[Congressional Record Volume 165, Number 170 (Monday, October 28, 2019)]
[House]
[Pages H8466-H8479]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      DIGNITY IN AGING ACT OF 2019

  Ms. BONAMICI. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 4334) to amend the Older Americans Act of 1965 to authorize 
appropriations for fiscal years 2020 through 2024, and for other 
purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 4334

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Dignity in 
     Aging Act of 2019''.
       (b) Table of Contents.--The table of contents of this Act 
     is the following:

Sec. 1. Short title; table of contents.

 TITLE I--ENSURING COLLABORATION AND PROMOTING INDEPENDENCE FOR OLDER 
                              INDIVIDUALS

Sec. 101. Person-centered, trauma-informed care.
Sec. 102. Vaccination.
Sec. 103. Functions of Assistant Secretary.
Sec. 104. Professional standards for nutrition official under Assistant 
              Secretary.
Sec. 105. Interagency Coordinating Committee on Age-Friendly 
              Communities.
Sec. 106. Technical assistance on age-friendly communities.
Sec. 107. Malnutrition.
Sec. 108. Coordination with resource centers.
Sec. 109. Arts education.
Sec. 110. Social determinants of health.
Sec. 111. Falls prevention and chronic disease self-management 
              education.
Sec. 112. Extension of RAISE Family Caregivers Act.
Sec. 113. Support for socially-isolated older Americans.
Sec. 114. Increased focus of Assistant Secretary on health effects 
              associated with social isolation.
Sec. 115. Advisory council on health effects associated with social 
              isolation.
Sec. 116. Supportive services and senior centers.
Sec. 117. Demonstration projects.
Sec. 118. Younger onset Alzheimer's Disease.
Sec. 119. Priority for the senior community service employment program.
Sec. 120. Direct care workforce.
Sec. 121. National resource center for older individuals experiencing 
              the long-term and adverse consequences of trauma.
Sec. 122. National Resource Center for Women and Retirement.
Sec. 123. Definition.
Sec. 124. Review of reports.
Sec. 125. Area plans.
Sec. 126. Addressing chronic pain management.
Sec. 127. Extension of the Supporting Grandparents Raising 
              Grandchildren Act.
Sec. 128. Screening for suicide risk.
Sec. 129. Traumatic brain injury.
Sec. 130. Addressing public health emergencies and emerging health 
              threats.
Sec. 131. Prevention of sexually transmitted diseases.
Sec. 132. Aging and Disability Resource Center.

   TITLE II--EMPOWERING THE AGING NETWORK TO MEET THE NEEDS OF OLDER 
                              INDIVIDUALS

Sec. 201. National family caregiver support program cap.
Sec. 202. Minimum funding level for State administrative expenses.
Sec. 203. Culturally-appropriate, medically-tailored meals.
Sec. 204. Business acumen provisions and clarification regarding 
              outside funding for area agencies on aging.
Sec. 205. Other practices.
Sec. 206. Caregiver assessments.
Sec. 207. Research and evaluation.
Sec. 208. Grant program for multigenerational collaboration.

       TITLE III--STRENGTHENING PROTECTIONS FOR OLDER INDIVIDUALS

Sec. 301. State Long-Term Care Ombudsman Program minimum funding and 
              maintenance of effort.
Sec. 302. State long-term care volunteer ombudsman representatives.
Sec. 303. Clarification regarding board and care facilities.
Sec. 304. Report on legal hotlines.
Sec. 305. Community outreach.
Sec. 306. Principles for person-directed services and supports during 
              serious illness.

         TITLE IV--MEETING THE NEEDS OF OLDER NATIVE AMERICANS

Sec. 401. Expanding supportive services for Native American aging 
              programs.
Sec. 402. Enhancing capacity to support Native American aging programs.

                         TITLE V--MISCELLANEOUS

Sec. 501. Technical corrections.
Sec. 502. Authorization of appropriations; uses of funds.
Sec. 503. Hold harmless formula.

 TITLE I--ENSURING COLLABORATION AND PROMOTING INDEPENDENCE FOR OLDER 
                              INDIVIDUALS

     SEC. 101. PERSON-CENTERED, TRAUMA-INFORMED CARE.

       Section 101(2) of the Older Americans Act of 1965 (42 
     U.S.C. 3001(2)) is amended by inserting ``(including access 
     to person-centered, trauma-informed care)'' after ``health''.

     SEC. 102. VACCINATION.

       Section 102(14) of the Older Americans Act of 1965 (42 
     U.S.C. 3002(14)) is amended--
       (1) in subparagraph (B) by inserting ``immunization 
     status,'' after ``oral health,'', and
       (2) in subparagraph (D) by inserting ``infectious disease, 
     and vaccine preventable disease,'' after ``disease),''.

     SEC. 103. FUNCTIONS OF ASSISTANT SECRETARY.

       (a) Review of Applications.-- Section 202 of the Older 
     Americans Act of 1965 (42 U.S.C. 3012) is amended--
       (1) by amending subsection (a)(4) to read as follows:
       ``(4) administer the grants provided by this Act but not 
     approve an application submitted by an applicant for a grant 
     for a program for which such applicant previously received a 
     grant unless the Assistant Secretary determines--
       ``(A) the program for which such application was submitted 
     is operating effectively to achieve its stated purpose; and
       ``(B) such applicant complied with the assurances provided 
     to the Assistant Secretary with the application for such 
     previous grant; and'', and
       (2) by adding at the end the following:
       ``(h) The Assistant Secretary shall publish, on an annual 
     basis, a list of centers and demonstration projects funded 
     under each title of the Act. The Assistant Secretary shall 
     ensure that this information is also directly provided to 
     States and area agencies on aging.''.
       (b)  Addressing the Needs of Older Individuals in 
     Disasters.--Section 202(a) of the Older Americans Act of 1965 
     (42 U.S.C. 3012(a)) is amended--
       (1) in paragraph (30) by striking ``and'' at the end,
       (2) in paragraph (31) by striking the period at the end and 
     inserting ``; and'', and
       (3) by adding at the end the following:
       ``(32) provide technical assistance to and share best 
     practices with States and area agencies on aging on how to 
     collaborate and coordinate activities and develop long-range 
     emergency preparedness plans with local and State emergency 
     response agencies, relief organizations, local and State 
     governments, federal agencies as appropriate, and any other 
     institutions that have responsibility for disaster relief 
     service delivery.''.

     SEC. 104. PROFESSIONAL STANDARDS FOR NUTRITION OFFICIAL UNDER 
                   ASSISTANT SECRETARY.

       Section 205(a)(2)(C)(ii) of the Older Americans Act of 1965 
     (42 U.S.C. 3016(a)(2)(C)(ii) is amended to read as follows:
       ``(ii) be a registered dietitian or registered dietitian 
     nutritionist.''.

     SEC. 105. INTERAGENCY COORDINATING COMMITTEE ON AGE-FRIENDLY 
                   COMMUNITIES.

       Section 203 of the Older Americans Act of 1965 (42 U.S.C. 
     3013) is amended--
       (1) in subsection (b)--
       (A) in paragraph (18) by striking ``and'' at the end,
       (B) in subparagraph (19) by striking the period at the end, 
     and inserting ``, and'', and
       (C) by adding at the end the following:
       ``(20) section 393D of the Public Health Service Act (42 
     U.S.C. 280b-1f), relating to safety of seniors.'', and
       (2) in subsection (c)--
       (A) in paragraph (1)--
       (i) by striking ``Aging'' and inserting ``Age-Friendly 
     Communities'', and
       (ii) by inserting ``to support the ability of older 
     individuals to age in place, including through the provision 
     of homelessness prevention services, support the ability of 
     older

[[Page H8467]]

     individuals to access preventive health care, promote age-
     friendly communities, and address the ability of older 
     individuals to access long-term care supports, including 
     access to caregivers and home- and community-based services'' 
     before the period at the end,
       (B) in paragraph (4) by inserting ``, except that the 1st 
     term of a member appointed to the Interagency Coordinating 
     Committee on Age-Friendly Communities shall begin not later 
     than 1 year after the effective date of this exception'' 
     before the period at the end,
       (C) in paragraph (5) by striking ``once each year'' and 
     inserting ``semiannually'',
       (D) in paragraph (6)--
       (i) in subparagraph (A)--

       (I) in clause (iii) by striking ``and'' at the end,
       (II) in clause (iv) by adding ``and'' at the end, and
       (III) by adding at the end the following:

       ``(v) identifying best practices for connecting older 
     individuals to services for which they may be eligible;'',
       (ii) in subparagraph (B)--

       (I) by inserting ``transportation,'' after ``housing,'' the 
     1st place it appears,
       (II) in clause (i) by striking ``and'' at the end,
       (III) by amending clause (ii) to read as follows:

       ``(ii) innovations in technology applications (including 
     assistive technology devices and assistive technology 
     services) that--
       ``(I) promote safe and accessible independent living 
     environments; and
       ``(II) give older individuals access to information on 
     available services or help in providing services to older 
     individuals, including information on transportation services 
     such as public transit, on-demand transportation services, 
     volunteer-based transportation services, and other private 
     transportation services; and'', and

       (IV) by adding at the end the following:

       ``(iii) transportation models that reduce costs of 
     transportation for older individuals and provide the ability 
     to schedule trips in advance and on demand, as 
     appropriate;'',
       (iii) in subparagraph (E)--

       (I) by striking ``nongovernmental experts and 
     organizations, including public health interest and research 
     groups and foundations'' and inserting ``nongovernmental 
     organizations, academic or research institutions, community-
     based organizations, and philanthropic organizations'', and
       (II) by striking ``(F)'' and inserting ``(G)'',

       (iv) by redesignating subparagraphs (E), (F), and (G) as 
     subparagraphs (F), (G), and (H), respectively,
       (v) by inserting after subparagraph (D) the following:
       ``(E) work with the Centers for Disease Control and 
     Prevention, the National Institute on Aging, Centers for 
     Medicare and Medicaid Services, the Housing and Urban 
     Development Office of Lead Hazard Control and Healthy Homes, 
     and other Federal agencies as appropriate, to develop 
     recommendations, in accordance with paragraph (1), to reduce 
     falls among older individuals that incorporate evidence-based 
     falls prevention programs and home modifications to reduce 
     and prevent falls;'', and
       (vi) by adding at the end the following:
       ``(9) In this subsection, the term `age-friendly community' 
     means a community that---
       ``(A) is taking steps--
       ``(i) to include accessible housing, accessible spaces and 
     buildings, safe and secure paths, variable route 
     transportation services, and programs and services designed 
     to maintain health and well-being;
       ``(ii) to respect and include older individuals in social 
     opportunities, civic participation, volunteerism, and 
     employment; and
       ``(iii) to facilitate access to supportive services for 
     older individuals; and
       ``(B) has a plan in place to meet local needs for housing, 
     transportation, civic participation, social connectedness, 
     and accessible spaces.'' and
       (3) by adding at the end the following:
       ``(d) Not later than 2 years after the effective date of 
     this subsection, the Comptroller General of the United States 
     shall conduct a study and issue a report that includes--
       ``(1) an inventory of Federal programs, administered by the 
     Department of Health and Human Services, the Department of 
     Housing and Urban Development, or any other Federal agency 
     determined appropriate by the Comptroller General, that 
     support home assessments and home modifications for older 
     individuals and individuals with disabilities,
       ``(2) statistical data, for recent fiscal years, on the 
     number of older individuals and individuals with disabilities 
     served by each Federal program described in paragraph (1) and 
     the approximate amount of Federal funding invested in each 
     such program,
       ``(3) a demographic analysis of individuals served by each 
     such program for recent fiscal years;
       ``(4) an analysis of duplication and gaps in populations 
     supported by the Federal programs described in paragraph (1),
       ``(5) what is known about the impact of the Federal 
     programs described in paragraph (1) on health status and 
     health outcomes in populations supported by such programs,
       ``(6) a review of Federal efforts to coordinate Federal 
     programs existing prior to the effective date of this 
     subsection that support home assessments and home 
     modifications for older individuals and individuals with 
     disabilities and any considerations for improving 
     coordination, which may include an indication of the Federal 
     agency or department that is best suited to coordinate such 
     Federal efforts, and
       ``(7) information on the extent to which consumer-friendly 
     resources, such as a brochure, are available through the 
     National Eldercare Locator Service established under section 
     202(a)(21), are accessible to all area agencies on aging, and 
     contain information on home assessments and home 
     modifications for older individuals attempting to live 
     independently and safely in their homes and for the 
     caregivers of such individuals.''.

