II 118th CONGRESS 2d Session S. 4283 IN THE SENATE OF THE UNITED STATES May 8, 2024 Mr. Casey (for himself, Ms. Klobuchar , Ms. Duckworth , Mr. Merkley , and Mr. Sanders ) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To establish grants to provide education on guardianship alternatives for older adults and people with disabilities to health care workers, educators, family members, and court workers and court-related personnel.

1. Short title This Act may be cited as the Alternatives to Guardianship Education Act . 2. Findings and purpose (a) Findings Congress finds the following: (1) Guardianship, although at times necessary, can negatively affect the person under guardianship by reducing or eliminating their self-determination and autonomy. (2) Although State courts and State laws attempt to provide some procedures to appoint trustworthy guardians, incidents of physical, financial, emotional, psychological, and other types of abuse have occurred to people under guardianship arrangements. (3) Once guardianship arrangements are in place, restoration of rights rarely occurs. (4) Less restrictive options to guardianship, such as supported decisionmaking and advance directives, offer ways to help people make decisions without losing their independence. (5) Awareness of guardianship alternatives by personnel that interact with individuals facing guardianship determinations, including health care workers, educators, family members, and court workers and court-related personnel, may help reduce unnecessary guardianship arrangements and preserve decisionmaking rights. (6) Families and disability support personnel have reported that they have limited awareness of guardianship alternatives. (b) Purpose The purpose of this Act is to improve the awareness of guardianship alternatives, for health care workers, educators, family members, and court workers and court-related personnel, through education programs. 3. Definitions In this Act: (1) Aging agency The term aging agency means an organization that represents older adults, and that may have experience in serving family members of such adults. (2) Disability The term disability has the meaning given the term in section 3 of the Americans with Disabilities Act of 1990 ( 42 U.S.C. 12102 ). (3) Disability agency The term disability agency means an organization serving people with disabilities that— (A) is operated by a board, on which— (i) a majority of the members are people with disabilities or their family members; and (ii) the number of members on the board who are people with disabilities is greater than the number of members on the board who are family members; (B) has an advisory panel or council, on which— (i) a majority of the members are people with disabilities or their family members; and (ii) the number of members on the board who are people with disabilities is greater than the number of members on the board who are family members; or (C) has employees, a majority of whom are people with disabilities. (4) Guardianship The term guardianship means— (A) a protective arrangement resulting from the process by which a State court determines that an adult individual lacks capacity to make decisions about self-care, finances, property, or personal affairs, and appoints another individual or entity known as a guardian, as a conservator, or by a similar term, as a surrogate decisionmaker; (B) a protective arrangement in which the court-appointed surrogate decisionmaker carries out duties to the individual and the court; or (C) a protective arrangement in which the court exercises oversight of the surrogate decisionmaker. (5) Indian tribe The term Indian Tribe has the meaning given the term in section 4 of the Indian Self-Determination and Education Assistance Act ( 25 U.S.C. 5304 ). (6) Legal services agency The term legal services agency means a public or nonprofit organization that has experience providing legal services to low-income older adults or adults with disabilities. (7) Older adult The term older adult has the meaning given the term older individual as defined in section 102 of the Older Americans Act of 1965 ( 42 U.S.C. 3002 ). (8) Secretary The term Secretary means the Secretary of Health and Human Services, acting through the Administrator of the Administration for Community Living. (9) State The term State means any of the 50 States, the District of Columbia, the Commonwealth of Puerto Rico, Guam, American Samoa, the United States Virgin Islands, and the Commonwealth of the Northern Marianas. I Guardianship alternatives education for health care workers 101. Definitions In this title: (1) Eligible entity The term eligible entity means a partnership (established by a disability agency, legal services agency, or aging agency)— (A) that includes— (i) that disability agency, legal services agency, or aging agency; and (ii) at least one health care entity, department of such an entity, or specialty office of such an entity, that has frequent contact with people with disabilities or older adults, including— (I) a primary care clinic, including a Federally qualified health center or rural health clinic (as such terms are defined in section 1861(aa) of the Social Security Act ( 42 U.S.C. 1395x(aa) )); (II) an emergency department; (III) a long-term care provider; (IV) a pediatric office; (V) a rehabilitation center; (VI) a geriatrician office; (VII) a neurology office; or (VIII) an entity providing a training program for health care workers in any specialty listed in this subparagraph; and (B) for which the establishing agency has memorialized the establishment, membership, and functions of the partnership in the form of a letter of support, memorandum of understanding, or similar document. (2) Health care workers The term health care workers means staff with direct contact with patients in health care settings, including physicians, advanced practice providers, nurses, medical assistants, social workers, health care administrators, dentists, dental hygiene professionals, receptionists, and mental health professionals. 