[Congressional Record Volume 163, Number 206 (Monday, December 18, 2017)]
[House]
[Pages H10148-H10152]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
RECOGNIZE, ASSIST, INCLUDE, SUPPORT, AND ENGAGE FAMILY CAREGIVERS ACT
OF 2017
Mr. ESTES of Kansas. Mr. Speaker, I move to suspend the rules and
pass the bill (H.R. 3759) to provide for the establishment and
maintenance of a Family Caregiving Strategy, and for other purposes, as
amended.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 3759
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 ``Recognize, Assist, Include,
Support, and Engage Family Caregivers Act of 2017'' or the
``RAISE Family Caregivers Act''.
SEC. 2. DEFINITIONS.
In this Act:
(1) Advisory council.--The term ``Advisory Council'' means
the Family Caregiving Advisory Council convened under section
4.
(2) Family caregiver.--The term ``family caregiver'' means
an adult family member or other individual who has a
significant relationship with, and who provides a broad range
of assistance to, an individual with a chronic or other
health condition, disability, or functional limitation.
(3) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(4) Strategy.--The term ``Strategy'' means the Family
Caregiving Strategy set forth under section 3.
SEC. 3. FAMILY CAREGIVING STRATEGY.
(a) In General.--The Secretary, in consultation with the
heads of other appropriate Federal agencies, shall develop
jointly with the Advisory Council and submit to the Committee
on Health, Education, Labor, and Pensions and the Special
Committee on Aging of the Senate, the Committee on Education
and the Workforce of the House of Representatives, and the
State agencies responsible for carrying out family caregiver
programs, and make publicly available on the internet website
of the Department of Health and Human Services, a Family
Caregiving Strategy.
(b) Contents.--The Strategy shall identify recommended
actions that Federal (under existing Federal programs),
State, and local governments, communities, health care
providers, long-term services and supports providers, and
others are taking, or may take, to recognize and support
family caregivers in a manner that reflects their diverse
needs, including with respect to the following:
(1) Promoting greater adoption of person- and family-
centered care in all health and long-term services and
supports settings, with the person receiving services and
supports and the family caregiver (as appropriate) at the
center of care teams.
(2) Assessment and service planning (including care
transitions and coordination) involving family caregivers and
care recipients.
(3) Information, education and training supports, referral,
and care coordination, including with respect to hospice
care, palliative care, and advance planning services.
(4) Respite options.
(5) Financial security and workplace issues.
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(6) Delivering services based on the performance, mission,
and purpose of a program while eliminating redundancies.
(c) Duties of the Secretary.--The Secretary, in carrying
out subsection (a), shall oversee the following:
(1) Collecting and making publicly available information
submitted by the Advisory Council under section 4(d) to the
Committee on Health, Education, Labor, and Pensions and the
Special Committee on Aging of the Senate, the Committee on
Education and the Workforce of the House of Representatives,
and the State agencies responsible for carrying out family
caregiver programs, including evidence-based or promising
practices and innovative models (both domestic and foreign)
regarding the provision of care by family caregivers or
support for family caregivers.
(2) Coordinating and assessing existing Federal Government
programs and activities to recognize and support family
caregivers while ensuring maximum effectiveness and avoiding
unnecessary duplication.
(3) Providing technical assistance, as appropriate, such as
disseminating identified best practices and information
sharing based on reports provided under section 4(d), to
State or local efforts to support family caregivers.