     SEC. 106. TECHNICAL ASSISTANCE ON AGE-FRIENDLY COMMUNITIES.

       Section 205(a)(2) of the Older Americans Act of 1965 (42 
     U.S.C. 3016(a)(2)) is amended--
       (1) by redesignating subparagraph (C) as subparagraph (D), 
     and
       (2) by inserting after subparagraph (B) the following:
       ``(C) The Assistant Secretary may provide technical 
     assistance, including through the regional offices of the 
     Administration, to State agencies, area agencies on aging, 
     local government agencies, or leaders in age-friendly 
     communities (as defined in section 203(c)(9)) regarding--
       ``(i) support for public and private entities in building 
     partnerships to promote such age-friendly communities;
       ``(ii) dissemination of, or consideration of ways to 
     implement, best practices and recommendations from the 
     Interagency Coordinating Committee on Age-Friendly 
     Communities established under section 203(c); and
       ``(iii) methods for managing and coordinating existing 
     programs to meet the needs of growing age-friendly 
     communities.''.

     SEC. 107. MALNUTRITION.

       The Older Americans Act of 1965 (42 U.S.C. 2011 et seq.) is 
     amended--
       (1) in section 102(14)(B) by inserting ``(including 
     screening for malnutrition)'' before the semicolon at the 
     end, and
       (2) in section 330(1) by striking ``and food insecurity'' 
     and inserting ``, food insecurity, and malnutrition''.

     SEC. 108. COORDINATION WITH RESOURCE CENTERS.

       (a) Area Plans.--Section 306(a) of the Older Americans Act 
     of 1965 (42 U.S.C. 3026(a)) is amended--
       (1) in paragraph (16) by striking ``and'' at the end,
       (2) in paragraph (17) by striking the period at the end and 
     inserting ``; and'', and
       (3) by adding at the end the following:
       ``(18) provide assurances that the area agency on aging 
     will collect data to determine--
       ``(A) the services that are needed by older individuals 
     whose needs were the focus of all centers funded under title 
     IV in fiscal year 2019; and
       ``(B) the effectiveness of the programs, policies, and 
     services provided by such area agency on aging in assisting 
     such individuals; and
       ``(19) provide assurances that the area agency on aging 
     will use outreach efforts that will identify older 
     individuals eligible for assistance under this Act, with 
     special emphasis on those older individuals whose needs were 
     the focus of all centers funded under title IV in fiscal year 
     2019.''.
       (b) State Plans.--Section 307(a) of the Older Americans Act 
     of 1965 (42 U.S.C. 3027) is amended by adding at the end the 
     following:
       ``(31) The plan shall contain an assurance that the State 
     shall prepare and submit to the Assistant Secretary annual 
     reports that describe--
       ``(A) data collected to determine the services that are 
     needed by older individuals whose needs were the focus of all 
     centers funded under title IV in fiscal year 2019;
       ``(B) data collected to determine the effectiveness of the 
     programs, policies, and services provided by area agencies on 
     aging in assisting such individuals; and,
       ``(C) outreach efforts and other activities carried out to 
     satisfy the assurances described in paragraphs (18) and (19) 
     of section 306(a).''.

     SEC. 109. ARTS EDUCATION.

       (a) Program Design.--Section 202(a)(5) of the Older 
     Americans Act of 1965 (42 U.S.C. 3012(a)(5)) is amended by 
     inserting ``cultural experiences, activities and services, 
     including the arts,'' after ``education),''.
       (b) Supportive Services.--Section 321(a)(7) of the Older 
     Americans Act of 1965 (42 U.S.C. 3030d(a)(7)) is amended by 
     inserting ``cultural experiences (including the arts),'' 
     after ``art therapy,''.

     SEC. 110. SOCIAL DETERMINANTS OF HEALTH.

       Section 301(a)(1) of the Older Americans Act of 1965 (42 
     U.S.C. 3021(a)(1)) is amended--
       (1) in subparagraph (C) by striking ``and'' at the end,
       (2) in subparagraph (D) by striking the period at the end 
     and inserting ``; and'', and
       (3) by adding at the end the following:
       ``(E) address the social determinants of health of older 
     individuals.''.

     SEC. 111. FALLS PREVENTION AND CHRONIC DISEASE SELF-
                   MANAGEMENT EDUCATION.

       Section 411(a) of the Older Americans Act of 1965 (42 
     U.S.C. 3032(a)) is amended--
       (1) by redesignating paragraphs (13) and (14) as paragraphs 
     (15) and (16), respectively, and
       (2) by inserting after paragraph (12) the following:
       ``(13) bringing to scale and sustaining evidence-based 
     falls prevention programs that

[[Page H8468]]

     will reduce the number of falls, fear of falling, and fall-
     related injuries in older individuals and older individuals 
     with disabilities;
       ``(14) bringing to scale and sustaining evidence-based 
     chronic disease self-management programs that empower older 
     individuals and older individuals with disabilities to better 
     manage their chronic conditions;''.

     SEC. 112. EXTENSION OF RAISE FAMILY CAREGIVERS ACT.

       Section 6 of the RAISE Family Caregivers Act (Public Law 
     115-119; 132 Stat. 27) is amended by striking ``3'' and 
     inserting ``4''.

     SEC. 113. SUPPORT FOR SOCIALLY-ISOLATED OLDER AMERICANS.

       Section 102(14) of the Older Americans Act of 1965 (42 
     U.S.C. 3002(14)) is amended--
       (1) in subparagraph (K) by striking ``and'' at the end,
       (2) in subparagraph (L) by striking ``(K)'' and inserting 
     ``(L)'',
       (3) by redesignating subparagraph (L) as subparagraph (M), 
     and
       (4) by inserting after subparagraph (K) the following:
       ``(L) screening for the prevention of negative health 
     effects associated with social isolation and coordination of 
     supportive services and health care to address negative 
     health effects associated with social isolation; and''.

     SEC. 114. INCREASED FOCUS OF ASSISTANT SECRETARY ON HEALTH 
                   EFFECTS ASSOCIATED WITH SOCIAL ISOLATION.

       Section 202(a) of the Older Americans Act of 1965 (42 
     U.S.C. 3012(a)), as amended by section 103, is amended--
       (1) in paragraph (31) by striking ``; and'' and inserting a 
     semicolon,
       (2) in paragraph (32) by striking the period at the end and 
     inserting ``; and'', and
       (3) by adding at the end the following:
       ``(33) develop objectives, priorities, and a long-term plan 
     for supporting State and local efforts involving education 
     about, prevention of, detection of, and response to negative 
     health effects associated with social isolation among older 
     individuals.''.

     SEC. 115. ADVISORY COUNCIL ON HEALTH EFFECTS ASSOCIATED WITH 
                   SOCIAL ISOLATION.

       Section 202 of the Older Americans Act of 1965 (42 U.S.C. 
     3012), as amended by section 103, is amended by adding at the 
     end the following:
       ``(i)(1) The Assistant Secretary shall convene an advisory 
     council on negative health effects associated with social 
     isolation with aging network stakeholders, including 
     caregivers, and select members in a manner that ensures 
     geographic diversity of the members--
       ``(A) to review and evaluate efforts to address negative 
     health effects associated with social isolation among older 
     individuals; and
       ``(B) to identify challenges, solutions, and best practices 
     related to such efforts.
       ``(2) The advisory council convened under paragraph (1) 
     shall--
       ``(A) ensure consideration of consumer-directed care 
     models; and
       ``(B) submit a report to Congress on its findings.
       ``(3) The Federal Advisory Committee Act (5 U.S.C. App.) 
     shall not apply with respect to the advisory council convened 
     under paragraph (1).''.

     SEC. 116. SUPPORTIVE SERVICES AND SENIOR CENTERS.

       Section 321(a) of the Older Americans Act of 1965 (42 
     U.S.C. 3030d(a)) is amended--
       (1) in paragraph (24) by striking ``and'' at the end,
       (2) by redesignating paragraph (25) as paragraph (26), and
       (3) by inserting after paragraph (24) the following:
       ``(25) services that promote or support social 
     connectedness and reduce negative health effects associated 
     with social isolation; and''.

     SEC. 117. DEMONSTRATION PROJECTS.

       (a) Demonstrations.--Section 411(a) of the Older Americans 
     Act of 1965 (42 U.S.C. 3032(a)), as amended by section 111, 
     is amended--
       (1) in paragraph (15) by striking ``and'' at the end,
       (2) by redesignating paragraph (16) as paragraph (17), and
       (3) by inserting after paragraph (15) the following:
       ``(16) projects that address negative health effects 
     associated with social isolation among older adults; and''.
       (b) Repeal.--Section 416 of the Older Americans Act of 1965 
     (42 U.S.C. 3032e) is repealed.

     SEC. 118. YOUNGER ONSET ALZHEIMER'S DISEASE.

       (a) Definition of ``Family Caregiver''.--Section 302(3) of 
     the Older Americans Act of 1965 (42 U.S.C. 3022(3)) is 
     amended by inserting ``of any age'' after ``an individual''.
       (b) Definition of ``Resident''.--Section 711(6) of the 
     Older Americans Act of 1965 (42 U.S.C. 3058(6)) is amended by 
     inserting ``of any age'' after ``individual''.

     SEC. 119. PRIORITY FOR THE SENIOR COMMUNITY SERVICE 
                   EMPLOYMENT PROGRAM.

       (a) Priority.--The Older Americans Act of 1965 (42 U.S.C. 
     3001 et seq.) is amended--
       (1) in section 503(a)(4)(C)--
       (A) in clause (iii) by striking ``and'' at the end,
       (B) in clause (iv) by adding ``and'' at the end, and
       (C) by adding at the end the following:
       ``(v) eligible individuals who have been incarcerated 
     within the last 5 years or are under supervision following 
     the release from prison or jail within the last 5 years;'',
       (2) in section 514(e)(1) by inserting ``older individuals 
     who have been incarcerated or are under supervision following 
     the release from prison or jail,'' after ``need,'', and
       (3) in section 518--
       (A) in subsection (a)(3)(B)(ii)--
       (i) in clause (IV) by striking ``or'' at the end,
       (ii) in clause (V) by striking the period at the end and 
     inserting ``; or'', and
       (iii) by adding at the end the following:
       ``(VI) have been incarcerated within the last 5 years or 
     are under supervision following the release from prison or 
     jail within the last 5 years.'', and
       (B) in subsection (b)(2)--
       (i) in subparagraph (F) by striking ``or'' at the end,
       (ii) in subparagraph (G) by striking the period at the end 
     and inserting ``; or'',
       (iii) by adding at the end the following:
       ``(H) has been incarcerated or is under supervision 
     following the release from prison or jail within the last 5 
     years.''.
       (b) Transition Period.--This section shall take effect 1 
     year after the date of the enactment of this Act.

     SEC. 120. DIRECT CARE WORKFORCE.

       (a) Demonstrations.--Section 411(a) of the Older Americans 
     Act of 1965 (42 U.S.C. 3032(a)), as amended by sections 111 
     and 117, is amended--
       (1) by redesignating paragraphs (16) and (17) as paragraphs 
     (17) and (18), respectively, and
       (2) by inserting after paragraph (15) the following:
       ``(16) in coordination with the Secretary of Labor, the 
     demonstration of new strategies for the recruitment, 
     retention, or advancement of direct care workers, and to 
     solicit, develop, and implement strategies--
       ``(A) to reduce barriers to entry for a diverse and high-
     quality direct care workforce, including providing wages, 
     benefits, and advancement opportunities needed to attract or 
     retain direct care workers;
       ``(B) to provide supportive services and career planning 
     for direct care workers; and
       ``(C) to support the advancement of direct care workers 
     through education and workforce development programs that 
     include necessary credential or licensing preparation, paid 
     on-the-job training or work-based learning, and appropriate 
     safety training;''.
       (b) Older American Community Service Employment Program.--
     Section 502(e)(2)(B) of the Older Americans Act of 1965 (42 
     U.S.C. 3056(e)(2)(B)) is amended--
       (1) in clause (iii) by striking ``and'' at the end,
       (2) in clause (iv) by adding ``and'' at the end, and
       (3) by adding at the end the following:
       ``(v) attract, retain, or advance the direct care 
     workforce, in consultation with the Assistant Secretary, 
     providing for wages and benefits needed to reduce barriers to 
     entry for a diverse and high-quality direct care workforce, 
     supportive services and career planning, and paid on-the-job 
     training or work-based learning, with appropriate safety 
     training;''.

