II 112th CONGRESS 1st Session S. 1819 IN THE SENATE OF THE UNITED STATES November 8, 2011 Mr. Kohl (for himself and Ms. Mikulski) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To amend the Older Americans Act of 1965 to improve programs and services.

1.

Short title

This Act may be cited as the Strengthening Services for America’s Seniors Act.

2.

Standardized assessment of needs of family caregivers

(a)

In general

Section 373 (42 U.S.C. 3030s–1) is amended— (1)by redesignating subsections (b) through (g) as subsections (c) through (h), respectively; (2)in subsection (d), as so redesignated, by striking subsection (b) and inserting subsection (c); (3)in subsection (e), as so redesignated, by striking subsection (b) and inserting subsection (c); and (4)by inserting after subsection (a) the following: (b)

Assessment program of needs of family caregivers

(1)

In general

The Assistant Secretary may make grants to States to establish a program, in accordance with the program requirements described in paragraph (5), to assess the needs of family caregivers for targeted support services described in paragraph (5)(C). (2)

Application by States

Each State seeking a grant under this subsection shall submit an application to the Assistant Secretary at such time, in such manner, and containing such information and assurances as the Assistant Secretary determines appropriate. (3)

Grant amount

The amount of a grant to a State under this subsection shall be determined according to such methodology as the Assistant Secretary determines appropriate. (4)

Program administration

A State receiving a grant under this subsection may enter into an agreement with area agencies on aging in the State, or an Aging and Disability Resource Center in the State, to administer the program, using such grant funds. (5)

Program Requirements

(A)

Standardized assessment

Assessments under a program established under paragraph (1)— (i)shall be conducted by social workers, care managers, nurses, or other appropriate professionals; and (ii)(I)shall be conducted with a standardized instrument to identify family caregiver needs; and (II)in a State in which an area agency on aging or an Aging and Disability Resource Center is using such an instrument on the date of enactment of the Strengthening Services for America’s Seniors Act, may continue to be conducted with that instrument. (B)

Questionnaire

(i)

In general

Subject to clause (ii), assessments under a program established as described in paragraph (1) shall include asking the family caregiver relevant questions in order to determine whether the family caregiver would benefit from any targeted support services described in subparagraph (C). (ii)

Completion on a voluntary basis

The answering of questions under clause (i) by a family caregiver shall be on a voluntary basis. (iii)

Addressing diverse caregiver needs and preferences

The questionnaire under this subparagraph shall be designed in a manner that accounts for, and aims to ascertain, the varying needs and preferences of family caregivers, based on the range of their capabilities, caregiving experience, and other relevant personal characteristics and circumstances. (C)

Targeted support services described

The following targeted support services are described in this subparagraph: (i)Information and assistance (including brochures and online resources for researching a disease or disability or for learning and managing a regular caregiving role, new technologies that can assist family caregivers, and practical assistance for locating services). (ii)Individual counseling (including advice and consultation sessions to bolster emotional support for the family caregiver to make well-informed decisions about how to cope with caregiver strain). (iii)Support groups, including groups which provide help for family caregivers to— (I)locate a support group either locally or online to share experiences and reduce isolation; (II)make well-informed caregiving decisions; and (III)reduce isolation. (iv)Education and training (including workshops and other resources available with information about stress management, self-care to maintain good physical and mental health, understanding and communicating with individuals with dementia, medication management, normal aging processes, change in disease and disability, the role of assistive technologies, and other relevant topics). (v)Respite care and emergency back-up services (including short-term in-home care services that gives the family caregiver a break from providing such care). (vi)Chore services (such as house cleaning) to assist the individual receiving care. (vii)Personal care (including outside help) to assist the individual receiving care. (viii)Legal and financial planning and consultation (including advice and counseling regarding long-term care planning, estate planning, powers of attorney, community property laws, tax advice, employment leave advice, advance directives, and end-of-life care). (ix)Transportation (including transportation to medical appointments) to assist the individual receiving care. (x)Other targeted support services, as determined appropriate by the State agency and approved by the Assistant Secretary. (D)

