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[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5633 Introduced in House (IH)]

113th CONGRESS
  2d Session
                                H. R. 5633

           To authorize grants for the support of caregivers.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                           September 18, 2014

 Mr. Pascrell introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL

 
           To authorize grants for the support of caregivers.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``In-Home Caregiver Assessment 
Resources and Education Act'' or the ``In-Home CARE Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) More than 65,000,000 unpaid caregivers provide care for 
        a chronically ill, disabled, or aged family member or friend 
        during any given year.
            (2) Sixty-six percent of unpaid caregivers are women. More 
        than 37 percent of caregivers live with children or 
        grandchildren who are under 18 years old.
            (3) Unpaid family caregivers spend an average of 20 hours 
        per week caring for their loved ones, and 13 percent of family 
        caregivers provide 40 or more hours of care per week.
            (4) Thirty-six percent of caregivers care for a parent.
            (5) Fourteen percent of caregivers care for a special needs 
        child, including an estimated 16,800,000 caregivers who care 
        for special needs children who are under 18 years old.
            (6) In 2007, the average caregiver for someone 50 years or 
        older spent $5,531 per year on out-of-pocket caregiving 
        expenses, which is more than 10 percent of the median income 
        for a family caregiver for that year. Forty-seven percent of 
        working caregivers have used up all or most of their savings 
        due to caregiving expenses.
            (7) Seventy-three percent of caregivers who provide care 
        for an individual over the age of 18 are currently working or 
        have worked while providing care. Sixty-six percent of such 
        caregivers have had to make some modifications to their work 
        schedule, from arriving late to work to leaving their job 
        entirely. One in 5 caregivers have had to take time off from 
        work.
            (8) Fifty-three percent of caregivers have experienced a 
        decline in their health as a result of caregiving, which has 
        affected their ability to provide care.
            (9) Forty-six percent of caregivers perform medical or 
        nursing tasks for patients with multiple physical and chronic 
        conditions. Of these caregivers, 78 percent were in charge of 
        managing a patient's medications, administering fluids, or 
        administering injections.
            (10) Nearly 20 percent of caregivers who assisted with 
        medication management and 33 percent who assisted with changing 
        dressings or bandages received no training about how to perform 
        these tasks.
            (11) The vast majority (78 percent) of caregivers indicated 
        they need more support related to caregiving.
            (12) Home visiting programs are cost-effective and have 
        been proven to improve outcomes for children and parents in 
        different domains ranging from child development to family 
        violence.

SEC. 3. PURPOSES.

    The purposes of this Act are--
            (1) to improve the ability of unpaid caregivers to care for 
        individuals in the home; and
            (2) to increase opportunities for individuals who are in 
        need of care to remain at home and reduce or postpone the need 
        for such individuals to receive care at an institution.

SEC. 4. CAREGIVER GRANTS.

    Subpart IV of part D of title III of the Public Health Service Act 
(42 U.S.C. 255 et seq.) is amended by adding at the end the following:

