I 
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 Representa-
tives 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. 
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(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 care-
givers have used up all or most of their savings due 
to caregiving expenses. 
(7) Seventy-three percent of caregivers who pro-
vide 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 
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to make some modifications to their work schedule, 
from arriving late to work to leaving their job en-
tirely. One in 5 caregivers have had to take time off 
from work. 
(8) Fifty-three percent of caregivers have expe-
rienced 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 as-
sisted 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 care-
givers indicated they need more support related to 
caregiving. 
(12) Home visiting programs are cost-effective 
and have been proven to improve outcomes for chil-
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dren 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 pro-
grams 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, man-
agement, supervision, or treatment of a child or 
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adult with a special need, such as a disease, dis-
ability, or the frailties of old age. 
‘‘(2) 
CAREGIVER
ASSESSMENT.—The 
term 
‘caregiver assessment’ means an assessment that in-
cludes talking directly to caregivers to better under-
stand 
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 indi-
vidual; 
‘‘(B) prevent physical self-injury or injury 
to others; or 
‘‘(C) avoid placement in an institutional 
facility. 
‘‘(4) ELIGIBLE ORGANIZATION.—The term ‘eli-
gible organization’ means— 
‘‘(A) a local government agency; 
‘‘(B) a health care entity; or 
‘‘(C) any other nonprofit or community or-
ganization, 
that can provide the services described in subsection 
(f). 
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‘‘(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 Depart-
ment of Health and Human Services (such as the 
Lifespan Respite Care Program), to ensure coordi-
nation of caregiver services for caregivers of children 
or adults with special needs; and 
‘‘(2) with the Director of the Centers for Medi-
care & Medicaid Services to avoid duplicative serv-
ices and payments. 
‘‘(d) APPLICATION.—An eligible organization that de-
sires a grant under this section shall submit an application 
at such time, in such manner, and containing such infor-
mation as the Secretary may require, including, at a min-
imum— 
‘‘(1) an outreach plan that identifies how the el-
igible organization will ascertain which caregivers in 
the community— 
‘‘(A) are most in need of support and edu-
cation, particularly caregivers who have had no 
training and provide complex chronic care ac-
tivities or perform medical or nursing tasks in 
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addition to assisting with activities of daily liv-
ing; 
‘‘(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 eligi-
ble organization will provide directly using grant 
funds, and a description of the services that the eli-
gible organization will use grant funds to provide 
through contracts or referrals; 
‘‘(3) a description of how the eligible organiza-
tion will identify gaps in the services that caregivers 
and children or adults with a special need who re-
ceive care from a caregiver in the community are re-
ceiving; 
‘‘(4) a description of how the eligible organiza-
tion can provide— 
‘‘(A) an initial visit to caregivers in order 
to complete a caregiver assessment, including a 
description of the eligible organization’s exper-
tise in conducting caregiver assessments; 
‘‘(B) education and training to help the 
caregiver learn how to best care for a child or 
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adult with a special need, by an individual with 
expertise in the tasks for which the caregiver 
requires education and training, including edu-
cation 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, anx-
iety, 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 modifica-
tions or physical environmental changes that 
will improve the health or quality of life of a 
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child or adult with a special need who is receiv-
ing care from a caregiver; 
‘‘(5) a description of the eligible organization’s 
ability to provide, or refer caregivers to local re-
sources or programs of the Department of Health 
and Human Services that will provide— 
‘‘(A) physical and mental health care, in-
cluding 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 commu-
nity-based agencies; 
‘‘(7) a description of the eligible organization’s 
understanding of caregiver issues— 
‘‘(A) across age groups; and 
‘‘(B) including disabilities and chronic con-
ditions that affect the populations that the eli-
gible organization will serve; 
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‘‘(8) a description of the capacity of the eligible 
organization to engage caregivers, family members, 
and children or adults with a special need who re-
ceive 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 sec-
tion, the Secretary shall give priority to eligible organiza-
tions 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; 
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