102. Grant program (a) In general The Secretary shall make grants, on a competitive basis, to eligible entities in States, and to eligible entities that serve Indian Tribes, to enable the recipients to carry out guardianship alternatives education programs for health care workers. (b) Term The Secretary may make such a grant for a first term of 3 years. An eligible entity may seek renewal of, and the Secretary may make, such a grant for a second term of 3 years, in order to expand service delivery of the education program to health care workers. 103. Applications To be eligible to receive a grant under this title, an entity shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require, including— (1) information identifying the target population to receive instruction, and a projected number of participants in and graduates of the education program to be carried out under the grant; (2) a needs assessment, identifying the need for guardianship alternatives education for the target population proposed; (3) information identifying who will facilitate the related instruction; (4) a description of how the entity will conduct outreach to health care workers for the education program; (5) a description of learning objectives for the education program; (6) a description of activities to be carried out under the grant; (7) an evaluation plan for the education program; (8) a timeline for establishing and carrying out the education program; (9) information that demonstrates the instructors’ knowledge of guardianship alternatives and experience in conducting education and training programs for the public; (10) information describing the format for the instruction, which may be in-person, online, or hybrid, and how the instruction and related materials will be accessible by all participants; and (11) a description of how the entity will, to the best of its ability, ensure the education program reaches populations from diverse backgrounds and communities and underserved demographic populations (such as an underserved race, ethnicity, gender, gender identity, sexual orientation, age, or type of disability). 104. Use of funds (a) Required uses An eligible entity that receives a grant under this title shall use the grant funds for— (1) implementing an education program to enhance the awareness of alternatives to guardianship for health care workers; and (2) ensuring that the guardianship alternatives education program— (A) discusses the background of guardianship, the possible consequences of unnecessary guardianship, and the need for guardianship alternatives; (B) covers the various guardianship alternatives available in the State or States involved; (C) includes a curriculum tailored to the needs of the target population; (D) includes, to the best of its ability, instructors with a diverse range of disabilities as instructors or speakers; (E) provides the instruction and related materials for the education program in accessible formats; and (F) includes, to the best of its ability, methods to reach populations from diverse backgrounds and communities and underserved demographic populations (such as an underserved race, ethnicity, gender, gender identity, sexual orientation, age, or type of disability). (b) Allowable uses The eligible entity may use the grant funds for— (1) recruiting individuals to receive guardianship alternatives education; (2) modifying a curriculum for the education program; (3) creating accessible materials for the education program, such as materials with Communication Access Realtime Translation, with American Sign Language, in Braille, in plain language, and in other appropriate formats; (4) transporting individuals enrolled in the education program to and from the instructional sessions; (5) providing child care during the instructional sessions for people in attendance; (6) conducting website management for the education program; (7) translating recruitment and instructional materials for the education program; (8) providing payment for venue for in-person instruction; (9) providing payment for costs of arranging for professional continuing education credits; (10) providing reasonable food and beverages for in-person instruction; (11) expanding or adapting an existing (as of the date of submission of the application for the grant) guardianship alternatives education program; or (12) providing payment for instructors (including guest instructors) and speakers. II Guardianship alternatives education for educators 201. Definitions In this title: (1) Educators The term educators means teachers and other staff (as defined in section 8101 of the Elementary and Secondary Education Act of 1965 ( 20 U.S.C. 7801 )), in a public or private elementary school or secondary school, that