``SEC. 339A. CAREGIVER GRANTS.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Administration for Community Living, shall award 3-year grants, 
on a competitive basis, to eligible organizations to carry out home 
visiting programs for unpaid caregivers.
    ``(b) Definitions.--In this section:
            ``(1) Caregiver.--The term `caregiver' means an unpaid 
        family member, foster parent, or other unpaid adult who 
        provides in-home monitoring, management, supervision, or 
        treatment of a child or adult with a special need, such as a 
        disease, disability, or the frailties of old age.
            ``(2) Caregiver assessment.--The term `caregiver 
        assessment' means an assessment that includes talking directly 
        to caregivers to better understand their needs, problems, 
        resources, and strengths.
            ``(3) Child or adult with a special need.--The term `child 
        or adult with a special need' means an individual for whom care 
        or supervision is required to--
                    ``(A) meet the basic needs of the individual;
                    ``(B) prevent physical self-injury or injury to 
                others; or
                    ``(C) avoid placement in an institutional facility.
            ``(4) Eligible organization.--The term `eligible 
        organization' means--
                    ``(A) a local government agency;
                    ``(B) a health care entity; or
                    ``(C) any other nonprofit or community 
                organization,
        that can provide the services described in subsection (f).
    ``(c) Coordination.--In carrying out this section, the Secretary 
shall coordinate--
            ``(1) with the heads of the National Family Caregiver 
        Support Program of the Administration on Aging and other 
        programs within the Department of Health and Human Services 
        (such as the Lifespan Respite Care Program), to ensure 
        coordination of caregiver services for caregivers of children 
        or adults with special needs; and
            ``(2) with the Director of the Centers for Medicare & 
        Medicaid Services to avoid duplicative services and payments.
    ``(d) Application.--An eligible organization that desires a grant 
under this section shall submit an application at such time, in such 
manner, and containing such information as the Secretary may require, 
including, at a minimum--
            ``(1) an outreach plan that identifies how the eligible 
        organization will ascertain which caregivers in the community--
                    ``(A) are most in need of support and education, 
                particularly caregivers who have had no training and 
                provide complex chronic care activities or perform 
                medical or nursing tasks in addition to assisting with 
                activities of daily living;
                    ``(B) are caring for individuals who are at the 
                greatest risk of needing institutional care; and
                    ``(C) desire to participate in the caregiver home 
                visiting program;
            ``(2) a description of the services that the eligible 
        organization will provide directly using grant funds, and a 
        description of the services that the eligible organization will 
        use grant funds to provide through contracts or referrals;
            ``(3) a description of how the eligible organization will 
        identify gaps in the services that caregivers and children or 
        adults with a special need who receive care from a caregiver in 
        the community are receiving;
            ``(4) a description of how the eligible organization can 
        provide--
                    ``(A) an initial visit to caregivers in order to 
                complete a caregiver assessment, including a 
                description of the eligible organization's expertise in 
                conducting caregiver assessments;
                    ``(B) education and training to help the caregiver 
                learn how to best care for a child or adult with a 
                special need, by an individual with expertise in the 
                tasks for which the caregiver requires education and 
                training, including education and training regarding, 
                as applicable--
                            ``(i) medication management;
                            ``(ii) wound care;
                            ``(iii) nutrition and food preparation for 
                        special diets;
                            ``(iv) falls prevention;
                            ``(v) management of depression, anxiety, 
                        stress, and other behavioral health conditions, 
                        including ways to minimize negative mental 
                        health effects;
                            ``(vi) assistance with activities of daily 
                        living;
                            ``(vii) ways to engage other family members 
                        in providing care;
                            ``(viii) ways to identify and utilize 
                        available community resources; and
                            ``(ix) abuse and neglect prevention; and
                    ``(C) recommendations for home modifications or 
                physical environmental changes that will improve the 
                health or quality of life of a child or adult with a 
                special need who is receiving care from a caregiver;
            ``(5) a description of the eligible organization's ability 
        to provide, or refer caregivers to local resources or programs 
        of the Department of Health and Human Services that will 
        provide--
                    ``(A) physical and mental health care, including 
                home health care and long-term support services;
                    ``(B) transportation;
                    ``(C) home modification services;
                    ``(D) respite care;
                    ``(E) adult day care;
                    ``(F) support groups; and
                    ``(G) legal assistance;
