I

106TH CONGRESS

1ST SESSION H. R. 1341

To amend the Older Americans Act of 1965 to establish a national family

caregiver support program, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

MARCH 25, 1999

Mr. MARTINEZ (for himself and Mr. WAXMAN) introduced the following bill;

which was referred to the Committee on Education and the Workforce

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 prefer to receive care

8 in their homes, rather than in institutions;
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1 (3)(A) more than 22,000,000 family caregivers

2 actively care for aging or ailing older individuals in

3 the United States;

4 (B) fewer than 2,000,000 older individuals re5 ceive care through nursing homes in the United

6 States; and

7 (C) therefore, a large portion of the care pro8 vided for the Nation’s older individuals is provided

9 by family caregivers;

10 (4) nearly 75 percent of family caregivers are

11 women, many of whom have other major responsibil12 ities, such as young children or jobs;

13 (5) the loss in productivity of businesses due to

14 necessary absences of caregiving employees ranges

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

16 (6) family caregivers offer support that is worth

17 billions of dollars;

18 (7) without the efforts of family caregivers,

19 many additional older individuals would receive care

20 services in a hospital or nursing home, a result that

21 would be far more expensive for taxpayers than as22 sisting family caregivers because—

23 (A) the Federal medicare and medicaid

24 programs pay for a large portion of expenses

25 associated with institutional care; and
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1 (B) institutional care is more expensive

2 than family caregiving;

3 (8) caregivers, on average, spend $2000 per

4 year for food, medication, and other expenses related

5 to caregiving;

6 (9)(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 (10) 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 and older individuals

20 with greatest economic need, consistent with the re21 quirements of section 305(a)(2)(E), and their care22 givers.

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

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

25 shall coordinate the activities of the agency with the activi-
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1 ties of other community agencies and voluntary organiza2 tions providing the types of services described in sub3 section (b).

4 ‘‘(e) QUALITY STANDARDS AND MECHANISMS AND

5 ACCOUNTABILITY.—

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

7 The State shall establish standards and mechanisms

8 designed to assure the quality of services provided

9 with assistance made available under this subpart.

10 ‘‘(2) DATA AND RECORDS.—The State shall col11 lect data and maintain records relating to the State

12 program in a standardized format specified by the

13 Assistant Secretary. The State shall furnish the

14 records to the Assistant Secretary, at such time as

15 the Assistant Secretary may require, in order to en16 able the Assistant Secretary to monitor State pro17 gram administration and compliance, and to evalu18 ate and compare the effectiveness of the State pro19 grams.

20 ‘‘(3) REPORTS.—The State shall prepare and

21 submit to the Assistant Secretary reports on the

22 data and records required under paragraph (2), in23 cluding information on the services funded under

24 this subpart, and standards and mechanisms by

25 which the quality of the services shall be assured.
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1 ‘‘(f) AVAILABILITY OF FUNDS.—

2 ‘‘(1) IN GENERAL.—A State shall use the por3 tion of the State allotment under section 304 that

4 is from amounts appropriated under section 303(d)

5 to carry out the State program under this subpart.

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

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

8 carry out the State program under this subpart may

9 be used, in addition to amounts available in accord10 ance with section 303(c)(1), for costs of administra11 tion of area plans.

12 ‘‘(3) FEDERAL SHARE.—

13 ‘‘(A) IN GENERAL.—Notwithstanding sec14 tion 304(d)(1)(D), the Federal share of the cost

15 of carrying out a State program under this sub16 part shall be 75 percent.

17 ‘‘(B) NON-FEDERAL SHARE.—The non18 Federal share of the costs shall be provided

19 from State and local sources.

20 ‘‘SEC. 342. MAINTENANCE OF EFFORT.

21 ‘‘Funds made available under this subpart shall sup22 plement, and not supplant, any Federal, State, or local

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

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

25 services described in section 341(b).
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1 ‘‘Subpart 2—National Innovation Programs

2 ‘‘SEC. 346. INNOVATION GRANT PROGRAM.

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

4 carry out a program for making grants to appropriate en5 tities on a competitive basis to foster the development and

6 testing of new approaches to—

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

8 and other informal caregivers of older individuals;

9 and

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

11 caregivers of older individuals, including minority

12 caregivers and distant caregivers.

13 ‘‘(b) EVALUATION AND DISSEMINATION OF RE14 SULTS.—The Assistant Secretary shall provide for evalua15 tion of the effectiveness of programs and activities funded

16 with grants made under this section, and for dissemina17 tion to States of descriptions and evaluations of the pro18 grams and activities, to enable States to incorporate suc19 cessful approaches into their individual State programs

20 under this part.

21 ‘‘(c) AVAILABILITY OF FUNDS.—

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

23 shall reserve not more than 10 percent of the

24 amount appropriated under section 303(d) for a fis25 cal year to carry out the program of the Assistant

26 Secretary under this section.
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1 ‘‘(2) NATIVE AMERICAN PROGRAMS AND ACTIVI2 TIES.—Twenty percent of the amount reserved

3 under paragraph (1) shall be available for programs

4 and activities under this section for caregivers serv5 ing Indians and Native Hawaiians, as defined in sec6 tion 625.