Referrals

In the case where a questionnaire completed by a family caregiver under subparagraph (B) indicates that the family caregiver would benefit from 1 or more of the targeted support services described in subparagraph (C), the agency administering the program shall provide referrals to the family caregiver for State, local, and private-sector caregiver programs and other resources that provide such targeted support services to such caregivers. (E)

Targeting and timing of assessments

Assessments under the program established under paragraph (1) may be conducted— (i)when an individual who is being assisted by a family caregiver transitions from one care setting to another; (ii)upon referral from a social worker, care manager, nurse, physician, or other appropriate professional; or (iii)according to circumstances determined by the State and approved by the Assistant Secretary. (F)

Coordination with other assessment

Assessments under the program established under paragraph (1) may be conducted separately or as part of, or in conjunction with, eligibility or other routine assessments of an individual who is being (or is going to be) assisted by a family caregiver. (G)

Followup services

As the Assistant Secretary determines appropriate, a State with a program described in paragraph (1) shall conduct followup activities with caregivers who have participated in an assessment to determine the status of the caregiver and whether services were provided. (H)

Reporting requirement

Each State with a program described in paragraph (1) shall periodically submit to the Assistant Secretary a report containing information on the number of caregivers assessed under the program, information on the number of referrals made for targeted support services under the program (disaggregated by type of service), demographic information on caregivers assessed under the program, and other information required by the Assistant Secretary. . (b)

Standardized assessment of needs of informal caregivers

Section 202 (42 U.S.C. 3012) is amended— (1)in subsection (b)(8)— (A)in subparagraph (D), by striking and; (B)in subparagraph (E), inserting and after the semicolon at the end; and (C)by adding at the end the following: (F)which may carry out the informal caregiver assessment program described in subsection (g); ; and (2)by adding at the end the following: (g)

Standardized assessment of needs of informal caregivers

(1)

In general

Aging and Disability Resource Centers implemented under subsection (b)(8) may carry out an assessment program with respect to informal caregivers and care recipients. Such assessment program shall be modeled on the family caregiver assessment program established under section 373(b). (2)

Definitions

For purposes of an informal caregiver assessment carried out in accordance with paragraph (1), the following definitions shall apply: (A)

Care recipient

The term care recipient means— (i)an older individual; (ii)an individual with a disability; or (iii)an individual with a special need. (B)

Individual with a special need

The term individual with a special need means an individual who requires care or supervision to— (i)meet the individual's basic needs; (ii)prevent physical self-injury or injury to others; or (iii)avoid placement in an institutional facility. (C)

Informal caregiver

(i)

In general

Subject to clause (ii), the term informal caregiver means an adult family member, or another individual, who is an informal provider of in-home and community care to a care recipient. (ii)

Alternate definition

A State that has a State law with an alternate definition of the term informal caregiver for purposes of a program described in paragraph (1) may use that definition (with respect to caregivers for care recipients) for purposes of provisions of this Act that relate to that program, if such alternative definition is broader than the definition in clause (i), and subject to approval by the Assistant Secretary. . (c)

Conforming amendment

Section 631(b) (42 U.S.C. 3057k–11(b)) is amended by striking subsections (c), (d), and (e) and inserting subsections (d), (e), and (f).

3.

Advisory Committee to Assess, Coordinate, and Improve Legal Assistance Activities

(a)

In general

Title II of the Older Americans Act of 1965 is amended— (1)in section 215(j) (42 U.S.C. 3020e–1(j)), by striking section 216 and inserting section 217; (2)by redesignating section 216 (42 U.S.C. 3020f) as section 217; and (3)by inserting after section 215 (42 U.S.C. 3020e–1) the following:

216.