have contact with students with disabilities and their caregivers, including— (A) teachers; (B) special education teachers; (C) special education directors; (D) transition coordinators; (E) State qualified vocational rehabilitation counselors, as defined in section 100(a)(3)(E) of the Rehabilitation Act of 1973 ( 29 U.S.C. 720(a)(3)(E) ); (F) any person providing pre-employment transition services, as defined in section 7 of the Rehabilitation Act of 1973 ( 29 U.S.C. 705 ); (G) paraprofessionals; (H) school social workers; (I) school psychologists; (J) school counselors; (K) educational diagnosticians; (L) specialized instructional support personnel, as defined in that section 8101; and (M) staff of a training program for an occupation described in any of subparagraphs (A) through (L). (2) Elementary school; secondary school The terms elementary school and secondary school have the meanings given the terms in section 8101 of the Elementary and Secondary Education Act of 1965 ( 20 U.S.C. 7801 ). (3) Eligible entity The term eligible entity means a partnership (established by a disability agency or legal services agency)— (A) that includes— (i) that disability agency or legal services agency; and (ii) a local educational agency, or a public or private elementary school or secondary school, that employs educators; and (B) for which the establishing agency has memorialized the establishment, membership, and functions of the partnership in the form of a letter of support, memorandum of understanding, or similar document. 202. Grant program (a) In general The Secretary shall make grants, on a competitive basis, to eligible entities in States, and to eligible entities that serve Indian Tribes, to enable the recipients to carry out guardianship alternatives education programs for educators. (b) Term The Secretary may make such a grant for a first term of 3 years. An eligible entity may seek renewal of, and the Secretary may make, such a grant for a second term of 3 years, in order to expand service delivery of the education program to educators. 203. Applications To be eligible to receive a grant under this title, an entity shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require, including— (1) information identifying the target population to receive instruction, and a projected number of participants in and graduates of the education program to be carried out under the grant; (2) a needs assessment, identifying the need for guardianship alternatives education for the target population; (3) information identifying who will facilitate the related instruction; (4) a description of how the entity will conduct outreach to educators for the education program; (5) a description of learning objectives for the education program; (6) a description of activities to be carried out under the grant; (7) an evaluation plan for the education program; (8) a timeline for establishing and carrying out the education program; (9) information that demonstrates the instructors’ knowledge of guardianship alternatives and experience in conducting education and training programs for the public; and (10) information describing the format for the instruction, which may be in-person, online, or hybrid, and how the instruction and related materials will be accessible by all participants. 204. Use of funds (a) Required uses An eligible entity that receives a grant under this title shall use the grant funds for implementing an education program to enhance the awareness of alternatives to guardianship for educators and ensuring that the education program meets the requirements of section 104(a)(2). (b) Allowable uses The eligible entity may use the grant funds to carry out the activities described in section 104(b), for the education program. III Guardianship alternatives education for families 301. Definitions In this title: (1) Eligible entity The term eligible entity means a disability agency, legal services agency, or aging agency with a goal to inform and support older adults, or people with disabilities, and their family members. (2) Family member The term family member means a member of the family of— (A) an older adult; or (B) a person with a disability. 302. Grant program (a) In general The Secretary shall make grants, on a competitive basis, to eligible entities in States, and to eligible entities that serve Indian Tribes, to enable the recipients to carry out guardianship alternatives education programs for family members of older adults and family members of people with disabilities. (b) Term The Secretary may make such a grant for a first term of 3 years. An eligible entity may seek renewal of, and the Secretary may make, such a grant for a second term of 3 years, in order to expand service delivery of the education program to such family members. 303. Applications To be eligible to receive a grant under this title, an entity shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require, including— (1) information identifying the target population to receive instruction, and a projected number of participants in and graduates of the education program to be carried out under the grant; (2) information identifying who will facilitate the related instruction for the education program; (3) a description of how the entity will conduct outreach to educators for the education program; (4) a description of learning objectives for the education program; (5) a description of activities to be carried out under the grant; (6) an evaluation plan for the education program; (7) a timeline for establishing and carrying out the education program; (8) information that demonstrates the instructors’ knowledge of guardianship alternatives and experience in conducting education and training programs for the public; and (9) information describing the format for the instruction, which may be in-person, online, or hybrid, and how the instruction and related materials will be accessible by all participants. 