(d) Initial Strategy; Updates.--The Secretary shall--
(1) not later than 18 months after the date of enactment of
this Act, develop, publish, and submit to the Committee on
Health, Education, Labor, and Pensions and the Special
Committee on Aging of the Senate, the Committee on Education
and the Workforce of the House of Representatives, and the
State agencies responsible for carrying out family caregiver
programs, an initial Strategy incorporating the items
addressed in the Advisory Council's initial report under
section 4(d) and other relevant information, including best
practices, for recognizing and supporting family caregivers;
and
(2) biennially update, republish, and submit to the
Committee on Health, Education, Labor, and Pensions and the
Special Committee on Aging of the Senate, the Committee on
Education and the Workforce of the House of Representatives,
and the State agencies responsible for carrying out family
caregiver programs the Strategy, taking into account the most
recent annual report submitted under section 4(d)(1)--
(A) to reflect new developments, challenges, opportunities,
and solutions; and
(B) to review progress based on recommendations for
recognizing and supporting family caregivers in the Strategy
and, based on the results of such review, recommend priority
actions for improving the implementation of such
recommendations, as appropriate.
(e) Process for Public Input.--The Secretary shall
establish a process for public input to inform the
development of, and updates to, the Strategy, including a
process for the public to submit recommendations to the
Advisory Council and an opportunity for public comment on the
proposed Strategy.
(f) No Preemption.--Nothing in this Act preempts any
authority of a State or local government to recognize or
support family caregivers.
(g) Rule of Construction.--Nothing in this Act shall be
construed to permit the Secretary (through regulation,
guidance, grant criteria, or otherwise) to--
(1) mandate, direct, or control the allocation of State or
local resources;
(2) mandate the use of any of the best practices identified
in the reports required under this Act; or
(3) otherwise expand the authority of the Secretary beyond
that expressly provided to the Secretary in this Act.
SEC. 4. FAMILY CAREGIVING ADVISORY COUNCIL.
(a) Convening.--The Secretary shall convene a Family
Caregiving Advisory Council to advise and provide
recommendations, including identified best practices, to the
Secretary on recognizing and supporting family caregivers.
(b) Membership.--
(1) In general.--The members of the Advisory Council shall
consist of--
(A) the appointed members under paragraph (2); and
(B) the Federal members under paragraph (3).
(2) Appointed members.--In addition to the Federal members
under paragraph (3), the Secretary shall appoint not more
than 15 voting members of the Advisory Council who are not
representatives of Federal departments or agencies and who
shall include at least one representative of each of the
following:
(A) Family caregivers.
(B) Older adults with long-term services and supports
needs.
(C) Individuals with disabilities.
(D) Health care and social service providers.
(E) Long-term services and supports providers.
(F) Employers.
(G) Paraprofessional workers.
(H) State and local officials.
(I) Accreditation bodies.
(J) Veterans.
(K) As appropriate, other experts and advocacy
organizations engaged in family caregiving.
(3) Federal members.--The Federal members of the Advisory
Council, who shall be nonvoting members, shall consist of the
following:
(A) The Administrator of the Centers for Medicare &
Medicaid Services (or the Administrator's designee).
(B) The Administrator of the Administration for Community
Living (or the Administrator's designee who has experience in
both aging and disability).
(C) The Secretary of Veterans Affairs (or the Secretary's
designee).
(D) The heads of other Federal departments or agencies (or
their designees), including relevant departments or agencies
that oversee labor and workforce, economic, government
financial policies, community service, and other impacted
populations, as appointed by the Secretary or the Chair of
the Advisory Council.
(4) Diverse representation.--The Secretary shall ensure
that the membership of the Advisory Council reflects the
diversity of family caregivers and individuals receiving
services and supports.
(c) Meetings.--The Advisory Council shall meet quarterly
during the 1-year period beginning on the date of enactment
of this Act and at least three times during each year
thereafter. Meetings of the Advisory Council shall be open to
the public.
(d) Advisory Council Annual Reports.--
(1) In general.--Not later than 12 months after the date of
enactment of this Act, and annually thereafter, the Advisory
Council shall submit to the Secretary, the Committee on
Health, Education, Labor, and Pensions and the Special
Committee on Aging of the Senate, the Committee on Education
and the Workforce of the House of Representatives, and the
State agencies responsible for carrying out family caregiver
programs, and make publicly available on the internet website
of the Department of Health and Human Services, a report
concerning the development, maintenance, and updating of the
Strategy, including a description of the outcomes of the
recommendations and any priorities included in the initial
report pursuant to paragraph (2), as appropriate.