     SEC. 121. NATIONAL RESOURCE CENTER FOR OLDER INDIVIDUALS 
                   EXPERIENCING THE LONG-TERM AND ADVERSE 
                   CONSEQUENCES OF TRAUMA.

       Section 411(a) of the Older Americans Act of 1965 (42 
     U.S.C. 3032(a), as amended by sections 111, 117, and 120, is 
     amended--
       (1) in paragraph (17) by striking ``and'' at the end,
       (2) in paragraph (18) by striking the period at the end, 
     and
       (3) by adding at the end the following:
       ``(19) the establishment and operation of a national 
     resource center that shall--
       ``(A) provide training and technical assistance to agencies 
     in the aging network delivering services to older individuals 
     experiencing the long-term and adverse consequences of 
     trauma;
       ``(B) share best practices with the aging network; and
       ``(C) make subgrants to the agencies best positioned to 
     advance and improve the delivery of person-centered, trauma-
     informed services for older individuals experiencing the 
     long-term and adverse consequences of trauma.''.

     SEC. 122. NATIONAL RESOURCE CENTER FOR WOMEN AND RETIREMENT.

       Section 202 of the Older Americans Act of 1965 (42 U.S.C. 
     3012), as amended by sections 103 and 115, is amended by 
     adding at the end the following:
       ``(j)(1) The Assistant Secretary shall, directly or by 
     grant or contract, operate the National Resource Center for 
     Women and Retirement (in this subsection referred to as the 
     `Center').
       ``(2) The Center shall--
       ``(A) provide basic financial management, retirement 
     planning, and other educational tools that promote financial 
     wellness and help to identify and prevent fraud and elder 
     exploitation, and integrate these with information on health 
     and long-term care;
       ``(B) annually disseminate a summary of outreach provided, 
     including work to provide user-friendly consumer information 
     and public education materials;
       ``(C) develop targeted outreach strategies;
       ``(D) provide technical assistance to State agencies and to 
     other public and nonprofit private agencies and 
     organizations; and
       ``(E) develop partnerships and collaborations to address 
     program objectives.''.

     SEC. 123. DEFINITION .

       Section 102 of the Older Americans Act of 1965 (42 U.S.C. 
     3002) is amended--

[[Page H8469]]

       (1) by redesignating paragraphs (41) through (54) as 
     paragraphs (42) through (55), and
       (2) by inserting after paragraph (40) the following:
       ``(41) The term `person-centered, trauma-informed' when 
     used with respect to services means services provided through 
     an aging program that--
       ``(A) use a holistic approach to providing services;
       ``(B) promote the dignity, strength and empowerment of 
     victims of trauma; and
       ``(C) incorporate research-based practices based on 
     knowledge about the role of trauma in trauma victims' 
     lives.''.

     SEC. 124. REVIEW OF REPORTS.

       Sec. 308(b) of the Older Americans Act of 1965 (42 U.S.C. 
     3028(b)) is amended by inserting at the end the following:
       ``(8) The Assistant Secretary shall review the reports 
     submitted under section 307(a)(31) and include aggregate data 
     in the report required by section 207(a), including data on--
       ``(A) the effectiveness of the programs, policies, and 
     services provided by area agencies on aging in assisting 
     individuals whose needs were the focus of all centers funded 
     under title IV in fiscal year 2019; and,
       ``(B) outreach efforts and other activities carried out to 
     satisfy the assurances described in paragraphs (18) and (19) 
     of section 306(a), to identify such older individuals and 
     their service needs.''.

     SEC. 125. AREA PLANS.

       Section 306(a)(4) of the Older Americans Act of 1965 (42 
     U.S.C. 3026(a)(4)) is amended in subparagraph (B)(i)(VII) by 
     inserting ``, specifically including survivors of the 
     Holocaust'' after ``placement''.

     SEC. 126. ADDRESSING CHRONIC PAIN MANAGEMENT.

       Section 102(14)(D) of the Older Americans Act of 1965 (42 
     U.S.C. 3002(14)) is amended by inserting ``chronic pain 
     management,'' after ``substance abuse reduction,''.

     SEC. 127. EXTENSION OF THE SUPPORTING GRANDPARENTS RAISING 
                   GRANDCHILDREN ACT.

        Section 3(f) of the Supporting Grandparents Raising 
     Grandchildren Act (Public Law 115-196) is amended by striking 
     ``3'' and inserting ``4''.

     SEC. 128. SCREENING FOR SUICIDE RISK.

       Section 102(14)(G) of the Older Americans Act of 1965 (42 
     U.S.C. 3002(14)(G)) is amended by inserting ``and screening 
     for suicide risk'' after ``depression''.

     SEC. 129. TRAUMATIC BRAIN INJURY.

       (a) Section 102 of the Older Americans Act of 1965 (42 
     U.S.C. 3002), as amended by section 113, is amended--
       (1) in paragraph (14)--
       (A) in paragraph (M) by striking ``(L)'' and inserting 
     ``(M)'',
       (B) by redesignating subparagraphs (H) through (M) as 
     subparagraphs (I) through (N), respectively,
       (C) by inserting after subparagraph (G) the following:
       ``(H) screening for fall-related traumatic brain injury; 
     coordination of treatment, rehabilitation, and related 
     services; and referral services;'', and
       (2) by adding at the end the following:
       ``(56) The term `traumatic brain injury' has the meaning 
     given to it in section 339B(d) of the Public Health Service 
     Act.''.
       (b) Section 321(a)(8) of the Older Americans Act of 1965 
     (42 U.S.C.3030d(a)(8)) is amended--
       (1) by striking ``screening and'' and inserting 
     ``screening, screening for negative health effects associated 
     with social isolation,'', and
       (2) by striking ``screening)'' and inserting ``screening, 
     and traumatic brain injury screening)''.
       (c) Section 411(a)(12) of the Older Americans Act of 1965 
     (42 U.S.C. 3032(a)(12)) is amended--
       (1) by inserting ``dementia,'' after ``dysfunction,'',
       (2) by striking ``and'' the 2d place it appears, and
       (3) by inserting ``and traumatic brain injury'' before the 
     semicolon at the end.

     SEC. 130. ADDRESSING PUBLIC HEALTH EMERGENCIES AND EMERGING 
                   HEALTH THREATS.

       Section 102(14) of the Older Americans Act of 1965 (42 
     U.S.C. 3002(14)), as amended by sections 113 and 129, is 
     amended--
       (1) in subparagraph (M) by striking ``and'' at the end,
       (2) in subparagraph (N) by striking ``(M)'' and inserting 
     ``(N)'',
       (3) by redesignating subparagraphs (K), (L), (M), and (N) 
     as subparagraphs (L), (M), (N), and (O) respectively, and
       (4) by inserting after subparagraph (J) the following:
       ``(K) responses to public health emergencies and emerging 
     health threats;''.

     SEC. 131. PREVENTION OF SEXUALLY TRANSMITTED DISEASES.

       Section 102(14)(D) of the Older Americans Act of 1965 (42 
     U.S.C. 3002(14)(D)), as amended by section 102, is amended by 
     inserting ``prevention of sexually transmitted disease,'' 
     after ``disease)''.

     SEC. 132. AGING AND DISABILITY RESOURCE CENTER.

       Section 102(4) of the Older Americans Act of 1965 (42 
     U.S.C. 3002(4)) is amended--
       (1) in the matter preceding subparagraph (A), by inserting 
     ``, in collaboration with (as appropriate) area agencies on 
     aging, centers for independent living (as described in part C 
     of title VII of the Rehabilitation Act of 1973 (29 U.S.C. 
     796f et seq.)), and other aging or disability entities'' 
     after ``provides'',
       (2) in subparagraph (B)--
       (A) by inserting ``services, supports, and'' after ``plan 
     for long-term'', and
       (B) by inserting ``and choices'' after ``desires''; and
       (3) in subparagraph (D) by striking ``(29 U.S.C. 796f et 
     seq.), and other community-based entities,'' and inserting 
     ``, and other community-based entities, including other aging 
     or disability entities''.

   TITLE II--EMPOWERING THE AGING NETWORK TO MEET THE NEEDS OF OLDER 
                              INDIVIDUALS

     SEC. 201. NATIONAL FAMILY CAREGIVER SUPPORT PROGRAM CAP.

       (a) Federal Share.--Section 373(g)(2) of the Older 
     Americans Act of 1965 (42 U.S.C. 3030s-1(g)(2)) is amended by 
     striking subparagraph (C).
       (b) Monitoring the Impact of the Elimination of the Cap on 
     Funds for Older Relative Caregivers.--
       (1) Report.--Not later than 18 months after the date of the 
     enactment of this Act, and annually thereafter, the Assistant 
     Secretary shall submit to the Committee on Education and 
     Labor of the House of Representatives and the Committee on 
     Health, Education, Labor, and Pensions of the Senate a report 
     on the impact of the amendment made by subsection (a) to 
     eliminate the limitation on funds that States may allocate to 
     provide support services to older relative caregivers in the 
     National Family Caregiver Support Program established under 
     part E of title III of the Older Americans Act of 1965 (42 
     U.S.C. 3030s-3030s-2). Each such report shall also be made 
     available to the public.
       (2) Contents.--For purposes of reports required by 
     paragraph (1), each State that receives an allotment under 
     such National Family Caregiver Support Program for fiscal 
     year 2020 or a subsequent fiscal year shall report to the 
     Assistant Secretary for the fiscal year involved the amount 
     of funds of the total Federal and non-Federal share allotment 
     used by the State to provide support services for caregiver 
     support for older relative caregivers and family caregivers.

     SEC. 202. MINIMUM FUNDING LEVEL FOR STATE ADMINISTRATIVE 
                   EXPENSES.

       Section 308(b)(2)(A) of the Older Americans Act of 1965 (42 
     U.S.C. 3028(b)(2)(B)) is amended by striking ``$500,000'' and 
     inserting ``$750,000''.

     SEC. 203. CULTURALLY-APPROPRIATE, MEDICALLY-TAILORED MEALS.

       Section 339(2)(A) of the Older Americans Act of 1965 (42 
     U.S.C. 3939h(2)(A)) is amended by inserting ``, including 
     cultural considerations and preferences (including needs 
     based on religious, cultural, or ethnic requirements) and 
     medically tailored meals'' before the comma at the end.

     SEC. 204. BUSINESS ACUMEN PROVISIONS AND CLARIFICATION 
                   REGARDING OUTSIDE FUNDING FOR AREA AGENCIES ON 
                   AGING.

       (a) Assistance Relating to Growing and Sustaining 
     Capacity.--Section 202(b)(9) of the Older Americans Act of 
     1965 (42 U.S.C. 3012(b)(9)) is amended--
       (1) in subparagraph (A) by striking ``and'' after the 
     semicolon at the end,
       (2) in subparagraph (B) by inserting ``and'' after the 
     semicolon at the end, and
       (3) by adding at the end the following:
       ``(C) business acumen, capacity building, organizational 
     development, innovation, and other methods of growing and 
     sustaining the capacity of the aging network to serve older 
     individuals and caregivers most effectively;''.
       (b) Clarifying Partnerships for Area Agencies on Aging.--
     Section 306 of the Older Americans Act of 1965 (42 U.S.C. 
     3026) is amended by adding at the end the following:
       ``(g) Nothing in this Act shall restrict an area agency on 
     aging from providing services not provided or authorized by 
     this Act, including through--
       ``(1) contracts with health care payers;
       ``(2) consumer private pay programs; or
       ``(3) other arrangements with entities or individuals that 
     increase the availability of home and community-based 
     services and supports in the planning and service area 
     supported by the area agency on aging.''.

     SEC. 205. OTHER PRACTICES.

       Section 315 of the Older Americans Act of 1965 (42 U.S.C. 
     3030c-2) is amended by adding at the end the following:
       ``(e) Response to Area Agencies on Aging.--Upon request 
     from an area agency on aging, the State shall make available 
     any policies or guidance pertaining to policies under this 
     section.''.

     SEC. 206. CAREGIVER ASSESSMENTS.

