I 
116TH CONGRESS 
1ST SESSION H. R. 4334 
To amend the Older Americans Act of 1965 to authorize appropriations 
for fiscal years 2020 through 2024, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 16, 2019 
Ms. BONAMICI (for herself, Ms. STEFANIK, Mrs. LEE of Nevada, Mr. COMER, 
Ms. WILD, and Mr. JOHNSON of South Dakota) introduced the following 
bill; which was referred to the Committee on Education and Labor 
A BILL 
To amend the Older Americans Act of 1965 to authorize 
appropriations for fiscal years 2020 through 2024, 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. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Dignity in Aging Act of 2019’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is the following: 
Sec. 1. Short title; table of contents. 
TITLE I—ENSURING COLLABORATION AND PROMOTING 
INDEPENDENCE FOR OLDER INDIVIDUALS 
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Sec. 101. Person-centered, trauma-informed care. 
Sec. 102. Vaccination. 
Sec. 103. Functions of Assistant Secretary. 
Sec. 104.
Professional standards for nutrition official under the Assistant Sec-
retary. 
Sec. 105. Interagency Coordinating Committee on Age-Friendly Communities. 
Sec. 106. Technical assistance on age-friendly communities. 
Sec. 107. Malnutrition. 
Sec. 108. Coordination with resource centers. 
Sec. 109. Arts education. 
Sec. 110. Social determinants of health. 
Sec. 111. Federal coordination of supports and services for living independently 
and safely at home. 
Sec. 112. Falls prevention and chronic disease self-management education. 
Sec. 113. Extension of RAISE Family Caregivers Act. 
Sec. 114. Support for socially isolated older Americans. 
Sec. 115. Increased focus of Assistant Secretary on social isolation. 
Sec. 116. Advisory council on social isolation. 
Sec. 117. Supportive services and senior centers. 
Sec. 118. Demonstration projects. 
Sec. 119. Younger onset Alzheimer’s Disease. 
Sec. 120. Priority for the senior community service employment program. 
Sec. 121. Direct care workforce. 
TITLE II—EMPOWERING THE AGING NETWORK TO MEET THE 
NEEDS OF OLDER INDIVIDUALS 
Sec. 201. National Family Caregiver Support Program cap. 
Sec. 202. Minimum funding level for State administrative expenses. 
Sec. 203. Culturally appropriate, medically tailored meals. 
Sec. 204. Business acumen provisions and clarification regarding outside fund-
ing for area agencies on aging. 
Sec. 205. Other practices. 
Sec. 206. Caregiver assessments. 
Sec. 207. Research and evaluation. 
Sec. 208. Grant program for multigenerational collaboration. 
TITLE III—STRENGTHENING PROTECTIONS FOR OLDER 
INDIVIDUALS 
Sec. 301. State Long-Term Care Ombudsman Program minimum funding and 
maintenance of effort. 
Sec. 302. State long-term care volunteer ombudsman representatives. 
Sec. 303. Clarification regarding board and care facilities. 
TITLE IV—MEETING THE NEEDS OF OLDER NATIVE AMERICANS 
Sec. 401. Expanding supportive services for Native American aging programs. 
Sec. 402. Enhancing capacity to support Native American aging programs. 
TITLE V—MISCELLANEOUS 
Sec. 501. Assistive technology. 
Sec. 502. Technical corrections. 
Sec. 503. Authorization of appropriations; uses of funds. 
Sec. 504. Effective date. 
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TITLE I—ENSURING COLLABO-
RATION 
AND 
PROMOTING 
INDEPENDENCE FOR OLDER 
INDIVIDUALS 
SEC. 101. PERSON-CENTERED, TRAUMA-INFORMED CARE. 
Section 101(2) of the Older Americans Act of 1965 
(42 U.S.C. 3001(2)) is amended by inserting ‘‘(including 
access to person-centered, trauma-informed care)’’ after 
‘‘health’’. 
SEC. 102. VACCINATION. 
Section 102(14) of the Older Americans Act of 1965 
(42 U.S.C. 3002(14)) is amended — 
(1) in subparagraph (B) by inserting ‘‘immuni-
zation status,’’ after ‘‘oral health,’’, and 
(2) in subparagraph (D) by inserting ‘‘infec-
tious disease, and vaccine preventable disease,’’ after 
‘‘disease),’’. 
SEC. 103. FUNCTIONS OF ASSISTANT SECRETARY. 