(2) Initial report.--The Advisory Council's initial report
under paragraph (1) shall include--
(A) an inventory and assessment of all federally funded
efforts to recognize and support family caregivers and the
outcomes of such efforts, including analyses of the extent to
which federally funded efforts are reaching family caregivers
and gaps in such efforts;
(B) recommendations--
(i) to improve and better coordinate Federal programs and
activities to recognize and support family caregivers, as
well as opportunities to improve the coordination of such
Federal programs and activities with State programs; and
(ii) to effectively deliver services based on the
performance, mission, and purpose of a program while
eliminating redundancies, avoiding unnecessary duplication
and overlap, and ensuring the needs of family caregivers are
met;
(C) the identification of challenges faced by family
caregivers, including financial, health, and other
challenges, and existing approaches to address such
challenges; and
(D) an evaluation of how family caregiving impacts the
Medicare program, the Medicaid program, and other Federal
programs.
(e) Nonapplicability of FACA.--The Federal Advisory
Committee Act (5 U.S.C. App.) shall not apply to the Advisory
Council.
SEC. 5. FUNDING.
No additional funds are authorized to be appropriated to
carry out this Act. This Act shall be carried out using funds
otherwise authorized.
SEC. 6. SUNSET PROVISION.
The authority and obligations established by this Act shall
terminate on the date that is 3 years after the date of
enactment of this Act.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Kansas (Mr. Estes) and the gentleman from Connecticut (Mr. Courtney)
each will control 20 minutes.
The Chair recognizes the gentleman from Kansas.
General Leave
Mr. ESTES of Kansas. Mr. Speaker, I ask unanimous consent that all
Members may have 5 legislative days in which to revise and extend their
remarks and include extraneous material on H.R. 3759.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Kansas?
There was no objection.
Mr. ESTES of Kansas. Mr. Speaker, I yield myself such time as I may
consume.
I rise today in support of H.R. 3759, the Recognize, Assist, Include,
Support, and Engage Family Caregivers Act of 2017, otherwise known as
the RAISE Family Caregivers Act.
Mr. Speaker, not all Americans have the luxury of complete
independence. They may struggle to dress themselves, manage their
retirement, or take their medications adequately. When we think of
these instances, we may think mostly of seniors, but that is not always
the case. Veterans, Americans
[[Page H10150]]
with physical and mental disabilities, wounded warriors, and even
children with medical conditions rely on a family caregiver to help
them live their daily lives.
Though they may have physical or functional limitations or an illness
or chronic health condition that impedes their ability to fully care
for themselves, many are able to remain safe and comfortable in their
homes due to the important role of the family caregiver.
Nationwide, there are roughly 40 million family caregivers who
provide physical and emotional care for parents, spouses, children, and
other loved ones in need of assistance. These caregivers are unsung
heroes who devote both their time and resources to the day-to-day
activities that are necessary to provide a disabled loved one with
care.
These activities may be to drive their loved ones to doctor
appointments, provide them with meals, assist in the management of
their finances, and administer at-home nursing and care so that their
loved ones may continue to live at home.
Taking on the role of a family caregiver is a deeply personal
decision, characterized by selflessness and compassion for a relative
in need. It is estimated that, on average, the Nation's caregivers
dedicate about 18 hours each week to carrying out their caregiver
tasks, while almost a third provide over 60 hours a week of care. These
activities provide an annual economic value of $470 billion each year.
About 60 percent of caregivers have full- or part-time jobs in
addition to their caregiving roles, leaving them to juggle their
caregiving obligations with their work hours and their personal and
family time.