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

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

9 directly or by grant or contract, carry out activities of na10 tional significance to promote quality and continuous im11 provement in the support services provided to family care12 givers and other informal caregivers of older individuals,

13 through program evaluation, training, technical assist14 ance, and research.

15 ‘‘(b) AVAILABILITY OF FUNDS.—The Assistant Sec16 retary shall reserve not more than 2 percent of the amount

17 appropriated under section 303(d) to carry out the activi18 ties under this section.’’.

19 SEC. 3. AUTHORIZATION OF APPROPRIATIONS; ALLOT20 MENTS.

21 (a) AUTHORIZATION OF APPROPRIATIONS.—Section

22 303(d) of the Older Americans Act of 1965 (42 U.S.C.

23 3023(d)) is amended to read as follows:

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

25 $125,000,000 for fiscal year 2000, and such sums as may
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1 be necessary for each of fiscal years 2001 through 2004,

2 to carry out part D (relating to the national family care3 giver support program).’’.

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

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

6 is amended in the first sentence—

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

8 by inserting ‘‘, and remaining after reservations of

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

10 ‘‘from the sums appropriated under section 303 for

11 each fiscal year’’; and

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

13 striking ‘‘sum appropriated’’ and inserting ‘‘remain14 ing sums’’.

15 SEC. 4. AVAILABILITY OF FUNDS FOR REALLOTMENT.

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

17 (42 U.S.C. 3024(b)) is amended in the first sentence by

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

19 subpart 1 of part D,’’.

20 SEC. 5. CONFORMING AMENDMENTS.

21 (a) RELOCATION OF PROVISIONS CONCERNING IN22 HOME SERVICES FOR FRAIL OLDER INDIVIDUALS.—Sec23 tion 321 of the Older Americans Act of 1965 (42 U.S.C.

24 3030d) is amended—
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1 (1) in subsection (a)(5), by striking ‘‘including’’

2 and all that follows and inserting ‘‘including—

3 ‘‘(A) client assessment, case management

4 services, and development and coordination of

5 community services;

6 ‘‘(B) in-home services for frail older indi7 viduals (including supportive activities for older

8 individuals with Alzheimer’s disease and related

9 disorders with neurological and organic brain

10 dysfunction) and for the families of the individ11 uals;

12 ‘‘(C) supportive activities to meet the spe13 cial needs of caregivers, including caretakers

14 who provide in-home services to frail older indi15 viduals; and

16 ‘‘(D) in-home services and other commu17 nity services, including shopping, escort, reader,

18 and letterwriting services, and provision of

19 home-delivered meals and transportation, to as20 sist older individuals to live independently in a

21 home environment;’’; and

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

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

24 includes—

25 ‘‘(1) homemaker and home health aide services;
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1 ‘‘(2) visiting and telephone reassurance;

2 ‘‘(3) chore maintenance;

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

4 day care as a respite service for families;

5 ‘‘(5) minor modification of homes that is nec6 essary to help older individuals remain at home and

7 that is not available under other programs, except

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

9 under this part for the modification;

10 ‘‘(6) personal care services; and

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

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

13 submitted in accordance with section 307; and

14 ‘‘(B) by the area agency on aging in the

15 area plan submitted in accordance with section

16 306.’’.

17 (b) REPEAL OF PART G.—Part G (relating to sup18 portive activities for caretakers who provide in-home serv19 ices to frail older individuals) of title III of the Older

20 Americans Act of 1965 (42 U.S.C. 3030p et seq.) is re21 pealed.

22 (c) OTHER CONFORMING AMENDMENTS.—

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

24 1965 (42 U.S.C. 3023) is amended by striking sub25 section (g).
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1 (2) Section 304(a) of the Older Americans Act

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

3 (A) in paragraph (1)—

4 (i) in the first sentence, by striking

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

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

7 (ii) in the last sentence, by striking

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

9 the exception’’ and inserting ‘‘For the pur10 poses of the exception’’; and

11 (B) by striking paragraph (3).

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

13 Act of 1965 (42 U.S.C. 3026(a)(2)) is amended by

14 striking subparagraph (B) and inserting the fol15 lowing:

16 ‘‘(B) in-home services (as defined in sec17 tion 321);’’.

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

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

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

21 342’’ and inserting ‘‘section 321’’;

22 (B) in paragraph (27), by striking ‘‘in23 home services under section 341’’ and inserting

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

25 (C) by striking paragraph (40); and
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1 (D) in paragraph (44), by inserting ‘‘(as

2 defined in section 321)’’ after ‘‘in-home serv3 ices’’.

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

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

6 3035a(b)(11)(A)(ii)(III)) is amended by striking

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

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

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

10 striking ‘‘section 342’’ and inserting ‘‘section 321’’.

11 SEC. 6. EFFECTIVE DATE.

12 The amendments made by this Act take effect on Oc13 tober 1, 1999.

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