[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[S. 495 Introduced in Senate (IS)]

112th CONGRESS
  1st Session
                                 S. 495

To expand and enhance existing adult day programs for individuals with 
  neurological diseases or conditions, including multiple sclerosis, 
Parkinson's disease, traumatic brain injury, and other similar diseases 
 or conditions, to support and improve access to respite services for 
  family caregivers who are taking care of such individuals, and for 
                            other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 7, 2011

   Mr. Casey introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
To expand and enhance existing adult day programs for individuals with 
  neurological diseases or conditions, including multiple sclerosis, 
Parkinson's disease, traumatic brain injury, and other similar diseases 
 or conditions, to support and improve access to respite services for 
  family caregivers who are taking care of such individuals, and for 
                            other purposes.

    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 ``Adult Day Achievement Center 
Enhancement Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) One in 6 people in the United States lives with a 
        neurological disease or condition that can often result in 
        disability, and which may require the individual to seek 
        assistance in carrying out the activities of daily living. 
        Neurological diseases or conditions such as multiple sclerosis 
        (MS), early-onset Parkinson's disease, and traumatic brain 
        injury (TBI) often affect younger adults in the middle of their 
        lives.
            (2) Multiple sclerosis is a chronic, often disabling 
        disease that attacks the central nervous system with symptoms 
        ranging from numbness in limbs to paralysis and loss of vision. 
        Most individuals with MS are diagnosed between the ages of 20 
        and 50. It is estimated that more than 400,000 individuals in 
        the United States are living with MS. Individuals living with 
        MS who experience more severe forms of the disease are likely 
        to require either home care or nursing home placement, though 
        the vast majority would prefer to remain at home to receive the 
        care they need. Where home care is concerned, approximately 80 
        percent of such care is provided by informal, unpaid, 
        caregivers who are generally family members.
            (3) Parkinson's disease is a chronic, progressive 
        neurological disease. The 4 primary symptoms of Parkinson's 
        disease are tremor, or trembling in hands, arms, legs, jaw, and 
        face; rigidity, or stiffness of the limbs and trunk; 
        bradykinesia, or slowness of movement; and postural 
        instability, or impaired balance and coordination. It is 
        estimated that nearly 1,000,000 individuals live with 
        Parkinson's disease and, of those individuals, 5 to 10 percent 
        are diagnosed with the disease before age 60 and deemed 
        ``early-onset''.
            (4) Traumatic brain injury is a neurological condition that 
        typically results from a blow or jolt to the head or a 
        penetrating head injury and that can impact one or more parts 
        of the brain, thereby temporarily or permanently disrupting 
        normal brain function. The Centers for Disease Control and 
        Prevention estimates that 1,400,000 new cases of TBI occur 
        annually, resulting in disabilities affecting up to 90,000 
        individuals among a broad range of age groups. Traumatic brain 
        injury is a serious issue that affects military service 
        members. Estimates in prior military conflicts, indicate that 
        TBI was present in 14 to 20 percent of surviving casualties.
            (5) Family caregivers are a crucial source of support and 
        assistance for individuals suffering with disabilities. Family 
        caregivers, the majority of whom are women, provide an 
        estimated $306,000,000,000 in unpaid services annually. The 
        current pool of potential family caregivers is dwindling, from 
        11 potential caregivers for each individual needing care today 
        to a projected ratio of 4 potential caregivers for each such 
        individual by 2050.
            (6) Recent studies indicate that the total estimated cost 
        to employers for full-time employees with intensive caregiving 
        responsibilities is $17,100,000,000 annually. The total 
        estimated cost to employers for all full-time, employed 
        caregivers is $33,600,000,000 annually.
            (7) Adult day programs can offer services, including 
        medical care, rehabilitation therapies, dignified assistance 
        with the activities of daily living, nutrition therapy, health 
        monitoring, social interaction, stimulating activities, and 
        transportation to seniors, individuals with disabilities, and 
        younger adults with chronic diseases.
            (8) Adult day programs geared toward individuals living 
        with neurological diseases or conditions such as MS, 
        Parkinson's disease, TBI, or other similar diseases or 
        conditions, provide an important response to the needs of 
        individuals living with these conditions and the caregivers of 
        such individuals. Adult day programs can help to ameliorate 
        symptoms, reduce dependency, provide important socialization 
        opportunities, and maintain quality of life.
            (9) Adult day programs have been shown to provide a range 
        of documented benefits, including improvements in functional 
        status, social support, and reductions in fatigue, depression, 
        and pain. Adult day programs also reduce ongoing medical care 
        and hospital costs and decrease admissions to nursing home 
        facilities, which can be costly for many families, by allowing 
        individuals to receive health and social services while 
        continuing to live at home.
            (10) There are currently few adult day programs focused on 
        younger adult populations in the United States. As a result, 
        the majority of individuals living with neurological diseases 
        are unable to access this important opportunity for maximizing 
        their health and wellness. Although individuals living with 
        neurological diseases or conditions may be able to access other 
        existing adult day programs, such programs are not typically 
        intended for younger adults living with chronic diseases or 
        conditions, and may not provide the appropriate services to 
        meet the age-related or disability status of these individuals.

SEC. 3. ESTABLISHMENT OF ADULT DAY PROGRAMS.

