,i #aacth ,,congress #b;d ,session ,h4 ,r4 #efcc ,,in ,,the ,,house ,,of ,,representatives ,september #ah1 #bjad ,mr4 ,pascrell introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce ,a ,,bill ,to authorize grants for the support of caregivers4 #a4 ,short title ,this ,act may be cited as the ,in-,home ,caregiver ,assessment ,resources and ,education ,act or the ,in-,home ,,care ,act4 #b4 ,findings ,congress finds the following3 7#a7 ,more than #fe1jjj1jjj unpaid caregivers provide care for a chronically ill1 disabled1 or aged family member or friend during any given year4 7#b7 ,sixty-six percent of unpaid caregivers are women4 ,more than #cg percent of caregivers live with children or grandchildren who are under #ah years old4 7#c7 ,unpaid family caregivers spend an average of #bj hours per week caring for their loved ones1 and #ac percent of family caregivers provide #dj or more hours of care per week4 7#d7 ,thirty-six percent of caregivers care for a parent4 7#e7 ,fourteen percent of caregivers care for a special needs child1 including an estimated #af1hjj1jjj caregivers who care for special needs children who are under #ah years old4 7#f7 ,in #bjjg1 the average caregiver for someone #ej years or older spent #e1eca per year on out-of-pocket caregiving expenses1 which is more than #aj percent of the median income for a family caregiver for that year4 ,forty-seven percent of working caregivers have used up all or most of their savings due to caregiving expenses4 7#g7 ,seventy-three percent of caregivers who provide care for an individual over the age of #ah are currently working or have worked while providing care4 ,sixty-six percent of such caregivers have had to make some modifications to their work schedule1 from arriving late to work to leaving their job entirely4 ,one in #e caregivers have had to take time off from work4 7#h7 ,fifty-three percent of caregivers have experienced a decline in their health as a result of caregiving1 which has affected their ability to provide care4 7#i7 ,forty-six percent of caregivers perform medical or nursing tasks for patients with multiple physical and chronic conditions4 ,of these caregivers1 #gh percent were in charge of managing a patient's medications1 administering fluids1 or administering injections4 7#aj7 ,nearly #bj percent of caregivers who assisted with medication management and #cc percent who assisted with changing dressings or bandages received no training about how to perform these tasks4 7#aa7 ,the vast majority 7#gh percent7 of caregivers indicated they need more support related to caregiving4 7#ab7 ,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 violence4 #c4 ,purposes ,the purposes of this ,act are-- 7#a7 to improve the ability of unpaid caregivers to care for individuals in the home2 and 7#b7 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 institution4 #d4 ,caregiver grants ,subpart ,,iv of part ,d of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bee et seq47 is amended by adding at the end the following3 #cci;,a4 ,caregiver grants 7a7 ,in ,general ,the ,secretary1 acting through the ,administrator of the ,administration for ,community ,living1 shall award #c-year grants1 on a competitive basis1 to eligible organizations to carry out home visiting programs for unpaid caregivers4 7b7 ,definitions ,in this section3 7#a7 ,caregiver ,the term caregiver means an unpaid family member1 foster parent1 or other unpaid adult who provides in-home monitoring1 management1 supervision1 or treatment of a child or adult with a special need1 such as a disease1 disability1 or the frailties of old age4 7#b7 ,caregiver assessment ,the term caregiver assessment means an assessment that includes talking directly to caregivers to better understand their needs1 problems1 resources1 and strengths4 7#c7 ,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-- 7,a7 meet the basic needs of the individual2 7,b7 prevent physical self-injury or injury to others2 or 7,c7 avoid placement in an institutional facility4 7#d7 ,eligible organization ,the term eligible organization means-- 7,a7 a local government agency2 7,b7 a health care entity2 or 7,c7 any other nonprofit or community organization1 that can provide the services described in subsection 7f74 7c7 ,coordination ,in carrying out this section1 the ,secretary shall coordinate-- 7#a7 with 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 7such as the ,lifespan ,respite ,care ,program71 to ensure coordination of caregiver services for caregivers of children or adults with special needs2 and 7#b7 with the ,director of the ,centers for ,medicare ,medicaid ,services to avoid duplicative services and payments4 7d7 ,application ,an eligible organization that desires a grant under this section shall submit an application at such time1 in such manner1 and containing such information as the ,secretary may require1 including1 at a minimum-- 7#a7 an outreach plan that identifies how the eligible organization will ascertain which caregivers in the community-- 7,a7 are most in need of support and education1 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 living2 7,b7 are caring for individuals who are at the greatest risk of needing institutional care2 and 7,c7 desire to participate in the caregiver home visiting program2 7#b7 a description of the services that the eligible organization will provide directly using grant funds1 and a description of the services that the eligible organization will use grant funds to provide through contracts or referrals2 7#c7 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 receiving2 7#d7 a description of how the eligible organization can provide-- 7,a7 an initial visit to caregivers in order to complete a caregiver assessment1 including a description of the eligible organization's expertise in conducting caregiver assessments2 7,b7 education and training to help the caregiver learn