304. Use of funds (a) Required uses An eligible entity that receives a grant under this title shall use the grant funds for implementing an education program to enhance the awareness of alternatives to guardianship for family members and ensuring that the education program meets the requirements of section 104(a)(2). (b) Allowable uses The eligible entity may use the grant funds to carry out the activities described in section 104(b), for the education program. IV Guardianship alternatives education for court workers and court-related personnel 401. Definitions In this title: (1) Court-related personnel The term court-related personnel means persons working in, or members of organizations supporting, court systems or court workers, including— (A) staff and members of local chapters of the American Bar Association; (B) staff and members of local chapters of the American Civil Liberties Union; (C) staff and members of local associations of court workers; (D) staff and members of elder rights law organizations; (E) staff and members of disability rights law organizations; (F) staff of an agency implementing a State protection and advocacy system, as defined in section 102 of the Developmental Disabilities Act and Bill of Rights of 2000 ( 42 U.S.C. 15002 ); (G) district attorneys and their staff; (H) court clerks and clerk staff not directly employed by the court; or (I) an entity providing a training program for any specialty relevant to an organization or occupation listed in this paragraph. (2) Court workers The term court workers means persons working in local court systems, including— (A) court staff; (B) law or court clerks and paralegals; (C) attorneys; and (D) judges. (3) Eligible entity The term eligible entity means a partnership (established by a disability agency, legal services agency, or aging agency)— (A) that includes— (i) that disability agency, legal services agency, or aging agency; and (ii) a court whose employees, or other court-related organization whose members, have contact with plaintiffs who are under or facing a guardianship or other protective arrangement or address cases related to guardianship and other protective arrangements; and (B) for which the establishing agency has memorialized the establishment, membership, and functions of the partnership in the form of a letter of support, memorandum of understanding, or similar document. 402. Grant program (a) In general The Secretary shall make grants, on a competitive basis, to eligible entities in States, and to eligible entities that serve Indian Tribes, to enable the recipients to carry out guardianship alternatives education programs for court workers and other court-related personnel. (b) Term The Secretary may make such a grant for a first term of 3 years. An eligible entity may seek renewal of, and the Secretary may make, such a grant for a second term of 3 years, in order to expand service delivery of the education program to court workers and other court-related personnel. 403. Applications To be eligible to receive a grant under this title, an entity shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require, including— (1) information identifying the target population to receive instruction, including a projected number of participants in and graduates of the education program to be carried out under the grant; (2) a needs assessment, identifying the need for guardianship alternatives education for the target population proposed; (3) information identifying who will facilitate the related instruction; (4) a description of how the entity will conduct outreach to the court workers or other court-related personnel proposed for the education program; (5) a description of learning objectives for the education program; (6) a description of activities to be carried out under the grant; (7) an evaluation plan for the education program; (8) a timeline for establishing and carrying out the education program; (9) information that demonstrates the instructors’ knowledge of guardianship alternatives and experience in conducting education and training programs for the public; and (10) information describing the format for the instruction, which may be in-person, online, or hybrid, and how the instruction and related materials will be accessible by all participants. 