            ``(6) a description of the eligible organization's ability 
        to coordinate with other State and community-based agencies;
            ``(7) a description of the eligible organization's 
        understanding of caregiver issues--
                    ``(A) across age groups; and
                    ``(B) including disabilities and chronic conditions 
                that affect the populations that the eligible 
                organization will serve;
            ``(8) a description of the capacity of the eligible 
        organization to engage caregivers, family members, and children 
        or adults with a special need who receive care from a 
        caregiver; and
            ``(9) with respect to the population of caregivers to whom 
        caregiver visits or services will be provided, or for whom 
        workers and volunteers will be recruited and trained, a 
        description of--
                    ``(A) the population of caregivers;
                    ``(B) the extent and nature of the needs of that 
                population; and
                    ``(C) existing caregiver services for that 
                population, including the number of caregivers served 
                and the extent of unmet need.
    ``(e) Priority.--In awarding grants under this section, the 
Secretary shall give priority to eligible organizations that--
            ``(1) the Secretary determines show the greatest likelihood 
        of implementing or enhancing caregiver home visiting services 
        for the greatest number of people;
            ``(2) will allow caregivers to contact the eligible 
        organization by phone, email, or two-way interactive video 
        after home visits have ended or if a caregiver has questions or 
        concerns;
            ``(3) have a proven record of caregiver support;
            ``(4) will use evidence-based programs; or
            ``(5) will provide matching funds or can demonstrate that 
        the program funded by a grant under this section will be 
        sustainable after grant funds are no longer provided.
    ``(f) Authorized Activities.--An eligible organization receiving a 
grant under this section shall use grant funds to--
            ``(1) conduct an initial home visit for each caregiver 
        participating in the program, during which a representative 
        from the eligible organization who has expertise in care 
        management and caregiving will perform a caregiver assessment 
        and determine what follow-up services may benefit the caregiver 
        and the child or adult with a special need who receives care 
        from the caregiver;
            ``(2) conduct home visits for the purpose of caregiver 
        education and training;
            ``(3) provide, or provide referrals for, the services 
        described in subsection (d)(5);
            ``(4) provide an assessment and referral for physical and 
        mental health services for the caregiver and for the child or 
        adult with a special need who receives care from the caregiver, 
        as needed; and
            ``(5) carry out any other activities that are described in 
        the grant application submitted under subsection (d).
    ``(g) Technical Assistance Center.--The Secretary shall establish 
or contract to establish a technical assistance center through which 
the Secretary shall--
            ``(1) provide models for programs funded by grants under 
        this section;
            ``(2) provide training for grantees;
            ``(3) answer questions from grantees; and
            ``(4) facilitate an exchange of information among grantees, 
        and between grantees and other programs within the Department 
        of Health and Human Services, including through use of the 
        Technical Assistance Exchange of the Administration for 
        Community Living, in order to maximize the use of existing 
        resources and services for caregivers and to avoid the 
        duplication of such services.
    ``(h) Evaluation.--
            ``(1) In general.--Not later than 1 year after the date of 
        enactment of this section, and annually thereafter, the 
        Secretary shall evaluate the success of the grant program 
        carried out under this section, based on criteria that the 
        Secretary may develop for such evaluation.
            ``(2) Optional contents of evaluation.--The evaluation 
        described in paragraph (1) may include an evaluation of--
                    ``(A) the extent to which children or adults with a 
                special need who are cared for by a participating 
                caregiver have--
                            ``(i) a reduction in the potential number 
                        of hospitalizations;
                            ``(ii) a reduction in the potential number 
                        of institutionalizations;
                            ``(iii) cost reductions across the health 
                        care system;
                            ``(iv) improved care; and
                            ``(v) improved quality of life (including a 
                        reduction of stress and anxiety and improved 
                        relationships and mood); and
                    ``(B) the extent to which participating caregivers 
                have improved quality of life (including a reduction of 
                stress and anxiety and improved health, relationships, 
                and mood).
    ``(i) Reports and Recommendations.--Not later than 1 year before 
the expiration of the grants awarded under this section, the Secretary 
shall prepare and submit a report to Congress that includes 
recommendations, based on the evaluation described in subsection (h), 
about--
            ``(1) changes to the grant program under this section;
            ``(2) the potential for expanding the number and scope of 
        caregiver home visiting program grants distributed by the 
        Secretary; and
            ``(3) extending the length of the grant program.
    ``(j) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be 
necessary.''.
                                 <all>
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