       (a) Definition of Caregiver Assessment.--Section 372(a) of 
     the Older Americans Act of 1965 (42 U.S.C. 3030s(a)) is 
     amended by adding at the end the following:
       ``(4) Caregiver assessment.--The term `caregiver 
     assessment' means a systematic process of gathering 
     information about the situation of a caregiver who 
     voluntarily participates in such process, which may include 
     contact through a home visit, the Internet, telephone or 
     teleconference, or in-person interaction, to identify the 
     caregiver's specific needs, barriers, and existing supports 
     as identified by the caregiver that--
       ``(A) provides the opportunity for the recognized caregiver 
     to participate in such process;
       ``(B) requires direct contact with the caregiver and is 
     used to appropriately target and tailor support services to 
     the caregiver's unique needs; and
       ``(C) includes reassessment of such specific needs, 
     barriers, and existing supports, including to accommodate a 
     significant change

[[Page H8470]]

     in the caregiving situation, which shall occur on a voluntary 
     basis with the consent of the caregiver.''.
       (b) Use of Caregiver Assessments.--Section 373(b) of the 
     Older Americans Act of 1965 (42 U.S.C. 3030s-1(b)) is amended 
     by inserting ``may be informed through the use of caregiver 
     assessments and'' after ``with,''.
       (c) Technical Assistance for Caregiver Assessments.--
     Section 373 of the Older Americans Act of 1965 (42 U.S.C. 
     3030s-1) is amended by adding at the end the following:
       ``(h) Technical Assistance for Caregiver Assessments.--Not 
     later than 1 year after the effective date of this 
     subsection, the Assistant Secretary, in consultation with 
     caregivers, older individuals, individuals with a disability 
     who receive care from an older relative caregiver, the aging 
     network, and other experts and stakeholders, shall provide 
     technical assistance to promote and implement the use of 
     caregiver assessments. Such technical assistance shall 
     include sharing available tools and templates, comprehensive 
     assessment protocols, and best practices concerning--
       ``(1) conducting caregiver assessments and reassessments;
       ``(2) implementing such assessments that are consistent 
     across a planning and service area; and
       ``(3) implementing caregiver support service plans, 
     including referrals to and coordination of activities with 
     relevant State and local services.''.
       (d) Reporting on Caregiver Assessment.--Section 373(e) of 
     the Older Americans Act of 1965 (42 U.S.C. 3030s-1(e)) is 
     amended--
       (1) in paragraph (3) by inserting ``, including caregiver 
     assessments used in the State,'' after ``mechanisms'' the 1st 
     place it appears, and
       (2) by adding at the end the following:
       ``(4) Report on caregiver assessments.--
       ``(A) In general.--Not later than 3 years after the 
     effective date of this paragraph, the Assistant Secretary 
     shall issue a report on the use of caregiver assessments by 
     area agencies on aging, entities contracting with such 
     agencies, and organizations. Such report shall include--
       ``(i) an analysis of the current use of caregiver 
     assessments, including a repository of caregiver assessment 
     tools or templates and comprehensive assessment protocols;
       ``(ii) using objective data, an analysis of the impact of 
     caregiver assessments on--

       ``(I) family caregivers and older relative caregivers; and
       ``(II) the individuals to whom the caregivers described in 
     subclause (I) provide care;

       ``(iii) an analysis of the impact of using caregiver 
     assessments on the aging network;
       ``(iv) an analysis of how caregiver assessments are being 
     used to identify the specific needs, barriers, and existing 
     supports of family caregivers and older relative caregivers;
       ``(v) recommendations for using caregiver assessments, 
     including in rural or underserved areas; and
       ``(vi) feedback from State agencies and area agencies on 
     aging, particularly in rural or underserved areas, on the 
     implementation of caregiver assessments.
       ``(B) Submission.--Not later than 6 months after the 
     issuance of the report under subparagraph (A), the Assistant 
     Secretary shall submit the report to the Committee on 
     Education and Labor of the House of Representatives, the 
     Committee on Health, Education, Labor, and Pensions of the 
     Senate, and the Special Committee on Aging of the Senate.''.

     SEC. 207. RESEARCH AND EVALUATION.

       Section 201 of the Older Americans Act of 1965 (42 U.S.C. 
     3011) is amended by adding at the end the following:
       ``(g)(1) The Assistant Secretary shall coordinate the 
     research and evaluation functions of this Act under a 
     National Research, Demonstration, and Evaluation Center for 
     the Aging Network (in this subsection referred to as the 
     `Center'), which shall be headed by a director designated by 
     the Assistant Secretary from individuals described in 
     paragraph (4).
       ``(2) The purpose of the Center shall be--
       ``(A) to coordinate research, research dissemination, 
     evaluation, demonstration projects, and related activities 
     carried out under this Act;
       ``(B) to provide assessment of the programs authorized 
     under this Act; and
       ``(C) to increase the repository of information on 
     evidence-based programs and interventions available to the 
     aging network. Such information shall be applicable to 
     existing programs and help in the development of new 
     evidence-based programs and interventions.
       ``(3) Activities of the Center shall include conducting, 
     promoting, coordinating, and providing support for--
       ``(A) research and evaluation activities that support the 
     objectives of this Act, including--
       ``(i) evaluation of new and existing programs and 
     interventions authorized by this Act; and
       ``(ii) research on and assessment of the relationship 
     between programs and interventions under this Act and the 
     health outcomes, social determinants of health, quality of 
     life, health care savings (including to the Medicare program 
     under title XVIII of the Social Security Act and the Medicaid 
     program under title XIX of such Act as practicable), and 
     independence of individuals served under this Act;
       ``(B) demonstration projects that support the objectives of 
     the Act and activities to bring effective demonstration 
     projects to scale with a prioritization of projects that 
     address the needs of underserved populations;
       ``(C) outreach and dissemination of research findings; and
       ``(D) technical assistance related to the activities 
     described in this subparagraph.
       ``(4) The director shall be an individual with substantial 
     knowledge of and experience in aging and health policy, and 
     research administration.
       ``(5) Not later than October 1, 2020, and at 5-year 
     intervals thereafter, the director shall prepare and publish 
     in the Federal Register for public comment a draft of a 5-
     year plan that--
       ``(A) outlines priorities for research, research 
     dissemination, evaluation, and related activities;
       ``(B) explains the basis for such priorities; and
       ``(C) describes how the plan will meet the needs of 
     underserved populations.
       ``(6) The director shall coordinate research, research 
     dissemination, evaluation, and demonstration projects, and 
     related activities with appropriate agency program staff, 
     and, as appropriate, coordinate with other Federal 
     departments and agencies involved in research in the field of 
     aging.
       ``(7) Not later than December 31, 2020, and annually 
     thereafter, the director shall prepare, and submit to the 
     Secretary, the Committee on Health, Education, Labor, and 
     Pensions of the Senate, the Special Committee on Aging of the 
     Senate, and the Committee on Education and Labor of the House 
     of Representatives, a report on the activities funded under 
     this section and title IV.
       ``(8) The director shall, as appropriate, consult with 
     experts on aging research and evaluation and aging network 
     stakeholders on the implementation of the activities 
     described under paragraph (3) of this subsection.
       ``(9) The director shall coordinate all research and 
     evaluation authorities under this Act.''.

     SEC. 208. GRANT PROGRAM FOR MULTIGENERATIONAL COLLABORATION.

       Section 417 of the Older Americans Act of 1965 (42 U.S.C. 
     3032f) is amended--
       (1) by amending subsection (a) to read as follows:
       ``(a) Grants and Contracts.--The Assistant Secretary shall 
     award grants to, and enter into contracts with, eligible 
     organizations to carry out projects--
       ``(1) to provide opportunities for older individuals to 
     participate in multigenerational activities and civic 
     engagement activities that contribute to the health and 
     wellness of older individuals and individuals in younger 
     generations by developing--
       ``(A) meaningful roles for participants;
       ``(B) reciprocity in relationship building;
       ``(C) reduced social isolation and improved participant 
     social connectedness;
       ``(D) improved economic well-being for older individuals;
       ``(E) increased lifelong learning; or
       ``(F) support for older relative caregivers by--
       ``(i) providing support for older relative caregivers (as 
     defined in section 372) raising children (such as kinship 
     navigator programs); or
       ``(ii) involving volunteers who are older individuals who 
     provide support and information to families who have a child 
     with a disability or chronic illness, or other families in 
     need of such family support;
       ``(2) to coordinate multigenerational activities and civic 
     engagement activities, including multigenerational nutrition 
     and meal service programs;
       ``(3) to promote volunteerism, including becoming a mentor 
     to young people; and
       ``(4) to facilitate development of and participation in 
     multigenerational activities and civic engagement 
     activities.'',
       (2) by amending subsection (b) to read as follows:
       ``(b) Use of Funds.--
       ``(1) In general.--An eligible organization shall use funds 
     made available under a grant awarded, or a contract entered 
     into, under this section to carry out a project described in 
     subsection (a).
       ``(2) Provision of projects through grantees.--In making 
     grants under this section, the Assistant Secretary shall 
     ensure that awards are made for the activities and projects 
     described in each of paragraphs (1) and (2) of subsection 
     (a).'';
       (3) in subsection (c)--
       (A) in the matter preceding paragraph (1), by inserting 
     ``that serves individuals in younger generations and older 
     individuals'' after ``to carry out a project'';
       (B) in paragraph (1) by inserting ``, intent to carry out, 
     or intent to partner with local organizations or multiservice 
     organizations to carry out,'' after ``record of carrying 
     out'',
       (C) in paragraph (3) by striking ``; and'' and inserting a 
     semicolon,
       (D) in paragraph (4) by striking the period at the end and 
     inserting ``; and'', and
       (E) by adding at the end the following:
       ``(5) eligible organizations proposing multigenerational 
     activity projects that utilize shared site programs, such as 
     collocated child care and long-term care facilities.'',
       (4) by amending subsection (e) to read as follows:
       ``(e) Eligible Organizations.--Organizations eligible to 
     receive a grant or enter into a contract under subsection (a) 
     shall--
       ``(1) be a State, an area agency on aging, or an 
     organization that provides opportunities for older 
     individuals to participate in activities described in such 
     subsection; and

[[Page H8471]]

       ``(2) have the capacity to conduct the coordination, 
     promotion, and facilitation described in such subsection 
     through the use of multigenerational coordinators.'',
       (5) by striking subsection (g),
       (6) in subsection (h)(2)(B)(i) by striking ``individuals 
     from the generations with older individuals'' and inserting 
     ``older individuals'',
       (7) by redesignating subsections (b) through (f) as 
     subsections (c) through (g), respectively, and
       (8) by inserting after subsection (a) the following:
       ``(b) Grant Period.--Each grant awarded or contract made 
     under subsection (a) shall be to carry out projects for a 
     period of not less than 36 months.''.

       TITLE III--STRENGTHENING PROTECTIONS FOR OLDER INDIVIDUALS

     SEC. 301. STATE LONG-TERM CARE OMBUDSMAN PROGRAM MINIMUM 
                   FUNDING AND MAINTENANCE OF EFFORT.

       The Older Americans Act of 1965 (42 U.S.C. 3001 et seq.) is 
     amended--
       (1) by amending section 306(a)(9) to read as follows:
       ``(9) provide assurances that--
       ``(A) the area agency on aging, in carrying out the State 
     Long-Term Care Ombudsman program under section 307(a)(9), 
     will expend not less than the total amount of funds 
     appropriated under this Act and expended by the agency in 
     fiscal year 2019 in carrying out such a program under this 
     title; and
       ``(B) funds made available to area agencies on aging 
     pursuant to section 712 shall be used to supplement and not 
     supplant other Federal, State, and local funds expended to 
     support activities described in section 712.'', and
       (2) by amending section 307(a)(9) to read as follows:
       ``(9) The plan shall provide assurances that--
       ``(A) the State agency will carry out, through the Office 
     of the State Long-Term Care Ombudsman, a State Long-Term Care 
     Ombudsman program in accordance with section 712 and this 
     title, and will expend for such purpose an amount that is not 
     less than an amount expended by the State agency with funds 
     received under this title for fiscal year 2019, and an amount 
     that is not less than the amount expended by the State agency 
     with funds received under title VII for fiscal year 2019; and
       ``(B) funds made available to state agencies pursuant to 
     section 712 shall be used to supplement and not supplant 
     other Federal, State, and local funds expended to support 
     activities described in section 712.''.

     SEC. 302. STATE LONG-TERM CARE VOLUNTEER OMBUDSMAN 
                   REPRESENTATIVES.