Section 202 of the Older Americans Act of 1965 (42 
U.S.C. 3012) is amended— 
(1) by amending subsection (a)(4) to read as 
follows: 
‘‘(4) administer the grants provided by this Act 
but not approve an application submitted by an ap-
plicant for a grant for a program for which such ap-
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(B) in paragraph (4) by inserting ‘‘, except 
that the 1st term of a member appointed to the 
Interagency Coordinating Committee on Age- 
Friendly Communities shall begin not later 
than 1 year after the date of the enactment of 
the Dignity in Aging Act of 2019’’ before the 
period at the end, 
(C) in paragraph (5) by striking ‘‘once 
each year’’ and inserting ‘‘semiannually’’, 
(D) in paragraph (6)— 
(i) in subparagraph (A)— 
(I) in clause (iii) by striking 
‘‘and’’ at the end, 
(II) in clause (iv) by adding 
‘‘and’’ at the end, and 
(III) by adding at the end the 
following: 
‘‘(v) identifying best practices for con-
necting older individuals to services for which 
they may be eligible;’’, and 
(ii) by amending subparagraph (B)(ii) 
to read as follows: 
‘‘(ii) innovations in technology applications 
(including assistance technology devices and as-
sistance technology services) that— 
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‘‘(I) promote safe and accessible inde-
pendent living environments; and 
‘‘(II) give older individuals access to 
information on available services or help in 
providing services to older individuals;’’, 
(E) in subparagraph (E) by striking ‘‘non-
governmental experts and organizations, includ-
ing public health interest and research groups 
and foundations’’ and inserting ‘‘nongovern-
mental organizations, academic or research in-
stitutions, community-based organizations, and 
philanthropic organizations’’, 
(F) by redesignating subparagraphs (E), 
(F), and (F) as subparagraphs (F), (G), and 
(H), respectively, 
(G) by inserting after subparagraph (D) 
the following: 
‘‘(E) work with the Centers for Disease Con-
trol, the National Institute on Aging, and the Hous-
ing and Urban Development Office of Lead Hazard 
Control and Healthy Homes, and other Federal 
agencies as appropriate, to develop recommenda-
tions, in accordance with paragraph (1), to reduce 
falls among older individuals that incorporate evi-
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dence-based falls prevention programs and home 
modifications to reduce and prevent falls;’’, and 
(H) by adding at the end the following: 
‘‘(9) In this subsection, the term ‘age-friendly com-
munity’ means a community that— 
‘‘(A) is taking steps— 
‘‘(i) to include accessible housing, acces-
sible spaces and buildings, safe and secure 
paths, variable route transportation services, 
and programs and services designed to maintain 
health and well-being; 
‘‘(ii) to respect and include older individ-
uals in social opportunities, civic participation, 
volunteerism, and employment; and 
‘‘(iii) to facilitate access to supportive serv-
ices for older individuals; and 
‘‘(B) has a plan in place to meet local needs for 
housing, transportation, civic participation, social 
connectedness, and accessible spaces.’’. 
SEC. 106. TECHNICAL ASSISTANCE ON AGE-FRIENDLY COM-
MUNITIES. 
Section 205(a)(2) of the Older Americans Act of 
1965 (42 U.S.C. 3016(a)(2)) is amended— 
(1) by redesignating subparagraph (C) as sub-
paragraph (D), and 
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(2) by inserting after subparagraph (B) the fol-
lowing: 
‘‘(C) The Assistant Secretary may provide 
technical assistance, including through the re-
gional offices of the Administration, to State 
agencies, area agencies on aging, local govern-
ment agencies, or leaders in age-friendly com-
munities (as defined in section 203(c)(9)) re-
garding— 
‘‘(i) dissemination of, or consideration 
of ways to implement, best practices and 
recommendations from the Interagency Co-
ordinating Committee on Age-Friendly 
Communities established under section 
203(c); and 
‘‘(ii) methods for managing and co-
ordinating existing programs to meet the 
needs of growing age-friendly commu-
nities.’’. 
SEC. 107. MALNUTRITION. 
The Older Americans Act of 1965 (42 U.S.C. 2011 
et seq.) is amended— 
(1) in section 102(14)(B) by inserting ‘‘(includ-
ing screening for malnutrition)’’ before the semi-
colon at the end, and 
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(2) in section 330(1) by striking ‘‘and food in-
security’’ and inserting ‘‘, food insecurity, and mal-
nutrition’’. 
SEC. 108. COORDINATION WITH RESOURCE CENTERS. 
(a) AREA PLANS.—Section 306(a) of the Older 
Americans Act of 1965 (42 U.S.C. 3026(a)) is amended— 
(1) in paragraph (16) by striking ‘‘and’’ at the 
end, 
(2) in paragraph (17) by striking the period at 
the end, and 
(3) by adding at the end the following: 
‘‘(18) provide assurances that the area agency 
on aging will collect data to determine the services 
that are needed by older individuals whose needs are 
the focus of all centers funded under title IV and the 
effectiveness of such activities in assisting these indi-
viduals. Each agency plan shall provide assurances 
that the area agency on aging will use outreach ef-
forts that will identify individuals eligible for assist-
ance under this Act, with special emphasis on those 
individuals whose needs are the focus of all centers 
funded under title IV.’’. 
(b) STATE PLANS.—Section 307(a) of the Older 
Americans Act of 1965 (42 U.S.C. 3027) by adding at 
the end the following: 
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‘‘(31) The plan shall provide assurances that 
the State will collect data to determine the services 
that are needed by older individuals whose needs are 
the focus of all centers funded under title IV and the 
effectiveness of such activities in assisting these indi-
viduals. Each State plan shall provide assurances 
that the State unit on aging will use outreach efforts 
that will identify individuals eligible for assistance 
under this Act, with special emphasis on those indi-
viduals whose needs are the focus of all centers 
funded under title IV’’. 
SEC. 109. ARTS EDUCATION. 
(a) PROGRAM DESIGN.—Section 202(a)(5) of the 
Older Americans Act of 1965 (42 U.S.C. 3012(a)(5)) is 
amended by inserting ‘‘cultural experiences, activities and 
services, including the arts,’’ after ‘‘education),’’. 
(b) SUPPORTIVE SERVICES.—Section 321(a)(7) of 
the Older Americans Act of 1965 (42 U.S.C. 3030d(a)(7)) 
is amended by inserting ‘‘cultural experiences (including 
the arts),’’ after ‘‘art therapy,’’. 
SEC. 110. SOCIAL DETERMINANTS OF HEALTH. 
Section 301(a)(1) of the Older Americans Act of 
1965 (42 U.S.C. 3021(a)(1)) is amended— 
(1) in subparagraph (C) by striking ‘‘and’’ at 
the end, 
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(2) in subparagraph (D) by striking the period 
at the end and inserting ‘‘; and’’, and 
(3) by adding at the end the following: 
‘‘(E) address the social determinants of 
health of older individuals.’’. 
SEC. 111. FEDERAL COORDINATION OF SUPPORTS AND 
SERVICES FOR LIVING INDEPENDENTLY AND 
SAFELY AT HOME. 
Title II of the Older Americans Act of 1965 (42 
U.S.C. 3011–3020) is amended by inserting after section 
203A the following: 
‘‘SEC. 203B. FEDERAL COORDINATION OF SUPPORTS AND 
SERVICES FOR LIVING INDEPENDENTLY AND 
SAFELY AT HOME. 
‘‘(a) INITIATIVE.—The Assistant Secretary shall 
carry out an initiative under this section to identify and 
disseminate information about Federal resources to pro-
mote falls prevention, home assessments, and home modi-
fications, which may include in-home assistive technology, 
to enable older individuals to live independently and safely 
in a home environment. 
‘‘(b) COORDINATION
OF FEDERAL EFFORTS.—In 
carrying out the initiative under this section, the Assistant 
Secretary shall coordinate, through memoranda of under-
standing, agreements, or other appropriate means of co-
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ordination, with all Federal efforts and Federal programs 
in effect on the effective date of this section that support 
evidence-based falls prevention, home assessments, and 
home modifications, which may include in-home assistive 
technology, for older individuals, including older individ-
uals with disabilities. 
‘‘(c) REPORTS.—Not later than 1 year after effective 
date of this section, and triennially thereafter as needed, 
the Assistant Secretary shall publish a report that in-
cludes— 
‘‘(1) an inventory of the then current Federal 
programs that support evidence-based falls preven-
tion, home assessments, and home modifications, 
which may include in-home assistive technology, for 
older individuals; 
‘‘(2) for the fiscal year of the report, statistical 
data on the number of older individuals served by 
each Federal program described in paragraph (1), 
including a demographic analysis and the approxi-
mate amount of Federal funding invested in each 
such program; and 
‘‘(3) an evaluation of the impact of Federal pro-
grams that support falls prevention and home modi-
fications, which may include in-home assistive tech-
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nology, on health status and health outcomes in pop-
ulations supported by such efforts and programs.’’. 
SEC. 112. FALLS PREVENTION AND CHRONIC DISEASE 
SELF-MANAGEMENT EDUCATION. 
Section 411(a) of the Older Americans Act of 1965 
(42 U.S.C. 3032(a)) is amended— 
(1) by redesignating paragraphs (13) and (14) 
as paragraphs (15) and (16), respectively, and 
(2) by inserting after paragraph (12) the fol-
lowing: 
‘‘(13) bringing to scale and sustaining evidence- 
based falls prevention programs that will reduce the 
number of falls, fear of falling, and fall-related inju-
ries in older individuals and individuals with disabil-
ities; 
‘‘(14) bringing to scale and sustaining evidence- 
based chronic disease self-management programs 
that empower older individuals and older individuals 
with disabilities to better manage their chronic con-
ditions;’’. 
SEC. 113. EXTENSION OF RAISE FAMILY CAREGIVERS ACT. 
Section 6 of the RAISE Family Caregivers Act (Pub-
lic Law 115–119; 132 Stat. 27) is amended by striking 
‘‘3’’ and inserting ‘‘4’’. 
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SEC. 114. SUPPORT FOR SOCIALLY ISOLATED OLDER AMER-
ICANS. 
Section 102(14) of the Older Americans Act of 1965 
(42 U.S.C. 3002(14)) is amended— 
(1) in subparagraph (K) by striking ‘‘; and’’, 
(2) by redesignating subparagraph (L) as sub-
paragraph (M), and 
(3) by inserting after subparagraph (K) the fol-
lowing: 
‘‘(L) screening for the prevention of social 
isolation and coordination of supportive services 
and health care to address social isolation and 
loneliness; and’’. 
SEC. 115. INCREASED FOCUS OF ASSISTANT SECRETARY ON 
SOCIAL ISOLATION. 
Section 202(a) of the Older Americans Act of 1965 
(42 U.S.C. 3012(a)) is amended— 
(1) in paragraph (30) by striking ‘‘; and’’ and 
inserting a semicolon, 
(2) in paragraph (31) by striking the period 
and inserting ‘‘; and’’, and 
(3) by adding at the end the following: 
‘‘(32) develop objectives, priorities, and a long- 
term plan for supporting State and local efforts in-
volving education about, prevention of, detection of, 
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and response to social isolation among older individ-
uals.’’. 
SEC. 116. ADVISORY COUNCIL ON SOCIAL ISOLATION. 
Section 202 of the Older Americans Act of 1965 (42 
U.S.C. 3012) is amended by adding at the end the fol-
lowing: 
‘‘(h)(1) The Assistant Secretary shall convene an ad-
visory council on social isolation with aging network stake-
holders and select members in a manner that ensures geo-
graphic diversity of the members— 
‘‘(A) to review and evaluate efforts to address 
social isolation and loneliness among older individ-
uals; and 
‘‘(B) to identify challenges, solutions, and best 
practices related to such efforts. 
‘‘(2) The advisory council convened under paragraph 
(1) shall— 
‘‘(A) ensure consideration of consumer-directed 
care models; and 
‘‘(B) submit a report to Congress on its find-
ings. 
‘‘(3) The Federal Advisory Committee Act (5 U.S.C. 
App.) shall not apply with respect to the advisory council 
convened under paragraph (1).’’. 
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SEC. 117. SUPPORTIVE SERVICES AND SENIOR CENTERS. 
Section 321(a) of the Older Americans Act of 1965 
(42 U.S.C. 3030d(a)) is amended— 
(1) in paragraph (8) by striking ‘‘behavioral 
health screening’’ and inserting ‘‘behavioral health 
screening, screening for social isolation and loneli-
ness,’’, 
(2) in paragraph (24) by striking ‘‘and’’ at the 
end, 
(3) by redesignating paragraph (25) as para-
graph (26), and 
(4) by inserting after paragraph (24) the fol-
lowing: 
‘‘(25) services that promote or support social 
connectiveness and reduce social isolation; and’’. 
SEC. 118. DEMONSTRATION PROJECTS. 
(a) DEMONSTRATIONS.—Section 411(a) of the Older 
Americans Act of 1965 (42 U.S.C. 3032(a)), as amended 
by section 112, is amended— 
(1) in paragraph (15) by striking ‘‘and’’ at the 
end, 
(2) by redesignating paragraph (16) as para-
graph (17), and 
(3) by inserting after paragraph (15) the fol-
lowing: 
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