The RAISE Family Caregivers Act will direct the Secretary of Health
and Human Services to develop a Family Caregiving Advisory Council to
make recommendations regarding best practices on recognizing and
supporting family caregivers. The council will include members from the
public and private sectors, family caregivers, elderly Americans and
people living with disabilities, State and local officials, and
healthcare providers. The Secretary will then publish the council's
findings so that the family caregivers may be equipped with the
information that they need to be successful in their roles.
The council will provide information about streamlining Federal and
State activities to maximize efficiency, and it will preserve the
integrity of family rights and person-centered care. This is an
opportunity to help improve the quality of life of millions of
Americans who both provide and receive familial care.
One important provision of the RAISE Family Caregivers Act ensures
that the Secretary of Health and Human Services is prohibited from
mandating best practices or expanding the Federal authority in any way.
Additionally, the bill does not authorize any additional funds for
the formation of the council and, after 3 years, the council and its
related activities will sunset.
The RAISE Family Caregivers Act is an important step we can take to
recognize the essential role of family caregivers and share important
information so that they can better care for others. This legislation
fulfills a bipartisan recommendation of the Federal Commission on Long-
Term Care. The Senate passed this bill earlier this year by unanimous
consent, and the House of Representatives now has the opportunity to
have this bill signed into law.
I urge my colleagues to support this bipartisan legislation so that
family caregivers are recognized for the important role they play in
our communities.
I reserve the balance of my time.
Mr. COURTNEY. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I join my colleague from Kansas (Mr. Estes) today and
rise in support of H.R. 3759, the Recognize, Assist, Include, Support,
and Engage Family Caregivers Act. I want to congratulate all the
cosponsors of this bill for their good work in terms of bringing this
forward, and, again, it looks very promising that it will be passed and
signed into law shortly.
Mr. Speaker, the number of Americans over the age of 65 is expected
to reach 70 million by 2030, roughly doubling the number that existed
in 2005. As those Americans age and require assistance with their daily
routines--taking medication, getting dressed, cooking, and attending
medical appointments--family caregivers will step in to make sure that
their loved ones are safe and cared for.
This is difficult work. For an adult child, caring for an aging
parent can quickly become a full-time job. Between juggling
appointments, understanding medications, helping make informed medical
decisions, a caregiver's own priorities can take a backseat. Most
caregivers have jobs of their own, and many care simultaneously for an
aging parent as well as their own children.
But caregivers are not only providing care for older Americans or
even younger Americans with developmental disabilities. They also serve
those who have served our country.
I recently met with a caregiver from my district, Jessica, who cares
for her husband, a veteran who suffered serious traumatic brain injury
during the battle of Fallujah. Her experience managing her husband's
complex medical needs while also raising their children goes to show
that ensuring caregivers are supported is a national priority.
The bill under consideration today would recognize the contribution
that family caregivers make toward the safety and health of older
Americans. It would require the Secretary of Health and Human Services
to develop and maintain a strategy to support family caregivers by
establishing an advisory body to bring together caregivers, older
adults, persons with disabilities, veterans, employers, and State and
local officials. This advisory council would make recommendations for
how to support, assist, and engage family caregivers.
Caregivers are needed to help Americans live independently in their
homes and communities for as long as possible. In my home State of
Connecticut, there are 459,000 family caregivers who provide an
estimated $5.9 billion in unpaid care, annually. Supporting older and
disabled Americans through caregiving and ensuring caregivers are
equipped to take on this important role benefits all Americans.
Evidence has shown that, when caregivers are supported, patients delay
placement in a nursing home, continuing with lower-cost, long-term
support in the home for much longer periods of time.
Caregiving is foundational to our long-term care system in the United
States. This legislation is an important step to ensure this work is
recognized and supported.
Again, as the gentleman pointed out, the Commission on Long-Term
Care, which was actually created by this body in 2012 as part of one of
the budget bills that passed that year, was a group of stakeholders
from all across the country, in various sectors, that came together and
issued a report that, unfortunately, I don't think has gotten the focus
and attention it needs with the demographics that our country is
experiencing right now: the aging of our society.