       Section 712(a)(5) of the Older Americans Act of 1965 (42 
     U.S.C. 3058g(a)(5)) is amended--
       (1) by redesignating subparagraph (D) as subparagraph (E), 
     and
       (2) by inserting after subparagraph (C) the following:
       ``(D) Volunteer ombudsman representatives.--An individual 
     designated as a volunteer ombudsman representative may 
     receive financial support and recognition from the Office of 
     the State Long-Term Care Ombudsman Program for expenses 
     incurred during service.''.

     SEC. 303. CLARIFICATION REGARDING BOARD AND CARE FACILITIES.

       Section 102(35)(C) of the Older Americans Act of 1965 (42 
     U.S.C. 3002(35)(C)) is amended by striking ``for purposes of 
     sections 307(a)(12) and 712,''.

     SEC. 304. REPORT ON LEGAL HOTLINES.

       Not later than 3 years after the date of the enactment of 
     this Act, the Assistant Secretary on Aging shall prepare and 
     submit to the Congress a report containing--
       (1) information on which States or localities operate 
     senior legal hotlines,
       (2) information on how such hotlines operated by States or 
     localities are funded,
       (3) information on the usefulness of senior legal hotlines 
     in the coordination and provision of legal assistance, and
       (4) recommendations on additional actions that should be 
     taken related to senior legal hotlines.

     SEC. 305. COMMUNITY OUTREACH.

       Section 721(b)(12) of the Older Americans Act of 1965 (42 
     U.S.C. 3058i(b)(12)) is amended--
       (1) in subparagraph (C) by inserting ``community outreach 
     and education,'' after ``technical assistance'', and
       (2) in subparagraph (F)--
       (A) by striking ``studying'' and inserting 
     ``implementing'', and
       (B) by inserting ``, programs, and materials'' after 
     ``practices''.

     SEC. 306. PRINCIPLES FOR PERSON-DIRECTED SERVICES AND 
                   SUPPORTS DURING SERIOUS ILLNESS.

       (a) Definitions.--
       (1) Administrator.--The term ``Administrator'' means the 
     Administrator of the Administration for Community Living.
       (2) Area agency on aging; assistant secretary; state 
     agency.--The terms ``area agency on aging'', ``Assistant 
     Secretary'', and ``State agency'' have the meanings given the 
     terms in section 102 of the Older Americans Act of 1965 (42 
     U.S.C. 3002).
       (3) Covered agency.--The term ``covered agency'' means--
       (A) a State agency or area agency on aging; and
       (B) a Federal agency other than the Department of Health 
     and Human Services, and a unit of that Department other than 
     the Administration on Aging, that the Assistant Secretary 
     determines performs functions for which the principles are 
     relevant, and the Centers for Medicare & Medicaid Services.
       (4) Principles.--The term ``principles'' means the 
     Principles for Person-directed Services and Supports during 
     Serious Illness, issued by the Administration on September 1, 
     2017, or an updated set of such Principles.
       (b) Dissemination.--The Administrator shall disseminate the 
     principles to appropriate stakeholders within the aging 
     network, as determined by the Assistant Secretary, and to 
     covered agencies. The covered agencies may use the principles 
     in setting priorities for service delivery and care plans in 
     programs carried out by the agencies.
       (c) Feedback.--The Administrator shall solicit, on an 
     ongoing basis, feedback on the principles from covered 
     agencies, experts in the fields of aging and dementia, and 
     stakeholders who provide or receive disability services.
       (d) Report.--Not less often than once, but not more often 
     than annually, during the 3 years after the date of the 
     enactment of this Act, the Administrator shall prepare and 
     submit to Congress a report describing the feedback received 
     under subsection (c) and indicating if any changes or updates 
     are needed to the principles.

         TITLE IV--MEETING THE NEEDS OF OLDER NATIVE AMERICANS

     SEC. 401. EXPANDING SUPPORTIVE SERVICES FOR NATIVE AMERICAN 
                   AGING PROGRAMS.

       Title VI of the Older Americans Act of 1965 (42 U.S.C. 3057 
     et seq.) is amended--
       (1) in part D--
       (A) by amending section 643 to read as follows:

     ``SEC. 643. AUTHORIZATION OF APPROPRIATIONS.

       ``There are authorized to be appropriated to carry out this 
     title--
       ``(1) for parts A and B, $38,524,324 for fiscal year 2020, 
     $40,835,783 for fiscal year 2021, $43,285,930 for fiscal year 
     2022, $45,883,086 for fiscal year 2023, and $48,636,071 for 
     fiscal year 2024; and
       ``(2) for part C subject to section 644, $10,785,575 for 
     fiscal year 2020, $11,432,710 for fiscal year 2021, 
     $12,118,672 for fiscal year 2022, $12,845,792 for fiscal year 
     2023, and $13,616,540 for fiscal year 2024.'', and
       (B) by adding at the end the following:

     ``SEC. 644. FUNDING SET ASIDE.

       ``Of the funds appropriated under section 643(1) for a 
     fiscal year, not more than 5 percent shall be made available 
     to carry out part D for such fiscal year if for such fiscal 
     year--
       ``(1) the funds appropriated for parts A and B are greater 
     than the funds appropriated for such parts for fiscal year 
     2019; and
       ``(2) the Assistant Secretary makes available for parts A 
     and B not less than the amount of resources made available 
     for fiscal year 2019.'',
       (2) by redesignating part D as part E, and
       (3) by inserting after part C the following:

    ``PART D--SUPPORTIVE SERVICES FOR HEALTHY AGING AND INDEPENDENCE

     ``SEC. 636. PROGRAM.

       ``(a) In General.--The Assistant Secretary shall carry out 
     a competitive demonstration program for making grants to 
     tribal or Native Hawaiian organizations with applications 
     approved under parts A and B, to pay for the Federal share of 
     carrying out programs, to enable the organizations to build 
     their capacity to provide a wider range of in-home and 
     community supportive services to enable older individuals to 
     maintain their health and independence and to avoid long-term 
     care facility placement.
       ``(b) Supportive Services.--
       ``(1) In general.--Subject to paragraph (2), supportive 
     services described in subsection (a) may include any of the 
     activities described in section 321(a).
       ``(2) Priority.--The Assistant Secretary, in making grants 
     under this section, shall give priority to organizations that 
     will use the grant funds for supportive services described in 
     subsection (a) that are for in-home assistance, 
     transportation, information and referral, case management, 
     health and wellness programs, legal services, family 
     caregiver support services, and other services that directly 
     support the independence of the older individuals served.
       ``(c) Rule of Construction.--Nothing in this section shall 
     be construed or interpreted to prohibit the provision of 
     supportive services under part A or B.''.

     SEC. 402. ENHANCING CAPACITY TO SUPPORT NATIVE AMERICAN AGING 
                   PROGRAMS.

       Title II of the Older Americans Act of 1965 (42 U.S.C. 3011 
     et seq.) is amended--
       (1) in section 201(c)(3)(H) by inserting ``to ensure 
     adequate capacity to deliver the services under such title, 
     which technical assistance programs may include program 
     management, data development and use, basic business skills, 
     grant development, program and service innovations, and staff 
     professional development and certification'' before the 
     semicolon at the end, and
       (2) section 216 is amended to read as follows:

     ``SEC. 216. AUTHORIZATION OF APPROPRIATIONS.

       ``(a) In General.--For purposes of carrying out this Act, 
     there are authorized to be appropriated for administration, 
     salaries, and expenses of the Administration $44,042,171 for 
     fiscal year 2020, $46,684,701 for fiscal year 2021, 
     $49,485,783 for fiscal year 2022, $52,454,930 for fiscal year 
     2023, and $55,602,226 for fiscal year 2024.
       ``(b) Authorization of Appropriations for Programs.--There 
     are authorized to be appropriated--

[[Page H8472]]

       ``(1) to carry out section 201(g), $20,000,000 for each of 
     the fiscal years 2020 through 2024;
       ``(2) to carry out section 202(a)(21) (relating to the 
     National Eldercare Locator Service), $2,186,227 for fiscal 
     year 2020, $2,317,401 for fiscal year 2021, $2,456,445 for 
     fiscal year 2022, $2,603,832 for fiscal year 2023, and 
     $2,760,062 for fiscal year 2024;
       ``(3) to carry out sections 215 and 202(j), $1,992,460 for 
     fiscal year 2020, $2,112,008 for fiscal year 2021, $2,238,728 
     for fiscal year 2022, $2,373,052 for fiscal year 2023, and 
     $2,515,435 for fiscal year 2024;
       ``(4) to carry out section 202 (relating to Elder Rights 
     Support Activities under this title), $1,375,011 for fiscal 
     year 2020, $1,457,511 for fiscal year 2021, $1,544,962 for 
     fiscal year 2022, $1,637,660 for fiscal year 2023, and 
     $1,735,919 for fiscal year 2024;
       ``(5) to carry out section 202(b) (relating to the Aging 
     and Disability Resource Centers), $8,708,043 for fiscal year 
     2020, $9,230,526 for fiscal year 2021, $9,784,357 for fiscal 
     year 2022, $10,371,419 for fiscal year 2023, and $10,993,704 
     for fiscal year 2024; and
       ``(6) to carry out section 201(c)(3)(H) (relating to 
     professional development and technical assistance for 
     programs under title VI), $500,000 for fiscal year 2021.''.

                         TITLE V--MISCELLANEOUS

     SEC. 501. TECHNICAL CORRECTIONS.

       The Older Americans Act of 1965 (42 U.S.C. 3001 et seq.) is 
     amended--
       (1) in section 102(37)(A) by striking ``paragraph (5)'' and 
     inserting ``paragraph (26)'',
       (2) in section 202(a)(23) by striking ``sections 307(a)(18) 
     and 731(b)(2)'' and inserting ``sections 307(a)(13) and 
     731'',
       (3) in section 202(e)(1)(A) by moving the left margin of 
     clause (i) 2 ems to the left,
       (4) in sections 203(c)(7), 207(b)(2)(B), and 215(i) by 
     striking ``Committee on Education and the Workforce'' and 
     inserting ``Committee on Education and Labor'',
       (5) in section 207(b)(3)(A) by striking ``Administrator of 
     the Health Care Finance Administration'' and inserting 
     ``Administrator of the Centers for Medicare and Medicaid 
     Services'',
       (6) in section 304(a)(3)(C) by striking ``term'' and all 
     that follows through ``does'', and inserting ``term `State' 
     does'',
       (7) in section 304(d)(1)(B) by striking ``(excluding'' and 
     all that follows through ``303(a)(3))'',
       (8) in section 306(a)--
       (A) by inserting ``the number of older individuals at risk 
     for institutional placement residing in such area,'' after 
     ``areas) residing in such area,'' the last place it appears, 
     and
       (B) in paragraph (2) by striking ``who are victims of'' and 
     inserting ``with'',
       (9) in section 339 by striking ``Institute of Medicine of 
     the National Academy of Sciences'' and inserting ``National 
     Academies of Sciences, Engineering, and Medicine'',
       (10) in section 611 by striking ``(a)'', and
       (11) in section 614(c)(4) by striking ``(a)(12)'' and 
     inserting ``(a)(11)''.

     SEC. 502. AUTHORIZATION OF APPROPRIATIONS; USES OF FUNDS.

       (a) Authorization of Appropriations; Uses of Funds.--
     Section 303 of the Older Americans Act of 1965 (42 U.S.C. 
     3023) is amended to read as follows:

     ``SEC. 303. AUTHORIZATION OF APPROPRIATIONS; USES OF FUNDS.