Advisory Committee to Assess, Coordinate, and Improve Legal Assistance Activities

(a)

Establishment

There is established an Advisory Committee to Assess, Coordinate, and Improve Legal Assistance Activities (referred to in this section as the Committee). (b)

Membership

(1)

Composition

The Committee shall be composed of 9 members— (A)with expertise with existing State legal assistance development programs carried out under section 731 and providers of State legal assistance under subtitle B of title III and title IV; and (B)of whom— (i)6 individuals shall be appointed by the Assistant Secretary— (I)1 of whom shall be a consumer advocate; (II)1 of whom shall be a professional advocate from a State agency or State Legal Services Developer; and (III)4 of whom shall be representatives from collaborating organizations under the National Legal Resource Center of the Administration; and (ii)3 individuals shall be appointed by the Comptroller General of the United States. (2)

Date

The appointments of the members of the Committee shall be made not later than 9 months after the date of enactment of the Strengthening Services for America’s Seniors Act. (3)

Period of appointment; vacancies

Members shall be appointed for the life of the Committee. Any vacancy in the Committee shall not affect its powers, but shall be filled in the same manner as the original appointment. (4)

Chairperson and vice chairperson

The Committee shall select a Chairperson and Vice Chairperson from among its members. (c)

Initial meeting

The Committee shall hold its first meeting not later than 9 months after the date of enactment of the Strengthening Services for America’s Seniors Act. (d)

Duties of the Committee

(1)

Definition

In this subsection, the term assistance activities includes— (A)legal assistance made available to older individuals in social or economic need under this Act; (B)activities of the National Legal Resource Center carried out under section 420(a); (C)State legal assistance developer activities carried out under section 731; and (D)any other directly related activity or program as determined appropriate by the Assistant Secretary. (2)

Study

(A)

In general

The Committee shall design, implement, and analyze results of a study of— (i)the extent to which State leadership is provided through the State legal assistance developer in States to enhance the coordination and effectiveness of legal assistance activities across the State; (ii)the extent to which— (I)there is data collection and reporting of information by legal assistance providers in States; (II)there is uniform statewide reporting among States; and (III)the value and impact of services provided is being captured at the State or local level; and (iii)the mechanisms to organize and promote legal assistance development and services to best meet the needs of older individuals with greatest social and economic need. (B)

Considerations

In carrying out subparagraph (A)(i), particular attention shall be given to— (i)State leadership on targeting limited legal resources to older individuals in greatest social and economic need; and (ii)State leadership on establishing priority legal issue areas in accordance with section 307(a)(11)(E). (3)

Recommendations

After completion and analysis of study results under paragraph (2), the Committee shall develop recommendations for the establishment of guidelines for— (A)enhancing the leadership capacity of the State legal assistance developers to carry out statewide coordinated legal assistance service delivery, with particular focus on enhancing leadership capacity to— (i)target limited legal resources to older individuals in greatest social and economic need; and (ii)establish priority legal issue areas in accord with priorities set forth in section 307(a)(11)(E); (B)developing a uniform national data collection system to be implemented in all States on legal assistance development and services; and (C)identifying mechanisms for organizing and promoting legal assistance activities to provide the highest quality, impact, and effectiveness to older individuals with the greatest social and economic need. (4)

Report

Not later than 1 years after the date of the establishment of the Committee, the Committee shall submit to the President, Congress, and the Assistant Secretary a report that contains a detailed statement of the findings and conclusions of the Committee, together with the recommendations described in paragraph (3). (e)

Duties of the Assistant Secretary

Not later than 180 days after receiving the report described in subsection (d)(4), the Assistant Secretary shall issue regulations or guidance, taking into consideration the recommendations described in subsection (d)(3). (f)

Powers

(1)

Information from Federal agencies

The Committee may secure directly from any Federal department or agency such information as the Committee considers necessary to carry out the provisions of this section. Upon request of the Committee, the head of such department or agency shall furnish such information to the Committee. (2)

Postal services

The Committee may use the United States mails in the same manner and under the same conditions as other departments and agencies of the Federal Government. (g)

Personnel and administration

(1)

Travel expenses

The members of the Committee shall not receive compensation for the performance of services for the Committee, but 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 Committee. Notwithstanding section 1342 of title 31, United States Code, the Secretary may accept the voluntary and uncompensated services of members of the Committee. (2)

Detail of government employees

Any Federal Government employee may be detailed to the Committee without reimbursement, and such detail shall be without interruption or loss of civil service status or privilege. (3)

Administrative and support services

The Assistant Secretary shall provide administrative and support services to the Committee. (4)

Procurement of temporary and intermittent services

The Chairman of the Committee may procure temporary and intermittent services under section 3109(b) of title 5, United States Code, at rates for individuals that do not exceed the daily equivalent of the annual rate of basic pay prescribed for level V of the Executive Schedule under section 5316 of such title. (h)

Exemption from termination requirements

Section 14 of the Federal Advisory Committee Act shall not apply to the Committee.