However, this is one of those recommendations for which signs of
intelligent life appeared in Congress, and we are taking up their call
for passing legislation like the RAISE Act.
So again, I want to congratulate all the sponsors for coming
together, and I am looking forward to sending this bill to the
President for his signature.
I reserve the balance of my time.
Mr. ESTES of Kansas. Mr. Speaker, I yield 3 minutes to the gentleman
from Mississippi (Mr. Harper).
Mr. HARPER. Mr. Speaker, I rise in support of H.R. 3759, the
Recognize, Assist, Include, Support, and Engage Family Caregivers Act
of 2017, or the RAISE Family Caregivers Act. This is a bipartisan and
bicameral bill.
I introduced the RAISE Act in the House along with Representative
Kathy Castor as well as Representatives Stefanik and Lujan Grisham.
There are now 107 cosponsors of the bill. An almost identical bill, S.
1028, introduced by Senator Collins and Senator Baldwin, passed the
House unanimously on September 26.
The RAISE Act is supported by a broad coalition of over 60
organizations, from AARP to United Cerebral Palsy. But I was
particularly inspired to introduce the RAISE Act because, frankly, like
many of our constituents, my wife and I are caregivers for our
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family, for our adult son, Livingston, who has fragile X syndrome.
About 12 million people of all ages need the support of family
caregivers today, and this number will more than double by the year
2050. By supporting family caregivers, we can help people live at home,
where they want to be, helping to delay or prevent costlier
institutional care and unnecessary hospitalizations, saving taxpayer
dollars.
The bill creates an advisory council within the Department of Health
and Human Services to identify and recommend actions that Federal,
State, and local governments, communities, healthcare providers, long-
term services and support providers, and others are taking, or may
take, to recognize and support those family caregivers. The idea is to
enhance coordination of and implementation under existing programs.
I appreciate the support we have received from the Education and the
Workforce Committee on this legislation, particularly the chair,
Virginia Foxx. My office has worked closely with the committee, AARP,
as well as with Representative Castor, Senator Collins, and Senator
Baldwin, to develop a bipartisan, bicameral piece of legislation with
broad coalition support that we could successfully bring to the floor.
CBO has scored the bill at $1 million over 50 years, but it sunsets
in 3 years, and no new funds are authorized to be appropriated.
This bill gives hope and comfort to the large number of family
caregivers across the country who are often struggling to look after
their loved ones, whether a special-needs child, a loved one with
traumatic brain injury, or an elderly parent or a spouse.
It is important that the Congress and the administration send this
message of caring and support for the family caregivers across our
Nation. I ask that Members vote ``yes'' on this bill.
Mr. COURTNEY. Mr. Speaker, I yield such time as she may consume to
the gentlewoman from Florida (Ms. Castor), a cosponsor of the bill, a
former member of the Education and the Workforce Committee; and even
though she has migrated to other committees, her heart still is with
the mission of the Education and the Workforce Committee, which is
obviously shown by her cosponsorship of this legislation.
Ms. CASTOR of Florida. Mr. Speaker, I thank my colleague, Mr.
Courtney, for yielding the time and for his advocacy on behalf of
America's families.
I rise in strong support of H.R. 3759, the RAISE Family Caregivers
Act, and I want to thank my good friend and colleague Congressman Gregg
Harper for being my partner in this endeavor to bring more attention to
the struggle of so many families across the country for more balance,
more support, when they must take care of a sick family member or a
friend.
I would also like to thank Senator Susan Collins and Senator Tammy
Baldwin, who have been tireless champions for caregivers and their
families.
Family caregiving has become the new normal in healthcare here in
America because it is oftentimes astronomically expensive to hire a
caregiver or to get a little respite. Some do, but for many families,
the better decision is a tough one, oftentimes, to make a very
significant personal sacrifice: quit your job or go part-time while
they devote themselves to their loved one.
All too often, caregivers are the only support system for their child
with special needs or an aging family member, and they have little to
no support for themselves.