       ``(a)(1) There are authorized to be appropriated to carry 
     out part B (relating to supportive services) $413,011,586 for 
     fiscal year 2020, $437,792,281 for fiscal year 2021, 
     $464,059,818 for fiscal year 2022, $491,903,407 for fiscal 
     year 2023, and $521,417,612 for fiscal year 2024.
       ``(2) Funds appropriated under paragraph (1) shall be 
     available to carry out section 712.
       ``(b)(1) There are authorized to be appropriated to carry 
     out subpart 1 of part C (relating to congregate nutrition 
     services) $531,279,663 for fiscal year 2020, $563,156,443 for 
     fiscal year 2021, $596,945,830 for fiscal year 2022, 
     $632,762,580 for fiscal year 2023, and $670,728,334 for 
     fiscal year 2024.
       ``(2) There are authorized to be appropriated to carry out 
     subpart 2 of part C (relating to home delivered nutrition 
     services) $269,577,167 for fiscal year 2020, $285,751,797 for 
     fiscal year 2021, $302,896,905 for fiscal year 2022, 
     $321,070,719 for fiscal year 2023, and $340,334,963 for 
     fiscal year 2024.
       ``(c) Grants made under part B, and subparts 1 and 2 of 
     part C, of this title may be used for paying part of the cost 
     of--
       ``(1) the administration of area plans by area agencies on 
     aging designated under section 305(a)(2)(A), including the 
     preparation of area plans on aging consistent with section 
     306 and the evaluation of activities carried out under such 
     plans; and
       ``(2) the development of comprehensive and coordinated 
     systems for supportive services, congregate and home 
     delivered nutrition services under subparts 1 and 2 of part 
     C, the development and operation of multipurpose senior 
     centers, and the delivery of legal assistance.
       ``(d) There are authorized to be appropriated to carry out 
     part D (relating to disease prevention and health promotion 
     services) $26,650,753 for fiscal year 2020, $28,249,798 for 
     fiscal year 2021, $29,944,786 for fiscal year 2022, 
     $31,741,473 for fiscal year 2023, and $33,645,961 for fiscal 
     year 2024.
       ``(e) There are authorized to be appropriated to carry out 
     part E (relating to family caregiver support) $194,331,264 
     for fiscal year 2020, $205,991,140 for fiscal year 2021, 
     $218,350,609 for fiscal year 2022, $231,451,645 for fiscal 
     year 2023, and $245,338,744 for fiscal year 2024.''.
       (b) Section 311(e) of the Older Americans Act of 1965 (42 
     U.S.C. 3030a(e)) is amended to read as follows:
       ``(e) There are authorized to be appropriated to carry out 
     this section (other than subsection (c)(1)) $171,682,200 for 
     fiscal year 2020, $181,983,132 for fiscal year 2021, 
     $192,902,120 for fiscal year 2022, $204,476,247 for fiscal 
     year 2023, and $216,744,822 for fiscal year 2024.''.
       (c) Section 411(b) of the Older Americans Act of 1965 (42 
     U.S.C. 3032(b)) is amended to read as follows:
       ``(b) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out--
       ``(1) aging network support activities under this section, 
     $14,549,157 for fiscal year 2020, $15,422,107 for fiscal year 
     2021, $16,347,433 for fiscal year 2022, $17,328,279 for 
     fiscal year 2023, and $18,367,976 for fiscal year 2024; and
       ``(2) elder rights support activities under this section, 
     $15,650,667 for fiscal year 2020, $16,589,707 for fiscal year 
     2021, $17,585,090 for fiscal year 2022, $18,640,195 for 
     fiscal year 2023, and $19,758,607 for fiscal year 2024.''.
       (d) Section 517(a) of the Older Americans Act of 1965 (42 
     U.S.C. 3056o(a)) is amended to read as follows:
       ``(a) In General.--There are authorized to be appropriated 
     to carry out this title $429,020,486 for fiscal year 2020, 
     $454,761,715 for fiscal year 2021, $482,047,418 for fiscal 
     year 2022, $510,970,263 for fiscal year 2023, and 
     $541,628,478 for fiscal year 2024.''.
       (e) Section 702 of the Older Americans Act of 1965 (42 
     U.S.C.3058a) is amended to read as follows:

     ``SEC. 702. AUTHORIZATION OF APPROPRIATIONS.

       ``(a) Ombudsman Program.--There are authorized to be 
     appropriated to carry out chapter 2, $18,110,027 for fiscal 
     year 2020, $19,196,629 for fiscal year 2021, $20,348,427 for 
     fiscal year 2022, $21,569,332 for fiscal year 2023, and 
     $22,863,492 for fiscal year 2024.
       ``(b) Other Programs.--There are authorized to be 
     appropriated to carry out chapters 3 and 4, $5,119,287 for 
     fiscal year 2020, $5,426,444 for fiscal year 2021, $5,752,031 
     for fiscal year 2022, $6,097,153 for fiscal year 2023, and 
     $6,462,982 for fiscal year 2024.''.

     SEC. 503. HOLD HARMLESS FORMULA.

       (a) In General.--Section 304(a)(3)(D) of the Older 
     Americans Act of 1965 (42 U.S.C. 3024(a)(3)(D)) is amended to 
     read as follows:
       ``(D)(i) In this subparagraph and paragraph (5):

       ``(I) The term `allot' means allot under this subsection 
     from a sum appropriated under section 303(a) or 303(b)(1), as 
     the case may be.
       ``(II) The term `covered fiscal year' means any of fiscal 
     years 2020 through 2029.

       ``(ii) If the sum appropriated under section 303(a) or 
     303(b)(1) for a particular fiscal year is less than or equal 
     to the sum appropriated under section 303(a) or 303(b)(1), 
     respectively, for fiscal year 2019, amounts shall be allotted 
     to States from the sum appropriated for the particular year 
     in accordance with paragraphs (1) and (2), and subparagraphs 
     (A) through (C) as applicable, but no State shall be allotted 
     an amount that is less than--

       ``(I) for fiscal year 2020, 99.75 percent of the 
     corresponding sum appropriated for fiscal year 2019;
       ``(II) for fiscal year 2021, 99.50 percent of that sum;
       ``(III) for fiscal year 2022, 99.25 percent of that sum;
       ``(IV) for fiscal year 2023, 99.00 percent of that sum;
       ``(V) for fiscal year 2024, 98.75 percent of that sum;
       ``(VI) for fiscal year 2025, 98.50 percent of that sum;
       ``(VII) for fiscal year 2026, 98.25 percent of that sum;
       ``(VIII) for fiscal year 2027, 98.00 percent of that sum;
       ``(IX) for fiscal year 2028, 97.75 percent of that sum;
       ``(X) for fiscal year 2029, 97.50 percent of that sum.

       ``(iii) If the sum appropriated under section 303(a) or 
     303(b)(1) for a particular covered fiscal year is greater 
     than the sum appropriated under section 303(a) or 303(b)(1), 
     respectively, for fiscal year 2019, the allotments to States 
     from the sum appropriated for the particular year shall be 
     calculated as follows:

       ``(I) From the portion equal to the corresponding sum 
     appropriated for fiscal year 2019, amounts shall be allotted 
     in accordance with paragraphs (1) and (2), and subparagraphs 
     (A) through (C) as applicable, but no State shall be allotted 
     an amount that is less than the percentage specified in 
     clause (ii), for that particular year, of the corresponding 
     sum appropriated for fiscal year 2019.
       ``(II) From the remainder, amounts shall be allotted in 
     accordance with paragraph (1), subparagraphs (A) through (C) 
     as applicable, and paragraph (2) to the extent needed to meet 
     the requirements of those subparagraphs.''.

       (b) Repeal.--Section 304(a)(3)(D) of the Older Americans 
     Act of 1965 (42 U.S.C. 3024(a)(3)(D)) is repealed effective 
     October 1, 2029.

  The SPEAKER pro tempore. Pursuant to the rule, the gentlewoman from 
Oregon (Ms. Bonamici) and the gentlewoman from New York (Ms. Stefanik) 
each will control 20 minutes.
  The Chair recognizes the gentlewoman from Oregon.


                             General Leave

  Ms. BONAMICI. Mr. Speaker, I ask unanimous consent that all Members

[[Page H8473]]

may have 5 legislative days in which to revise and extend their remarks 
and insert extraneous material on H.R. 4334, the Dignity in Aging Act.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from Oregon?
  There was no objection.
  Ms. BONAMICI. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in strong support of H.R. 4334, the Dignity in 
Aging Act of 2019. I introduced this bipartisan bill to reauthorize and 
update the Older Americans Act, or OAA, which was first passed in 1965 
as part of President Lyndon Johnson's Great Society initiative.
  For more than 50 years, OAA programs have helped older Americans 
maintain their independence and their dignity.
  Today, the Older Americans Act serves about 11 million individuals 
each year, with 3 million of those Americans relying regularly on OAA 
programs to meet their basic needs. Unfortunately, funding for the 
Older Americans Act lags far behind the increasing demand for its 
services.
  Although the population of Americans over age 60 has grown more than 
60 percent since 2001, OAA funding has only grown by about 20 percent. 
Adjusting for inflation, this means that OAA funding has declined by 
about 16 percent.
  That erosion of funding exacerbates the vast unmet need in my home 
State of Oregon and across the country. It means that every day in our 
communities there are seniors who do not have the care they need and 
deserve.
  I have heard and read too many stories about seniors rationing 
medication or saving portions of their meal so they can stretch their 
resources just a bit further into the week. I will never forget the 
story I heard of an 80-year-old woman in Oregon who was living in her 
car. She did not know where to turn for help.
  Far too many Americans continue to face poverty, discrimination, and 
barriers to basic necessities. This is, in part, because OAA programs 
are underfunded and not fully supported.
  According a 2015 GAO report, OAA services do not reach 83 percent of 
the low-income, older Americans who experience food insecurity. That is 
more than four out of every five seniors in need.
  Today, we recommit to investing in OAA programs because we have an 
obligation, a moral obligation, to take care of those who cared for us.
  The Dignity in Aging Act authorizes record levels of funding for OAA 
programs, which will help expand access to food assistance, 
transportation, and other basic services that the growing population of 
seniors needs to live independently.
  Under this bill, all OAA programs are eligible to receive an 
immediate 7 percent increase in funding and a 6 percent increase each 
year thereafter. This will result in a more than 35 percent total 
increase in program funding over the 5-year reauthorization program, 
restoring OAA funding to prerecession baseline.
  This is a good investment because OAA programs help seniors stay in 
their homes and out of costly facilities.
  The bill also recognizes the need to support family caregivers and 
direct-care workers. It extends the RAISE Family Caregivers Act, which 
helps develop a national strategy to recognize and support those caring 
for their loved ones. My 91-year-old mother has Alzheimer's, so I know 
how important caregivers are.
  H.R. 4334 strengthens our focus on combating social isolation, which 
greatly increases the risk of stroke, heart disease, dementia, and 
premature death. It does so by incorporating social isolation screening 
into the health and supportive services that seniors receive and by 
empowering local organizations to evaluate solutions for social 
isolation.
  The Dignity in Aging Act also establishes a National Research, 
Demonstration, and Evaluation Center for the Aging Network. This center 
will be responsible for conducting, promoting, and coordinating 
research, including evaluation and demonstration projects and related 
technical assistance through the act. The center will increase the 
repository of information on evidence-based programs and interventions 
available to the Aging Network.
  The bill improves economic opportunity and engagement for older 
Americans. It includes individuals who are justice-involved as a 
priority population for the Senior Community Service Employment 
Program.
  The bill also encourages the inclusion of arts education and cultural 
experiences, among other supportive services, and further allows for 
demonstration funds to be used for multigenerational collaboration 
projects that provide opportunities for older individuals to 
participate in multigenerational activities and civic engagement 
activities.
  Finally, this bipartisan legislation seeks to improve services for 
historically underserved and marginalized individuals, including Native 
Americans, Holocaust survivors, and LGBT seniors. For example, it will 
create a National Technical Assistance Center dedicated to expanding 
the Aging Network's capacity to deliver person-centered, trauma-
informed services that meet the needs of aging trauma survivors.
  The bill codifies the National Resource Center on Women and 
Retirement to recognize the ongoing importance of their work, and it 
improves data collection and outreach for all resource centers that 
focus on populations needing additional or unique services.
  This bill provides a rare bipartisan opportunity to help millions of 
older Americans across the country spend less of their limited income 
on costly care and, just as importantly, empowers every individual to 
age with dignity.
  I would like to thank Education and Labor Committee Chairman  Bobby 
Scott and Ranking Member Virginia Foxx, as well as my coleads on the 
bill--Representative Elise Stefanik; Subcommittee Ranking Member 
Representative   James Comer; and Representatives Susie Lee, Susan 
Wild, and Dusty Johnson--for working together to bring this bipartisan 
bill to the floor.
  I also want to thank the hardworking staff, especially Carrie Hughes 
and Ali Hard from the committee; my personal office staff: Jack 
Arriaga, Allison Smith, and Rachael Bornstein; and the staff on both 
sides of the aisle.
  Mr. Speaker, I encourage my colleagues to join me in supporting this 
legislation so we can better care for those who have cared for us, and 
I reserve the balance of my time.
  Ms. STEFANIK. Mr. Speaker, I yield myself such time as I may consume.
  As the Representative of a district that has one of the largest 
constituencies of older Americans, I am proud to rise as a coauthor of 
H.R. 4334, the Dignity in Aging Act, bipartisan legislation that 
reauthorizes the Older Americans Act, which will directly benefit the 
seniors in my district and the seniors across the country.
  Since 1965, this statute has provided a wide range of social and 
nutrition services for Americans aged 60 years or older. In addition to 
well-known programs like Meals on Wheels, the Older Americans Act 
supports services that include nutrition programs providing meals at 
senior centers, schools, and churches; care to prevent abuse, neglect, 
and exploitation of seniors; family caregiver support systems; and 
community service employment opportunities for older Americans.
  This legislation is full of bipartisan agreements and priorities, and 
during times of stark political divide, it is encouraging to be here 
today with my colleagues on both sides of the aisle to speak in support 
of the Dignity in Aging Act, which is the product of a diligent, 
congenial effort that embodies the good that can come from working 
across the aisle.
  The bill before us today provides States the flexibility to spend 
funds on the issues impacting their senior communities, which include 
support for older Americans who have become caregivers of younger 
relatives due to the devastating toll of the opioid epidemic on our 
communities.
  It enhances the cost effectiveness of critical programs and ensures 
program accountability and integrity by prohibiting the renewal of 
grants that do not demonstrate effectiveness.
  It assists formerly incarcerated, older individuals in reentering the 
workforce rather than re-offend and ensures that funded programs are 
evidence based and effectively serving seniors.

