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.
Be it enacted by the Senate and House of Representa-
tives 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 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 re-
ceive care through nursing homes in the United
States; and
(C) therefore, a large portion of the care pro-
vided for the Nation’s older individuals is provided
by family caregivers;
(4) nearly 75 percent of family caregivers are
women, many of whom have other major responsibil-
ities, such as young children or jobs;
(5) 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;
(6) family caregivers offer support that is worth
billions of dollars;
(7) without the efforts of family caregivers,
many additional older individuals would receive care
services in a hospital or nursing home, a result that
would be far more expensive for taxpayers than as-
sisting family caregivers because—
(A) the Federal medicare and medicaid
programs pay for a large portion of expenses
associated with institutional care; and
(B) institutional care is more expensive
than family caregiving;
(8) caregivers, on average, spend $2000 per
year for food, medication, and other expenses related
to caregiving;
(9)(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
(10) 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 PRO-
GRAM.
(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 multi-
faceted 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 sup-
port groups, and caregiver training to eligible care-
givers 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 respon-
sibilities; and
‘‘(5) supplemental services, on a limited basis,
to complement the care provided by eligible care-
givers.
‘‘(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 individ-
uals with greatest social need and older individuals
with greatest economic need, consistent with the re-
quirements of section 305(a)(2)(E), and their care-
givers.
‘‘(d) COORDINATION WITH SERVICE PROVIDERS.—
In carrying out this subpart, each area agency on aging
shall coordinate the activities of the agency with the activi-
ties of other community agencies and voluntary organiza-
tions providing the types of services described in sub-
section (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 col-
lect 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 en-
able the Assistant Secretary to monitor State pro-
gram administration and compliance, and to evalu-
ate and compare the effectiveness of the State pro-
grams.
‘‘(3) REPORTS.—The State shall prepare and
submit to the Assistant Secretary reports on the
data and records required under paragraph (2), in-
cluding 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 por-
tion 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 accord-
ance with section 303(c)(1), for costs of administra-
tion of area plans.
‘‘(3) FEDERAL SHARE.—
‘‘(A) IN GENERAL.—Notwithstanding sec-
tion 304(d)(1)(D), the Federal share of the cost
of carrying out a State program under this sub-
part 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 sup-
plement, 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).
‘‘(2) NATIVE AMERICAN PROGRAMS AND ACTIVI-
TIES.—Twenty percent of the amount reserved
under paragraph (1) shall be available for programs
and activities under this section for caregivers serv-
ing Indians and Native Hawaiians, as defined in sec-
tion 625.
‘‘SEC. 347. ACTIVITIES OF NATIONAL SIGNIFICANCE.
‘‘(a) IN GENERAL.—The Assistant Secretary shall,
directly or by grant or contract, carry out activities of na-
tional significance to promote quality and continuous im-
provement in the support services provided to family care-
givers and other informal caregivers of older individuals,
through program evaluation, training, technical assist-
ance, and research.
‘‘(b) AVAILABILITY OF FUNDS.—The Assistant Sec-
retary shall reserve not more than 2 percent of the amount
appropriated under section 303(d) to carry out the activi-
ties under this section.’’.
SEC. 3. AUTHORIZATION OF APPROPRIATIONS; ALLOT-
MENTS.
(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 care-
giver 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 ‘‘remain-
ing 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.—Sec-
tion 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 indi-
viduals (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 individ-
uals;
‘‘(C) supportive activities to meet the spe-
cial needs of caregivers, including caretakers
who provide in-home services to frail older indi-
viduals; and
‘‘(D) in-home services and other commu-
nity services, including shopping, escort, reader,
and letterwriting services, and provision of
home-delivered meals and transportation, to as-
sist 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 nec-
essary 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 sup-
portive activities for caretakers who provide in-home serv-
ices to frail older individuals) of title III of the Older
Americans Act of 1965 (42 U.S.C. 3030p et seq.) is re-
pealed.
(c) OTHER CONFORMING AMENDMENTS.—
(1) Section 303 of the Older Americans Act of
1965 (42 U.S.C. 3023) is amended by striking sub-
section (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 pur-
poses 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 fol-
lowing:
‘‘(B) in-home services (as defined in sec-
tion 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 serv-
ices’’.
(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 Oc-
tober 1, 1999.
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