Many of America's veterans stay integrated in communities because of
the sacrifices of their family members to make sure that they get out
and about and get to their appointments and get the care and
interaction that they need.
{time} 1645
Family caregivers help with many basic activities, like eating,
dressing, transportation, bathing; and sometimes they are called upon
to do things that are a little more complicated, such as even a little
bit of medical care or nursing care.
Here are some of the shocking statistics: about 40 million family
caregivers provide about $470 billion annually in unpaid care to their
loved ones, and about 3.7 million family caregivers provide care to a
child under the age of 18 due to a medical or behavioral condition or
disability.
Because of the massive commitment of time, many caregivers leave the
workforce. Caregivers age 50 and older, who leave the workforce to care
for a parent, lose, on average, nearly $304,000 in wages and benefits
over their lifetime. Women are most often the main caregivers and their
average is even higher, about $324,000 in lost benefits and wages.
In my home State of Florida, there are almost 3 million caregivers at
any given time and they provide over 2.6 billion hours of care.
A closer look at the work-related effects, as well as the personal,
financial, and emotional hardships, demonstrates an increasing need to
come together to better understand the unique needs of our caregivers
and what we can do to support them.
That is why Congressman Harper and I introduced the bipartisanship
Recognize, Assist, Include, Support, and Engage--RAISE--Family
Caregivers Act. The RAISE Family Caregivers Act will create and
maintain a common national family caregiver strategy led by the
Secretary of Health and Human Services so that we can develop some
additional support systems for the folks back home.
Our bill will bring together a diverse spectrum of stakeholders,
experts, folks who are working every day to take care of their loved
ones to be a part of the advisory council that will help develop some
additional recommendations, hopefully for this Congress.
We must ensure that family caregivers have the resources and tools
they need to face lost wages and the personal demands of taking care of
their loved one while ensuring that their loved one does receive the
best care.
I would like to thank the AARP, the Alzheimer's Association, the
Elizabeth Dole Foundation, the Family Caregiver Alliance, and so many
more that have encouraged us on this important piece of legislation.
As the complexity and intensity of family caregiving increases, I
believe that this legislation will help boost families and allow us to
be smart and efficient with our resources.
Mr. Speaker, I urge adoption of this important bipartisanship bill.
Mr. COURTNEY. Mr. Speaker, I want to congratulate the sponsors of
this legislation and also just note that the Elizabeth Dole Foundation
is a strong supporter. This is a group that has been formed to help
wounded warriors in terms of getting the caregiving help that they need
from other family members who are sometimes overlooked in terms of our
country's appreciation for those who wear the uniform of this country.
Mr. Speaker, I call for support for the bill, and I yield back the
balance of my time.
Mr. ESTES of Kansas. Mr. Speaker, I yield myself the remainder of my
time.
Mr. Speaker, before I came to Congress in April, I served as the
Kansas State treasurer. In that role, I had the opportunity to
implement the ABLE Act, which was legislation that was passed here in
the last few years.
Talking with a lot of parents, as they were abled and concerned about
how do they care for their disabled children, led to the creation of
the ABLE Act. During that process, we also talked with a lot of other
caregivers who cared for maybe senior citizens, maybe adult children
who were in their home, and wanted to make sure that that burden that
they faced in providing that family care was ameliorated and supported
in any way that it could be.
The RAISE Family Caregivers Act will help recognize the essential
role of family caregivers and share important information so that they
may better care for others.
This legislation fulfills a bipartisanship recommendation from the
Commission on Long-Term Care, and I urge my colleagues to vote in favor
of H.R. 3759.
Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore. The question is on the motion offered by the
gentleman from Kansas (Mr. Estes) that the House suspend the rules and
pass the bill, H.R. 3759, as amended.
The question was taken; and (two-thirds being in the affirmative) the
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rules were suspended and the bill, as amended, was passed.
A motion to reconsider was laid on the table.
____________________