how to best care for a child or adult with a special need1 by an individual with expertise in the tasks for which the caregiver requires education and training1 including education and training regarding1 as applicable-- 7i7 medication management2 7ii7 wound care2 7iii7 nutrition and food preparation for special diets2 7iv7 falls prevention2 7v7 management of depression1 anxiety1 stress1 and other behavioral health conditions1 including ways to minimize negative mental health effects2 7vi7 assistance with activities of daily living2 7vii7 ways to engage other family members in providing care2 7viii7 ways to identify and utilize available community resources2 and 7ix7 abuse and neglect prevention2 and 7,c7 recommendations for home modifications or physical environmental changes that will improve the health or quality of life of a child or adult with a special need who is receiving care from a caregiver2 7#e7 a description of the eligible organization's ability to provide1 or refer caregivers to local resources or programs of the ,department of ,health and ,human ,services that will provide-- 7,a7 physical and mental health care1 including home health care and long-term support services2 7,b7 transportation2 7,c7 home modification services2 7,d7 respite care2 7,e7 adult day care2 7,f7 support groups2 and 7,g7 legal assistance2 7#f7 a description of the eligible organization's ability to coordinate with other ,state and community-based agencies2 7#g7 a description of the eligible organization's understanding of caregiver issues-- 7,a7 across age groups2 and 7,b7 including disabilities and chronic conditions that affect the populations that the eligible organization will serve2 7#h7 a description of the capacity of the eligible organization to engage caregivers1 family members1 and children or adults with a special need who receive care from a caregiver2 and 7#i7 with respect to the population of caregivers to whom caregiver visits or services will be provided1 or for whom workers and volunteers will be recruited and trained1 a description of-- 7,a7 the population of caregivers2 7,b7 the extent and nature of the needs of that population2 and 7,c7 existing caregiver services for that population1 including the number of caregivers served and the extent of unmet need4 7e7 ,priority ,in awarding grants under this section1 the ,secretary shall give priority to eligible organizations that-- 7#a7 the ,secretary determines show the greatest likelihood of implementing or enhancing caregiver home visiting services for the greatest number of people2 7#b7 will allow caregivers to contact the eligible organization by phone1 email1 or two-way interactive video after home visits have ended or if a caregiver has questions or concerns2 7#c7 have a proven record of caregiver support2 7#d7 will use evidence-based programs2 or 7#e7 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 provided4 7f7 ,authorized activities ,an eligible organization receiving a grant under this section shall use grant funds to-- 7#a7 conduct an initial home visit for each caregiver participating in the program1 during which a representative from the eligible organization who has expertise in care management 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 caregiver2 7#b7 conduct home visits for the purpose of caregiver education and training2 7#c7 provide1 or provide referrals for1 the services described in subsection 7d77#e72 7#d7 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 caregiver1 as needed2 and 7#e7 carry out any other activities that are described in the grant application submitted under subsection 7d74 7g7 ,technical assistance center ,the ,secretary shall establish or contract to establish a technical assistance center through which the ,secretary shall-- 7#a7 provide models for programs funded by grants under this section2 7#b7 provide training for grantees2 7#c7 answer questions from grantees2 and 7#d7 facilitate an exchange of information among grantees1 and between grantees and other programs within the ,department of ,health and ,human ,services1 including through use of the ,technical ,assistance ,exchange of the ,administration for ,community ,living1 in order to maximize the use of existing resources and services for caregivers and to avoid the duplication of such services4 7h7 ,evaluation 7#a7 ,in ,general ,not later than #a year after the date of enactment of this section1 and annually thereafter1 the ,secretary shall evaluate the success of the grant program carried out under this section1 based on criteria that the ,secretary may develop for such evaluation4 7#b7 ,optional contents of evaluation ,the evaluation described in paragraph 7#a7 may include an evaluation of-- 7,a7 the extent to which children or adults with a special need who are cared for by a participating caregiver have-- 7i7 a reduction in the potential number of hospitalizations2 7ii7 a reduction in the potential number of institutionalizations2 7iii7 cost reductions across the health care system2 7iv7 improved care2 and 7v7 improved quality of life 7including a reduction of stress and anxiety and improved relationships and mood72 and 7,b7 the extent to which participating caregivers have improved quality of life 7including a reduction of stress and anxiety and improved health1 relationships1 and mood74 7i7 ,reports and ,recommendations ,not later than #a year before the expiration of the grants awarded under this section1 the ,secretary shall prepare and submit a report to ,congress that includes recommendations1 based on the evaluation described in subsection 7h71 about-- 7#a7 changes to the grant program under this section2 7#b7 the potential for expanding the number and scope of caregiver home visiting program grants distributed by the ,secretary2 and 7#c7 extending the length of the grant program4 7j7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary4 4