for the mentally retarded, or 
        nursing home, or would receive, although less costly, home and 
        community-based waiver services under section 1915(c) of the 
        Social Security Act (42 U.S.C. 1396n(c)), such a result being 
        far more expensive for taxpayers than assisting family 
        caregivers since--
                    (A) the Federal medicare and medicaid programs pay 
                for a large portion of expenses associated with such 
                institutional care; and
                    (B) such institutional care is more expensive than 
                family caregiving;
            (9) caregivers, on average, spend $2,000 per year for food, 
        medication, and other expenses related to caregiving;
            (10)(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
            (11) 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, older individuals with greatest economic need, and 
        older individuals providing care and supports to persons with 
        mental retardation and related developmental disabilities (as 
        defined in section 102 of the Developmental Disabilities 
        Assistance and Bill of Rights Act (42 U.S.C. 6000) (referred to 
        in this part as ``developmental disabilities'')) 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;
            ``(2) serving the needs of particular groups of caregivers 
        of older individuals, including minority caregivers and distant 
        caregivers; and
            ``(3) linking family support programs with the State entity 
        or agency that administers or funds programs for persons with 
        mental retardation or related developmental disabilities and 
        their families.
    ``(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.
                                 <all>
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