Title: In-Home CARE Act
Policy area: Health

Summary:
In-Home Caregiver Assessment Resources and Education Act or the In-Home CARE Act
This bill amends the Public Health Service Act to require the Administration for Community Living to award grants to carry out home visiting programs for unpaid caregivers.
The Department of Health and Human Services must coordinate with the National Family Caregiver Support Program, the Centers for Medicare & Medicaid Services, the Department of Veterans Affairs, and others on this grant program.
Grantees must provide:

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 1606 Introduced in Senate (IS)]

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115th CONGRESS
  1st Session
                                S. 1606

           To authorize grants for the support of caregivers.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             July 20, 2017

Mr. Booker (for himself and Mr. Franken) introduced the following bill; 
     which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 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 43,000,000 unpaid caregivers provide care for 
        a chronically ill, disabled, or aged family member or friend 
        during any given year.
            (2) Sixty percent of unpaid caregivers are women. More than 
        37 percent of caregivers live with children or grandchildren 
        who are under 18 years old.
            (3) Ethnic minority caregivers, particularly African-
        American and Hispanic-American caregivers, experience greater 
        strain and worse physical health than their counterparts. More 
        than 50 percent of African Americans are ``sandwiched'' between 
        caring for an older person and a younger person under age 18.
            (4) The needs of caregivers and care recipients vary by 
        several factors such as race and ethnicity, age, social class, 
        sexual orientation, geographical location, gender, military or 
        veteran status, relationship between caregiver and care 
        recipient, health status, and other factors.
            (5) Unpaid family caregivers spend an average of 24 hours 
        per week caring for their loved ones, and about 23 percent of 
        family caregivers provide 41 or more hours of care per week.
            (6) Forty-nine percent of caregivers care for a parent.
            (7) Fourteen percent of caregivers provide care for a 
        special needs child, including an estimated 16,800,000 
        caregivers who care for a special needs child under 18 years of 
        age.
            (8) In 2016, the average caregiver for someone 18 years or 
        older spent $6,954 per year on out-of-pocket caregiving 
        expenses, which is nearly 20 percent of the average annual 
        income of caregivers.
            (9) Sixty percent of caregivers who provide care for an 
        individual over the age of 18 are currently working or have 
        worked while providing care. Three in five caregivers have had 
        to make some modifications to their work schedule, from 
        arriving late to work to leaving their job entirely. Almost 
        half of employed caregivers have had to take time off from 
        work.
            (10) 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. Thirty-five percent of 
        caregivers report having difficulty finding time for oneself, 
        and 29 percent report difficulty managing emotional and 
        physical stress or balancing work and family responsibilities.
            (11) Forty-six percent of caregivers of adults 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.
            (12) Nearly 20 percent of caregivers of adults who assisted 
        with medication management and 33 percent who assisted with 
        changing dressings or bandages received no training about how 
        to perform these tasks.
            (13) The vast majority of caregivers (84 percent) indicated 
        they need more support related to caregiving.
            (14) 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 or 
        hospital.

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 consistent 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 has experience providing the services described in 
        subsection (f).
    ``(c) Coordination.--In carrying out this section, the Secretary 
shall coordinate with--
            ``(1) 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) and the Secretary of Veterans 
        Affairs, to ensure coordination of caregiver services for 
        caregivers of children or adults with special needs; and
            ``(2) the Administrator 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, based on evidence-
                based models, 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) fall prevention;
                            ``(v) management of depression, anxiety, 
                        stress, trauma, 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 could 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 
        appropriate programs of the Department of Health and Human 
        Services or the Department of Veterans Affairs 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 demographic groups, including age, 
                gender, race and ethnicity, socioeconomic status, 
                sexual orientation, military status, and geographical 
                region; 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 
        that best meet the needs of the community;
            ``(2) will allow caregivers to contact the eligible 
        organization by phone, email, or 2-way interactive video for up 
        to 6 months after home visits have ended, or to otherwise 
        contact the organization at any time 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 in the home 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 evidence-based 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 2 years 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 connection to community 
                        resources;
                            ``(v) improved care; and
                            ``(vi) 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, 
                mood, and connection to community resources).
    ``(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.''.
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