    (a) Survey of Existing Adult Day Programs.--
            (1) In general.--Not later than 90 days after the date of 
        the enactment of this section, the Assistant Secretary for 
        Aging shall initiate a comprehensive survey of current adult 
        day programs that provide care and support to individuals 
        living with neurological diseases or conditions, including 
        multiple sclerosis, Parkinson's disease, traumatic brain 
        injury, and any other similar disease or condition.
            (2) Survey elements.--In carrying out the survey under 
        paragraph (1), the Assistant Secretary for Aging may utilize 
        existing publicly available research on adult day programs, and 
        shall--
                    (A) identify ongoing successful adult day programs, 
                including by providing a brief description of how such 
                programs were initially established and funded;
                    (B) develop a set of best practices to help guide 
                the establishment and replication of additional 
                successful adult day programs, including--
                            (i) program guidelines;
                            (ii) recommendations on the scope of 
                        services that should be provided (which may 
                        include rehabilitation therapy, psychosocial 
                        support, social stimulation and interaction, 
                        and spiritual, educational, or other such 
                        services); and
                            (iii) performance goals and indicators to 
                        measure and analyze the outcomes generated by 
                        the services provided and to evaluate the 
                        overall success of the program; and
                    (C) evaluate the extent to which the Administration 
                on Aging supports adult day programs, either directly 
                or indirectly, through current Federal grant programs.
            (3) Report.--Not later than 180 days after initiating the 
        survey under paragraph (1), the Assistant Secretary for Aging 
        shall prepare and make publicly available a summary report on 
        the results of the survey. Such report shall include each of 
        the elements described in paragraph (2).
    (b) Establishment of Grant Program.--
            (1) In general.--Not later than 90 days after producing the 
        report required by subsection (a)(3), the Assistant Secretary 
        for Aging shall establish within the Administration on Aging a 
        competitive grant program for awarding grants annually to 
        eligible entities, based on the best practices developed under 
        subsection (a), to fund adult day programs.
            (2) Eligible entities.--In order to be eligible for a grant 
        under this subsection, an entity shall demonstrate the 
        following:
                    (A) Understanding of the special needs of 
                individuals living with neurological diseases or 
                conditions such as multiple sclerosis, Parkinson's 
                disease, traumatic brain injury, or other similar 
                diseases or conditions, including the functional 
                abilities of such individuals and the potential 
                complications across all types of cases and stages of 
                such diseases or conditions.
                    (B) Understanding of the issues experienced by 
                family caregivers who assist a family member with a 
                neurological disease or condition such as multiple 
                sclerosis, Parkinson's disease, traumatic brain injury, 
                or other similar disease or condition.
                    (C) A capacity to provide the services recommended 
                by the best practices developed under subsection (a).
            (3) Additional selection requirement.--The Assistant 
        Secretary for Aging shall not award a grant to an entity under 
        this subsection if the amount of the award would constitute 
        more than 40 percent of the operating budget of the entity in 
        the fiscal year for which funds for the grant are authorized to 
        be expended. For purposes of this subsection, the fair market 
        value of annual in-kind contributions of equipment or services 
        shall be considered as part of the operating budget of the 
        entity.
            (4) Selection of grant recipients.--Not later than 90 days 
        after establishing the grant program under this subsection, the 
        Assistant Secretary for Aging shall award the first annual 
        series of grants under the program. In awarding grants under 
        this subsection, the Assistant Secretary shall ensure, to the 
        extent practicable, a diverse geographic representation among 
        grant recipients and that, subject to the availability of 
        appropriations--
                    (A) a minimum of 5 entities are selected as grant 
                recipients for the first fiscal year for which such 
                grants are awarded;
                    (B) a minimum of 10 entities are selected as grant 
                recipients for the second such fiscal year;
                    (C) a minimum of 12 entities are selected as grant 
                recipients for the third such fiscal year; and
                    (D) a minimum of 15 entities are selected as grant 
                recipients for the fourth such fiscal year.
            (5) Report.--No later than 1 year after the initial award 
        of grants under this subsection, and annually thereafter, the 
        Assistant Secretary for Aging shall prepare and make publicly 
        available a brief summary report on the grant program under 
        this section. Each such report shall include the following:
                    (A) A description of the adult day programs 
                receiving funding under this section, including the 
                amount of Federal funding awarded and the expected 
                outcomes of each program.
                    (B) A description of performance goals and 
                indicators to monitor the progress of grant recipients 
                in--
                            (i) responding to the needs of individuals 
                        living with neurological diseases or conditions 
                        such as multiple sclerosis, Parkinson's 
                        disease, traumatic brain injury, and other 
                        similar diseases or conditions; and
                            (ii) assisting the family caregivers of 
                        such individuals.
                    (C) Any plans for improving oversight and 
                management of the grant program.
    (c) Definitions.--In this Act:
            (1) The term ``adult day program'' means a program that 
        provides comprehensive and effective care and support services 
        to individuals living with neurological diseases or conditions 
        such as multiple sclerosis, Parkinson's disease, traumatic 
        brain injury, or other similar diseases or conditions that may 
        result in a functional or degenerative disability and to the 
        family caregivers of such individuals, and that may assist such 
        individuals and family caregivers in ways that--
                    (A) maintain or improve the functional abilities of 
                such individuals, or otherwise help such individuals 
                adjust to changing functional abilities;
                    (B) prevent the onset of complications associated 
                with severe forms of the disease or condition;
                    (C) promote alternatives to placement in nursing 
                homes;
                    (D) reduce the strain on family caregivers taking 
                care of a family member living with such a disease or 
                condition;
                    (E) focus on supporting the emotional, social, and 
                intellectual needs of a younger adult population; or
                    (F) address the needs of veterans living with such 
                a disease or condition.
            (2) The term ``family caregiver'' means a family member or 
        foster parent who provides unpaid assistance (which may include 
        in-home monitoring, management, supervision, care and 
        treatment, or other similar assistance) to another adult family 
        member with a special need.
    (d) Authorization of Appropriations.--There are authorized to be 
appropriated, in addition to amounts otherwise made available for such 
purpose, such sums as may be necessary to carry out this section.
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