404. Use of funds (a) Required uses An eligible entity that receives a grant under this title shall use the grant funds for implementing an education program to enhance the awareness of alternatives to guardianship for court workers or other court-related personnel and ensuring that the education program meets the requirements of section 104(a)(2). (b) Allowable uses The eligible entity may use the grant funds to carry out the activities described in section 104(b), for the education program. V Administration 501. Grant Advisory Council (a) In general The Secretary shall establish an advisory council, to be known as the Grant Advisory Council , to advise eligible entities that receive grants under this Act on activities carried out under the grants. (b) Composition The advisory council shall be composed of 13 members, consisting of— (1) 3 experts who have experience in counseling individuals and guiding individuals to guardianship alternatives, or who have data-driven expertise in ways to guide individuals to guardianship alternatives, which may include— (A) a social services program administrator; (B) a guardianship researcher; or (C) an advocate for people with disabilities; and (2) 1 health care administrator or manager with experience with guardianship alternatives; (3) 1 administrator from a school served by a local educational agency, and 1 administrator from an institution of higher education, with experience with guardianship alternatives; (4) 1 family member, as defined in section 301, with experience with guardianship alternatives; (5) 1 court worker, as defined in section 401, with experience with guardianship alternatives; (6) 3 people with disabilities, or older adults, who have successfully transitioned to a guardianship alternative, of which at least 1 shall be a person with a disability and at least 1 shall be an older adult; and (7) 3 people with disabilities, or older adults, who are in a guardianship alternative, of which at least 1 shall be a person with a disability and at least 1 shall be an older adult. (c) Period of appointment; vacancies Members shall be appointed for the life of the advisory council. Any vacancy in the council shall not affect the powers of the advisory council, but shall be filled in the same manner as the original appointment was made. (d) Chairman and vice chairman The advisory council shall select a Chairperson and Vice Chairperson from among its members. (e) Duties The advisory council shall— (1) advise the Secretary on, and provide general oversight for, the grant programs carried out under titles I through IV concerning the activities carried out under the grants, including development of the curricula for guardianship alternatives education; (2) consult with the Secretary on the awarding of the grants; (3) provide recommendations for sustainability and expansion of the guardianship alternatives education programs carried out under the grants, such as development of a train-the-trainer model for such an education program; and (4) provide input for the evaluation methods and implementation of the evaluation described in section 502, including advising the Secretary on additional criteria for the evaluator to evaluate under section 502, to measure effectiveness of guardianship alternatives education programs described in section 502. (f) Report Not later than September 30, 2027, and not later than September 30, 2030, the advisory council shall prepare a report containing recommendations on the programs, activities, and curricula described in subsection (e)(1) and the sustainability and expansion described in subsection (e)(3). The advisory council shall submit the report to the covered committees defined in section 504(f). (g) Travel expenses Subject to the limit described in section 505(b), the members of the advisory council shall be allowed travel expenses, including per diem in lieu of subsistence, at rates authorized for employees of agencies under subchapter I of chapter 57 of title 5, United States Code, while away from their homes or regular places of business in the performance of services for the advisory council. (h) Detail of government employees Any Federal Government employee may be detailed to the advisory council without reimbursement to serve as a staff member for the advisory council, and such detail shall be without interruption or loss of civil service status or privilege. (i) Termination The advisory council shall terminate on October 1, 2030. 502. Evaluation of education programs (a) Independent evaluator The Secretary shall enter into a contract with an independent entity, who is not a grant recipient under this Act and who has expertise in evaluating programs for people with disabilities or programs for older adults, to carry out an evaluation of the education programs carried out under this Act. (b) Population covered by evaluation In conducting the evaluation, the evaluator shall consider the impact of the education programs carried out under this Act on all participants served by the education programs and on each underserved demographic population (such as an underserved race, ethnicity, gender, gender identity, sexual orientation, age, or type of disability) served by the education programs. (c) Performance (1) Performance in changing awareness of guardianship alternatives (A) Awareness of program participants The evaluator shall measure program participants’ awareness of guardianship alternatives as a result of the education programs. (B) Awareness due to dissemination The evaluator shall measure the dissemination of information on guardianship alternatives in the workplaces and communities of participants in the education programs, as a result of the education programs, to evaluate how far awareness of guardianship alternatives has expanded beyond the participants. (2) Effectiveness of education programs The evaluator shall measure the effectiveness of the education programs on any additional criterion that the advisory committee advised the Secretary to adopt, and the Secretary adopted, in accordance with section 501(e)(4). (d) Policy changes at the State level In conducting the evaluation, the evaluator shall identify any guardianship policy changes at the State level, including the creation of, removal of, or changes to guardianship policies. 