[[Page H8474]]

  Additionally, this bill includes long-overdue updates from the 
Younger Onset Alzheimer's Act that I co-led with my friend and 
colleague from New York, Congresswoman Kathleen Rice.
  Those under 60 with this heartbreaking disease face unique hardships, 
for themselves and for their families. The current support structures 
for individuals with Alzheimer's are focused almost exclusively on 
seniors, leaving the 200,000 Americans living with younger onset 
Alzheimer's without access to these critical services.
  This bill ensures individuals of any age living with Alzheimer's 
receive full access to the services and support provided by the Older 
Americans Act.
  I am also very proud to say that included in this bill is language 
from another bipartisan legislative proposal that I coauthored 
encouraging the use of caregiver assessments to identify the needs of 
family caregivers.
  This individualized approach to care will ensure that both caregivers 
and those who require assistance are provided tailored support to 
achieve the best possible health outcomes.
  There is another group of older Americans in this country we must not 
forget: the nearly 80,000 Holocaust survivors who live among us. As 
victims of the very worst of humanity, Holocaust survivors deserve 
devoted care and support to address the unimaginable, horrific trauma 
they experienced. Sadly, one-third of our country's Holocaust survivors 
live in poverty.
  During the markup process in the House Committee on Education and 
Labor, I was honored to work with my friend and colleague, 
Representative Bonamici, on a provision that works to address the needs 
of aging Holocaust survivors.
  Institutional placement can present a unique challenge to those who 
have suffered the trauma of the Holocaust, so it is critical that these 
individuals are identified for the services necessary to support 
independent living. Our provision will ensure local outreach efforts 
place a special emphasis on Holocaust survivors and others at risk for 
institutional placement.
  Additionally, the bill recognizes the specific needs of this 
community by ensuring that nutrition programs should meet the 
religious, cultural, or ethnic dietary requirements of all older 
Americans.
  These men and women have survived unconscionable suffering, yet many 
continue to live with physical and emotional scars from the horror they 
faced. Together, we acknowledge their resilience and seek to offer 
opportunities that allow them to live healthy, dignified, and 
independent lives through their elder years.
  Mr. Speaker, I am encouraged by the bipartisan effort from the 
Education and Labor Committee that has resulted in the meaningful 
legislation before us today. I strongly encourage all of my colleagues 
to vote ``yes'' on H.R. 4334, the Dignity in Aging Act. In doing so, we 
reaffirm our commitment to our Nation's older generation.
  Mr. Speaker, I reserve the balance of my time.
  Ms. BONAMICI. Mr. Speaker, I yield 3 minutes to the gentleman from 
Virginia (Mr. Scott), chairman of the Education and Labor Committee.
  Mr. SCOTT of Virginia. Mr. Speaker, I thank Representatives Bonamici, 
Stefanik, Lee of Nevada, Comer, Wild, and Johnson of South Dakota for 
their work on this bipartisan bill.
  I want to specifically recognize Ms. Bonamici, who serves as the 
chair of the Subcommittee on Civil Rights and Human Services for the 
Committee on Education and Labor. Because of her leadership, we are 
here today to consider the Dignity in Aging Act and to reauthorize the 
Older Americans Act and, thereby, support and invest in our Nation's 
seniors.

                              {time}  1445

  Congress first passed the Older Americans Act in 1965, along with 
Medicare, Medicaid, and other civil rights legislation as part of 
President Johnson's great society.
  Fifty-four years later, this act continues to support a range of 
programs that now help 11 million aging Americans retain their 
independence and avoid costly institutional care. This includes 3 
million Americans who regularly use OAA services to address their basic 
needs, especially food, transportation, and social interaction.
  Unfortunately, the OAA funding has not kept pace with inflation and 
the growing population of aging Americans. In 2010, the annual funding 
was $42.95 per senior in today's dollars. Today, it is not $42.95, it 
is only $27.25.
  This disinvestment has weakened the OAA programs at a time when 
services are in high demand. According to a 2015 GAO report, OAA 
services fail to reach a vast majority of low-income Americans who 
experience food insecurity.
  The investments we make through this legislation will not only allow 
us to help seniors, but also help us save money. OAA services allow 
older Americans to delay or altogether avoid costlier care by promoting 
healthier behaviors and promoting critical supportive services.
  The bill funds OAA services at record levels. It focuses on the vital 
role of family caregivers, as well as direct care workers, and allows 
those with early onset Alzheimer's to benefit from the act.
  As the number of older Americans continues to increase, the Dignity 
in Aging Act is an opportunity for us to strengthen essential services 
that allow millions of Americans across the country to age 
independently and with dignity. I urge my colleagues to support the 
Dignity in Aging Act of 2019.
  Ms. STEFANIK. Mr. Speaker, I yield 2 minutes to the gentleman from 
Kentucky (Mr. Comer), the ranking member of the Subcommittee on Civil 
Rights and Human Services.
  Mr. COMER. Mr. Speaker, today's life expectancy rate in our Nation is 
at a historic high, and that is great news. It also means we need to be 
doing all we can to ensure that Americans have access to quality, 
timely services which allow them to live independently in their homes 
as long as possible.
  Since 1965, the Older Americans Act, or OAA, has governed the 
organization and delivery of services for senior citizens throughout 
the country. With more than 41 million Americans aged 65 and older, the 
social and nutritional programs offered by OAA are critical to helping 
them maintain independence.
  The reach of this law is substantial and covers many aspects of elder 
care. In addition to well-known programs like Meals on Wheels, OAA 
supports services provided by more than 300 State organizations and 
approximately 20,000 local providers. Some of these services include: 
Nutrition programs providing meals at senior centers, schools and 
churches; care to prevent the abuse, neglect, and exploitation of 
seniors; family caregiver support systems; and community service 
employment opportunities for older Americans. These types of programs 
offer valuable assistance for America's seniors, and we must ensure the 
law is aging as well as the people it serves.
  I am proud that our committee has worked together to produce 
bipartisan, effective legislation to support our Nation's seniors. 
Specifically, the Dignity in Aging Act we are considering today 
eliminates the arbitrary cap on the percentage of funding Area Agencies 
on Aging can use to provide services to older caregivers raising 
younger relatives. These provisions will be especially beneficial for 
my constituents in Kentucky where, in the midst of the opioid crisis, 
many older relatives have taken on the responsibilities of raising 
children whose parents are not present or unable to take care of them.
  As an original cosponsor of this legislation, and the ranking member 
of the subcommittee of jurisdiction, I appreciate the work of 
Chairwoman Bonamici, and my colleagues on the Committee on Education 
and Labor to advance the Dignity in Aging Act of 2019.
  I urge all my colleagues to support this legislation to build upon 
the flexible policies found in the Older Americans Act to promote 
consumer-driven, independent living for our Nation's elderly 
population.
  Ms. BONAMICI. Mr. Speaker, I yield 1 minute to the gentlewoman from 
Illinois (Ms. Underwood), a member of the Education and Labor 
Committee.
  Ms. UNDERWOOD. Mr. Speaker, I rise today in strong support of H.R. 
4334, the Dignity in Aging Act of 2019. This is a strong bipartisan 
bill to reauthorize the Older Americans Act, which provides vital 
services and support to seniors and their families in our community.

[[Page H8475]]

  Reauthorization has been an important local priority in my community 
in northern Illinois.
  During the August work period, I held a roundtable on the issue at 
the Fox Valley Older Adult Services with local stakeholders. Their 
priorities for reauthorization included increased funding, 
transportation, legal services, and support for seniors who age in 
place, and their caregivers.
  That is why I am so proud that the bill that we are discussing today, 
among other improvements: Increases overall transportation program 
funding by 35 percent; improves access to that funding; increases 
availability and accessibility of meals for seniors; and strengthens 
support for family caregivers, including those caring for individuals 
with younger-onset Alzheimer's disease.
  I am so proud that this bill includes my bipartisan amendment to 
ensure that programs that serve seniors are ready to respond to 
outbreaks or other public health emergencies.
  I urge my colleagues on both sides of the aisle to support the 
Dignity in Aging Act so that our seniors have the services and support 
they need.
  Ms. STEFANIK. Mr. Speaker, I yield 2 minutes to the gentleman from 
Georgia (Mr. Allen), the ranking member on the Subcommittee on Early 
Childhood, Elementary, and Secondary Education.
  Mr. ALLEN. Mr. Speaker, 54 years ago, our country made a commitment 
to older Americans and their families. In 1965, the Older Americans Act 
was enacted to support a wide range of services and programs for 
individuals over the age of 60. By passing this legislation, Congress 
made a promise to help provide compassionate care to our Nation's most 
vulnerable adults who are sometimes exploited, abused, or neglected.

  This legislation is vital to Georgia's seniors, and it supports many 
important community-based services like nutrition programs at churches 
and family caregiver support.
  I have seen the benefits of these programs firsthand, as I have had 
several opportunities to deliver Meals on Wheels to those who are 
unable to grocery shop or prepare a warm meal for themselves. What a 
privilege, as a Member of Congress, to visit with these older adults 
and talk to them about their contribution to this great country as we 
delivered these meals.
  This legislation upholds the dignity of those who are aging, and it 
has received bipartisan support for more than 50 years. Today should be 
no different, as we have a responsibility to uphold the promise that 
was made to support our Nation's seniors.
  I urge my colleagues to, once again, reauthorize the Older Americans 
Act.
  Ms. BONAMICI. Mr. Speaker, I yield 3 minutes to the gentlewoman from 
New York (Miss Rice) who, along with Representative Stefanik, were lead 
sponsors of the Younger Onset Alzheimer's Act, which was included in 
this legislation.
  Miss RICE of New York. Mr. Speaker, I rise today in support of H.R. 
4334, the Dignity in Aging Act of 2019, which includes key provisions 
from our bill, the Younger Onset Alzheimer's Act.
  This critical legislation will amend the Older Americans Act to 
ensure that the hundreds of thousands of Americans living with younger-
onset Alzheimer's disease receive the care and support that they 
desperately need and deserve.
  The Older Americans Act was originally enacted in 1965 and supports a 
range of home and community-based programs for Americans age 60 and 
older. These programs include nutritional services like Meals on 
Wheels, in-home and adult daycare, transportation services, legal aid, 
elder abuse prevention, and vital assistance and support for family 
caregivers. These programs have become absolutely essential to people 
living with Alzheimer's disease and their families.
  However, today 5 percent of Americans living with Alzheimer's 
disease, approximately 250,000 people, are living with younger-onset 
Alzheimer's, a disease that has a particularly devastating effect on 
families, with diagnoses coming in individual's thirties, forties, or 
fifties, when they still have young children, new homes and growing 
careers. They are in the prime of their lives, and they don't always 
have the financial stability to leave the workforce, which is usually 
inevitable.
  And because of their young age, they are currently ineligible for all 
OAA-funded programs. Virtually overnight, these families face 
unimaginable and unforeseen financial and emotional strain; and yet 
they are denied access to critical OAA programs, programs that we know 
work, and that so many people with Alzheimer's rely on every day.
  By including major provisions from our bill, the Dignity in Aging Act 
will ensure that younger Alzheimer's patients and their families have 
access to critical programs and support.
  Before I conclude, Mr. Speaker, I want to take a moment to 
acknowledge two of my constituents who helped bring this issue to my 
attention, Karen Henley and Connie Wasserman.
  Karen lost her husband, Mike, to younger-onset Alzheimer's in 2012. 
He was diagnosed at the age of 36 and passed away at 47.
  Karen, Mike, and their two children, Brandon and Courtney, 
experienced firsthand how challenging it is for people with this 
disease to find affordable and quality care.
  Connie Wasserman is the Associate Executive Director of Social 
Services of the Sid Jacobson JCC in East Hills, New York. For years, 
she has played a crucial role in supporting people and families living 
with younger-onset Alzheimer's right on Long Island, families like the 
Henleys, who had nowhere to go.
  But because the government does not fund Alzheimer's programs for 
people under the age of 60, Connie has had to start her own. And right 
now, she relies almost entirely on private funding.
  Connie and Karen have become tireless advocates for those living with 
younger-onset Alzheimer's, and they worked closely with my office on 
this bill.
  As fate should have it, today is Karen and Mike Henley's wedding 
anniversary and, in honor of them, I ask all of my colleagues to 
support the Dignity in Aging Act of 2019.
  Ms. STEFANIK. Mr. Speaker, I yield 4 minutes to the gentlewoman from 
North Carolina (Ms. Foxx), the Republican leader of the Committee on 
Education and Labor.
  Ms. FOXX of North Carolina. Mr. Speaker, I would like to begin by 
thanking Representative Stefanik for her leadership on this legislation 
before us today.
  I rise today to speak in support of H.R. 4334, the Dignity in Aging 
Act, which will reauthorize the Older Americans Act through 2024.
  For over 50 years, the Older Americans Act, or OAA, has helped 
provide social and nutrition services to older Americans. With more 
than 40 million Americans aged 65 and older, the programs and services 
offered by OAA are helping them maintain independence, and the data 
shows overwhelmingly that these programs help older Americans live 
higher-quality lives.
  The reach of this law is substantial and covers many aspects of elder 
care beyond just well-known programs like Meals on Wheels. OAA supports 
services that include: Nutrition programs providing meals at senior 
centers, schools, and churches; care to prevent the abuse, neglect, and 
exploitation of seniors; family caregiver support systems; and services 
to help older Americans move into employment.