. (b)

Authorization of appropriations

Section 217 of the Older Americans Act of 1965, as redesignated by subsection (a), is amended by adding at the end the following: (d)

Advisory Committee To Assess, Coordinate, and Improve Legal Assistance Activities

There is authorized to be appropriated to carry out section 216, $300,000 for fiscal year 2012. .

4.

Improving the State Long-Term Care Ombudsman programs

(a)

National Ombudsman Resource Center

Section 202(a)(18)(B) of the Older Americans Act of 1965 (42 U.S.C. 3012(a)(18)(B)) is amended by striking make available and all that follows and inserting “reserve and provide, for the funding of the National Ombudsman Resource Center (which may include enabling the center to collaborate and participate with the Centers for Medicare & Medicaid Services in providing training for State survey agencies with an agreement in effect under section 1864 of the Social Security Act (42 U.S.C. 1395aa) or, in the case of States without such an agency, work with the Administrator for the Centers for Medicare & Medicaid Services to improve the investigative processes used by the center to address complaints by residents of long-term care facilities)— (i)for fiscal year 2012, not less than $2,000,000; and (ii)for each subsequent fiscal year, not less than the sum of— (I)$100,000; and (II)the amount made available under this subparagraph for the fiscal year preceding the year for which the sum is determined; . (b)

Functions of program

(1)

Private and unimpeded access to Ombudsman services

Section 712(b)(1)(A) of the Older Americans Act of 1965 (42 U.S.C. 3058g(b)(1)(A)) is amended by striking access and inserting private and unimpeded access. (2)

Ombudsman development of resident and family councils

Section 712(a)(3)(H)(iii) of such Act (42 U.S.C. 3058g(a)(3)(H)(iii)) is amended by striking provide technical support for and inserting actively encourage and assist in. (3)

Local entity development of resident and family councils

Section 712(a)(5)(B)(vi) of such Act (42 U.S.C. 3058g(a)(5)(B)(vi)) is amended by striking support and inserting actively encourage and assist in. (c)

Ombudsman authority with respect to HIPAA

Section 712(b) of the Older Americans Act of 1965 (42 U.S.C. 3058g(b)) is amended— (1)in paragraph (1)(B)(i) by striking the medical and social records of a and inserting all records concerning a; and (2)by adding at the end the following: (3)For purposes of section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (including regulations issued under that section) (42 U.S.C. 1320d–2 note), the Ombudsman and a representative of the Office shall be considered a health oversight agency, so that release of residents' individually identifiable health information to the Ombudsman or representative is not precluded in cases in which the requirements of clause (i) or (ii) of paragraph (1)(B) are otherwise met. . (d)

Disclosure and confidentiality

Section 712(d) of the Older Americans Act of 1965 (42 U.S.C. 3058g(d)) is amended— (1)in paragraph (1), by striking files and inserting information; and (2)in paragraph (2)— (A)in the paragraph heading, by striking Identity of complainant or resident and inserting Procedures; (B)in subparagraph (A)— (i)by striking files or records the first place it appears and inserting information (including files or records); and (ii)by striking disclose and all that follows and inserting disclose such information);; (C)in subparagraph (B)— (i)in the matter preceding clause (i), by striking files or records and inserting information; and (ii)in clause (iii), by striking the period and inserting ; and; and (D)by adding at the end the following: (C)require that the Ombudsman and each representative of the Office hold in strict confidence all communications with individuals seeking assistance under this Act, and take all reasonable steps to safeguard the confidentiality of information provided to the Ombudsman or a representative of the Office under this title by a complainant or resident. .