503. State data collection on protective arrangements (a) Rehabilitation Act of 1973 The Rehabilitation Act of 1973 is amended— (1) in section 101(a)(10) ( 29 U.S.C. 721(a)(10) )— (A) by redesignating subparagraphs (F) through (H) as subparagraphs (G) through (I), respectively; and (B) by inserting after subparagraph (E) the following: (F) The Commissioner shall require that each designated State unit include in the reports additional information described in section 503(b) of the Alternatives to Guardianship Education Act . ; and (2) in section 607 ( 29 U.S.C. 795l ), by inserting (except with respect to information under subparagraph (F) of section 101(a)(10)) after section 101(a)(10) . (b) Data To be collected and submitted by States In order to provide objective, measurable data on guardianships and guardianship alternatives in the States, States receiving funds under title I of the Rehabilitation Act of 1973 ( 29 U.S.C. 720 et seq. ) shall collect and report to the Secretary, in accordance with subsection (a), information about each of the following: (1) The number and type of guardianships and protective arrangements established and dissolved each calendar year in the State. (2) Demographic information of guardians and people under guardianship arrangements, including type of guardian (such as family member, friend, professional private guardian, or public agency). (3) The average length of a guardianship arrangement in the State, as of the time such data is reported. (4) Information about the reasons for guardianship arrangements in the State. (5) Information about the reasons that guardianship arrangements were terminated in the State since the last report, including receipt of guardianship alternatives education. 504. Reporting (a) Eligible entity reports Each eligible entity that receives a grant under this Act for an education program shall annually prepare and submit to the Secretary a progress report, that measures the change in indicators described in paragraphs (1) and (2) of section 502(c), as a result of the education program, and the change in policies described in section 502(d). (b) Summary effectiveness report The Secretary shall annually— (1) prepare a summary report on the change, in the aggregate, in indicators described in paragraphs (1) and (2) of section 502(c), as a result of the education programs carried out under this Act, and the change in policies described in section 502(d), which report shall include— (A) information on methods of outreach to recruit participants for the education programs from diverse backgrounds and communities, including the number of the participants recruited through each method; (B) the total number of participants in the education programs, and the percentage of such participants who completed the education programs; and (C) data on demographic characteristics, including the race, ethnicity, gender, gender identity, age, and type of disability, of the participants, and data on the geographic location of the participants, in the education programs; and (2) submit the report to the Committee on Health, Education, Labor, and Pensions and the Special Committee on Aging of the Senate, and the Committee on Education and the Workforce of the House of Representatives. (c) Renewal report Not later than 3 years after the date of enactment of this Act, the Secretary shall prepare and submit to the covered committees a formative report on the instruction provided through the guardianship alternatives education program during the 2-year period after eligible entities first receive grants under this Act. The Secretary shall use the information in the report in determining whether to renew grants for eligible entities for a second grant term. The Secretary shall submit the report to the grant recipients whose grants are renewed, to inform the work of the recipients during the second grant term. (d) State data report The Secretary shall prepare a report containing the data collected under section 503, and make the report publicly available. (e) Final report Not later than 1 year after the end of the last second grant term to be completed under this Act, the Secretary shall prepare and submit to the covered committees a final report summarizing all actions taken under grants made available under this Act. (f) Covered committees In this section, the term covered committees means the Committee on Health, Education, Labor, and Pensions, the Committee on Finance, and the Special Committee on Aging of the Senate, and the Committee on Education and the Workforce and the Committee on Energy and Commerce of the House of Representatives. 505. Authorization of appropriations (a) In general There is authorized to be appropriated to carry out this Act, $10,000,000 for each of fiscal years 2025 through 2030. (b) Administration and evaluation From the amount made available under subsection (a) for each fiscal year, the Secretary shall reserve not more than 5 percent for administration of this Act, including carrying out the activities required in sections 501 through 504.