  This reauthorization is the product of bipartisan hard work with 
Members of the Education and Labor Committee and shows the good that 
can come from working together. Through productive conversation and 
compromise, we have successfully authorized grants for States and Area 
Agencies on Aging, AAAs, responsible for coordinating local services 
for older individuals.
  Specifically, the supportive services program funds a wide range of 
social services aimed at helping our older population remain 
independent in their own homes and communities. These services include, 
case management, adult daycare, and other numerous activities of senior 
centers. Additionally, States are required to devote a certain portion 
of funding to access services, home care, and legal assistance.
  Furthermore, local agencies that implement the law on the ground will 
receive additional clarity about cost-sharing policies designed to 
increase the cost-effectiveness of OAA programs.

[[Page H8476]]

  The bill also infuses additional accountability over hardworking 
taxpayer funds into these programs by requiring programs to demonstrate 
they met their stated goals prior to receiving a renewal of their 
grant.
  In addition to funding for supportive services and nutrition 
services, H.R. 4334 also provides for caregiver support. The bill 
continues support for the National Family Caregiver Support Program, 
which provides funds to States to support Americans caring for aging 
family members.

                              {time}  1500

  The program provides a range of services, including information and 
assistance to caregivers about available services, counseling, 
organization of support groups and caregiver education, respite 
services to provide families temporary relief from care-giving 
responsibilities, and supplemental services to complement care provided 
by other caregivers.
  The bill also provides increased flexibility to states by lifting a 
cap on the percentage of funds that can go to older relative 
caregivers, which will allow for additional support for those seniors 
who have taken responsibility for caring for family members due to the 
growing problem of opioids in our Nation.
  Mr. Speaker, I am very encouraged by the teamwork and bipartisanship 
that went into this bill. H.R. 4334, the Dignity in Aging Act, reflects 
Congress' commitment to our Nation's seniors and builds upon the law's 
flexible policies, allowing older Americans to age with health, 
dignity, and independence in the communities of their choosing.
  I would like, again, to thank Representative Stefanik for her 
diligent work on this legislation and Chairman Scott for his commitment 
to bipartisanship. I strongly urge all of my colleagues to support this 
reauthorization that will benefit an entire generation of older 
Americans.
  Ms. BONAMICI. Mr. Speaker, I yield 3 minutes to the gentlewoman from 
Pennsylvania (Ms. Wild), a member of the Education and Labor Committee 
and a passionate advocate for suicide prevention.
  Ms. WILD. Mr. Speaker, back in 1965, when President Lyndon Johnson 
signed the Older Americans Act, Congress codified into law an essential 
and universal truth, that each generation has a responsibility to 
protect and support those who raised and have cared for us.
  These bonds of solidarity tie our society together. We are stronger 
both as individuals and as a Nation when we hold each other up.
  The objectives of the Older Americans Act were to secure adequate 
income in retirement, the best possible physical and mental health 
services without regard to economic status, suitable housing and 
transportation, restorative services, and employment opportunities free 
of discrimination.
  The programs funded through the OAA remain immensely popular, but 
funding has not kept pace. In 2010, OAA funding was approximately 
$42.95 per senior in today's dollars. Today, it is just $27.25 per 
senior.
  Every time funding fails to meet demand, the foundation of our Great 
Society is chipped away. Every time funding fails to meet demand, we 
run the risk of malnutrition, unsafe living conditions, and social 
isolation for our seniors.
  Fortunately, there is a solution, and that solution is the 
legislation we are voting on today. The Dignity in Aging Act of 2019 is 
a bipartisan reauthorization of the OAA, which gives all OAA programs 
an immediate 7 percent increase in fiscal year 2020 and a 6 percent 
increase every year thereafter.
  Reflecting the fact that this is a national priority, transcending 
differences of party and politics, three of my Republican colleagues--
Representative Dusty Johnson, Representative Stefanik, and 
Representative Comer--worked alongside me as original cosponsors of 
this legislation, which was introduced by my colleague Representative 
Bonamici.
  Critically, this legislation includes provisions that will guide 
OAA's nutrition programs, like Meals on Wheels, programs that meet an 
urgent need across our country, and it includes language that will 
benefit our seniors by ensuring access to nutritional services that are 
culturally sensitive and reflect the diverse needs of our communities.
  I am particularly proud that this bill updates the OAA by putting a 
greater focus on countering social isolation, empowering local 
organizations to develop solutions that incorporate social isolation 
screening into mental health and supportive services that seniors 
receive.
  That is why I proposed an amendment unanimously adopted by the 
Education and Labor Committee as part of the underlying legislation to 
add screening for suicide risk to the disease prevention and health 
promotion services offered under the OAA.
  Older Americans are among the most at-risk members of our population 
when it comes to the suicide epidemic across our Nation. We must stand 
with these fellow Americans and offer them our support as we all work 
to break the stigma around suicide and mental health, and as we all 
work to build a society in which we prioritize mental health just as 
much as physical health.
  Ms. STEFANIK. Mr. Speaker, I reserve the balance of my time.
  Ms. BONAMICI. Mr. Speaker, I yield myself such time as I may consume.
  I include in the Record letters of support from AARP supporting H.R. 
4334, a letter from the Jewish Federation of North America supporting 
H.R. 4334, a letter from the Alzheimer's Association and the 
Alzheimer's Impact Movement supporting the legislation, a letter from 
72 national organizations representing older adults and caregivers 
across the country, and a letter from Meals on Wheels supporting H.R. 
4334 and its attention to the impacts of social isolation.


                                                         AARP,

                                                 October 25, 2019.
       Dear Representative: On behalf of our nearly 38 million 
     members and all older Americans nationwide, AARP is pleased 
     to support H.R. 4334, the bipartisan Dignity in Aging Act of 
     2019, legislation to reauthorize the Older Americans Act 
     (OAA). We urge you to pass this legislation that will 
     maintain the critical service and information roles of OAA 
     programs and promote greater responsiveness to the needs of 
     older Americans.
       Too often, advancing age and increasing frailty threaten 
     the ability of older Americans to live independently in their 
     own homes and communities. The fear of having to leave family 
     behind and enter a nursing home weighs heavily on the minds 
     of many. According to AARP's Home and Community Preferences 
     Survey, the vast majority of adults age 50-plus--more than 
     three out of four people--want to remain in their community 
     as long as possible. Giving Americans the support they need 
     to live at home with independence and dignity has always been 
     a bedrock goal of OAA, and it has been remarkably successful.
       For many older Americans, the key to being able to stay in 
     their own homes is the dedication and commitment of family 
     caregivers. An estimated 40 million family caregivers provide 
     a staggering $470 billion annually in unpaid care to their 
     loved ones--ranging from bathing and dressing to paying bills 
     and transportation and assisting with medical/nursing tasks. 
     By supporting family caregivers, we can help people stay at 
     home, helping to delay or prevent more costly nursing home 
     care and unnecessary hospitalizations. Therefore, we are 
     pleased the Dignity in Aging Act addresses AARP's family 
     caregiving priorities, including further strengthening the 
     National Family Caregiver Support Program (NFCSP) and 
     extending the bipartisan Recognize, Assist, Include, Support, 
     and Engage (RAISE) Family Caregivers Act (P.L. 115-119).
       Specifically, the legislation includes H.R. 3782, the 
     bipartisan Supporting Family Caregivers Act sponsored by 
     Representatives Andy Levin and Elise Stefanik. This provision 
     will help make sure that more caregivers can get their needs 
     assessed when they turn to NFCSP for support. Understanding 
     the family caregiving situation is a critical step in the 
     process for linking the family caregiver to the most 
     appropriate support services, as every family's needs are 
     unique. Assessments of the caregiving situation provide 
     information to help target services more effectively. Better 
     targeting of support services can also help maintain the 
     health and well-being of the caregiver, sustain their ability 
     to provide care, produce better outcomes for their loved 
     ones, and prevent or delay nursing home placement. H.R. 4334 
     also provides more time for implementation of the RAISE 
     Family Caregivers Act. This will allow the Advisory Council 
     to do its work and find additional meaningful solutions to 
     better support the 40 million family caregivers nationwide.
       Importantly, H.R. 4334 also provides increased funding 
     levels for OAA programs. People age 80 and older are among 
     the most likely to need assistance to live independently in 
     their homes and communities. The population of Americans in 
     this age group is projected to increase by 54 percent from 
     2019 to 2030. Additionally, over the next decade, the number 
     of family caregivers is not expected to keep up with the 
     large number of

[[Page H8477]]

     older adults needing care, underscoring the need for greater 
     investments in OAA programs. Increased funding levels will 
     assist more older Americans and caregivers, thus helping more 
     older adults remain at home and in better health, avoiding 
     costlier services.
       We urge you to vote for the Dignity in Aging Act. Prompt 
     reauthorization of this law will help ensure the 
     sustainability of OAA programs, and as a result, our loved 
     ones can continue to turn to these vital services for their 
     health and economic security as they age. If you have any 
     questions, feel free to contact me.
           Sincerely,

                                                 Bill Sweeney,

                                            Senior Vice President,
     Government Affairs.
                                  ____

                                         The Jewish Federations of


                                                North America,

                                 Washington, DC, October 25, 2019.
     Chairman Robert C. Scott,
     House Education and Labor Committee,
     Washington, DC.
     Ranking Member Virginia Foxx,
     House Education and Labor Committee,
     Washington, DC.
     Chairwoman Suzanne Bonamici,
     House Education and Labor Committee, Subcommittee on Civil 
         Rights and Human Services,
     Washington, DC.
     Ranking Member James R. Comer,
     House Education and Labor Committee, Subcommittee on Civil 
         Rights and Human Services,
     Washington, DC.
       Dear Chairman Scott, Ranking Member Foxx, Chairwoman 
     Bonamici and Ranking Member Comer: The Jewish Federations of 
     North America (JFNA) is proud to endorse H.R. 4334, the 
     Dignity in Aging Act of 2019. JFNA represents 146 local 
     Jewish Federations, 300 Network communities, and thousands of 
     affiliated social service agencies across the continent. Our 
     movement protects and enhances the well-being of Jews 
     worldwide through the values of tikkun olam (repairing the 
     world), tzedakah (charity and social justice) and torah 
     (Jewish learning). