I 

111TH CONGRESS 

2D SESSION H. R. 6208 

To expand and enhance existing adult day programs for people with multiple 

sclerosis or other similar diseases, to support and improve access to 

respite services for family caregivers who are taking care of such people, 

and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 23, 2010 

Ms. LEE of California introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

A BILL 

To expand and enhance existing adult day programs for 

people with multiple sclerosis or other similar diseases, 

to support and improve access to respite services for 

family caregivers who are taking care of such people, 

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. SHORT TITLE. 

4 This Act may be cited as the ‘‘Adult Day Achieve5 ment Center Enhancement Act’’. 

6 SEC. 2. FINDINGS. 

7 The Congress finds the following: 


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1 (1) Multiple sclerosis (or MS) is a chronic, 

2 often disabling disease that attacks the central nerv3 ous system, which is made up of the brain, spinal 

4 cord, and optic nerves. Most people with multiple 

5 sclerosis are diagnosed between the ages of 20 and 

6 50 years of age. 

7 (2) The symptoms of MS may be mild, such as 

8 numbness in the limbs, or severe, such as paralysis 

9 or loss of vision. The progress, severity, and specific 

10 symptoms of MS are unpredictable and vary from 

11 one person to another. 

12 (3) Persons living with MS who experience 

13 more severe forms of MS are likely to require either 

14 home care or nursing home placement, though the 

15 vast majority would prefer to remain at home to re16 ceive the care they need. Where home care is con17 cerned, approximately 80 percent of such care is 

18 provided by informal, unpaid, caregivers who are 

19 generally family members. 

20 (4) Family caregivers of people with MS gen21 erally average 60 years of age. Almost half spend 

22 more than 20 hours per week providing care for 

23 their family member living with MS and have been 

24 fulfilling this role on average for over 13 years. 


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1 (5) In general, family caregivers, the majority 

2 of whom are women, provide an estimated 

3 $306,000,000,000 in ‘‘free’’ services annually. The 

4 pool of potential family caregivers is dwindling, from 

5 11 potential caregivers for each person needing care 

6 today to a projected 4 to 1 ratio by 2050. 

7 (6) Recent studies indicate that the total esti8 mated cost to employers for full-time employees with 

9 intensive caregiving responsibilities is 

10 $17,100,000,000. The total estimated cost to em11 ployers for all full-time, employed caregivers is 

12 $33,600,000,000 annually. 

13 (7) Adult day programs can offer services, in14 cluding medical care, rehabilitation therapies, dig15 nified assistance with activities of daily living, nutri16 tion therapy, health monitoring, social interaction, 

17 stimulating activities, and transportation, to seniors, 

18 people with disabilities, and younger adults with 

19 chronic diseases. 

20 (8) Adult day programs geared toward people 

21 living with MS, or other similar diseases, provide an 

22 important response to the needs of people with se23 vere MS and their caregivers. These MS Adult Day 

24 Programs (MSADPs) can help to ameliorate MS 

25 symptoms, reduce dependency, provide important soVerDate Mar 15 2010 21:20 Sep 27, 2010 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H6208.IH H6208

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1 cialization opportunities, and maintain quality of 

2 life. 

3 (9) MSADP programs have been shown to pro4 vide a range of documented benefits to people living 

5 with MS including improvements in functional sta6 tus, fatigue, depression, pain and social support. 

7 MSADPs also reduce ongoing medical care and hos8 pital costs and decrease admissions to nursing home 

9 facilities, which can be costly for many families, by 

10 allowing individuals to receive health and social serv11 ices while continuing to live at home. 

12 (10) There are less than a dozen MSADPs in 

13 the United States at present and as a result the ma14 jority of people living with MS are unable to access 

15 this important opportunity for maximizing their 

16 health and wellness. Although people living with MS 

17 may be able to access other existing adult day pro18 grams, such programs are not typically intended for 

19 younger adults living with chronic diseases like MS, 

20 and may not provide the appropriate services to 

21 meet the age-related or disability status of these in22 dividuals. 

23 SEC. 3. ESTABLISHMENT OF ADULT DAY PROGRAMS. 

24 (a) SURVEY OF EXISTING ADULT DAY PROGRAMS.— 


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1 (1) IN GENERAL.—Not later than 90 days after 

2 the date of the enactment of this section, the Assist3 ant Secretary for Aging shall initiate a comprehen4 sive survey of current adult day programs that pro5 vide care and support to individuals living with mul6 tiple sclerosis, including any multiple sclerosis adult 

7 day programs and other similar adult day programs 

8 as defined in this Act. 

9 (2) SURVEY ELEMENTS.—In carrying out the 

10 survey under paragraph (1), the Assistant Secretary 

11 for Aging may utilize existing publicly available re12 search on adult day programs, and shall— 

13 (A) identify ongoing successful MSADPs 

14 and other similar adult day programs, including 

15 by providing a brief description of how such 

16 programs were initially established and funded; 

17 (B) develop a set of best practices to help 

18 guide the establishment and replication of addi19 tional successful MSADPs and other similar 

20 adult day programs, including— 

21 (i) program guidelines; 

22 (ii) recommendations on the scope of 

23 services that should be provided (which 

24 may include rehabilitation therapy, psycho25 social support, social stimulation and interVerDate Mar 15 2010 04:31 Sep 25, 2010 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H6208.IH H6208

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1 action, and spiritual, educational, or other 

2 such services); and 

3 (iii) performance goals and indicators 

4 to measure and analyze the outcomes gen5 erated by the services provided and to 

6 evaluate the overall success of the pro7 gram; and 

8 (C) evaluate the extent to which the Ad9 ministration on Aging supports MSADPs and 

10 other similar adult day programs, either di11 rectly or indirectly, through current Federal 

12 grant programs. 

13 (3) REPORT.—Not later than 180 days after 

14 initiating the survey under paragraph (1), the As15 sistant Secretary for Aging shall produce and make 

16 publicly available a summary report on the results of 

17 the survey. Such report shall include each of the ele18 ments described in paragraph (2). 

19 (b) ESTABLISHMENT OF GRANT PROGRAM.— 

20 (1) IN GENERAL.—Not later than 90 days after 

21 producing the report required by subsection (a)(3), 

22 the Assistant Secretary for Aging shall establish 

23 within the Administration on Aging a competitive 

24 grant program for awarding grants annually to eligi25 ble entities, based on the best practices developed 


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1 under subsection (a), to fund MSADPs and other 

2 similar adult day programs. 

3 (2) ELIGIBLE ENTITIES.—In order to be eligi4 ble for a grant under this subsection, an entity shall 

5 demonstrate the following: 

6 (A) Understanding of the special needs of 

7 people living with multiple sclerosis or other 

8 similar diseases, including their functional abili9 ties and the potential complications across all 

10 types of cases and stages of multiple sclerosis 

11 or other such similar diseases. 

12 (B) Understanding of the issues experi13 enced by family caregivers who assist a family 

14 member with multiple sclerosis or another such 

15 similar disease. 

16 (C) A capacity to provide the services rec17 ommended by the best practices developed 

18 under subsection (a). 

19 (3) ADDITIONAL SELECTION REQUIREMENT.— 

20 The Assistant Secretary for Aging shall not award 

21 a grant to an entity under this subsection if the 

22 amount of the award would constitute more than 40 

23 percent of the operating budget of the entity in the 

24 fiscal year for which funds for the grant are author25 ized to be expended. For purposes of this subsection, 


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1 the fair market value of annual in-kind contributions 

2 of equipment or services shall be considered as part 

3 of the operating budget of the entity. 

4 (4) SELECTION OF GRANT RECIPIENTS.—Not 

5 later than 90 days after establishing the grant pro6 gram under this subsection, the Assistant Secretary 

7 for Aging shall award the first annual series of 

8 grants under the program. In awarding grants under 

9 this subsection, the Assistant Secretary should en10 sure, to the extent practicable, a diverse geographic 

11 representation among grant recipients and that, sub12 ject to the availability of appropriations— 

13 (A) a minimum of 5 entities are selected as 

14 grant recipients for the first fiscal year for 

15 which such grants are awarded; 

16 (B) a minimum of 10 entities are selected 

17 as grant recipients for the second such fiscal 

18 year; 

19 (C) a minimum of 12 entities are selected 

20 as grant recipients for the third such fiscal 

21 year; and 

22 (D) a minimum of 15 entities are selected 

23 as grant recipients for the fourth such fiscal 

24 year. 


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1 (5) REPORT.—No later than 1 year after the 

2 initial award of grants under this subsection, and 

3 annually thereafter, the Assistant Secretary for 

4 Aging shall produce and make publicly available a 

5 brief summary report on the grant program under 

6 this section. Each such report shall include the fol7 lowing: 

8 (A) A description of the adult day pro9 grams receiving funding under this section, in10 cluding the amount of Federal funding awarded 

11 and the expected outcomes of each program. 

12 (B) A description of performance goals and 

13 indicators to monitor the progress of grant re14 cipients in— 

15 (i) responding to the needs of individ16 uals living with multiple sclerosis or other 

17 such similar chronic diseases; and 

18 (ii) assisting the family caregivers of 

19 such individuals. 

20 (C) Any plans for improving oversight and 

21 management of the grant program. 

22 (c) DEFINITIONS.—In this Act: 

23 (1) The term ‘‘multiple sclerosis adult day pro24 gram’’ or ‘‘MSADP’’ means an adult day program 

25 that provides comprehensive and effective care and 


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1 support services to individuals living with multiple 

2 sclerosis and their family caregivers and that may 

3 assist participants in ways that— 

4 (A) maintain or improve their functional 

5 abilities, or otherwise help them adjust to their 

6 changing functional abilities; 

7 (B) prevent the onset of complications as8 sociated with severe forms of the disease; 

9 (C) promote alternatives to placement in 

10 nursing homes; 

11 (D) reduce the strain on family caregivers 

12 taking care of a family member with multiple 

13 sclerosis; or 

14 (E) focus on supporting the emotional, so15 cial, and intellectual needs of a younger adult 

16 population. 

17 (2) The term ‘‘other similar adult day pro18 gram’’ means an adult day program that provides a 

19 set of services similar to those of an MSADP, but 

20 for individuals living with other chronic diseases 

21 similar to multiple sclerosis that affect an individ22 ual’s central nervous system, and that may result in 

23 a functional or degenerative disability. 

24 (3) The term ‘‘family caregiver’’ means a family 

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1 ance (which may include in-home monitoring, man2 agement, supervision, care and treatment, or other 

3 similar assistance) to another adult family member 

4 with a special need. 

5 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 

6 out this section, in addition to amounts otherwise made 

7 available for such purpose, there are authorized to be ap8 propriated, and to remain available until expended, the fol9 lowing: 

10 (1) $1,000,000 for fiscal year 2011. 

11 (2) $3,000,000 for fiscal year 2012. 

12 (3) $6,000,000 for fiscal year 2013. 

13 (4) $8,000,000 for fiscal year 2014. 

14 (5) $10,000,000 for fiscal year 2015. 

Æ 


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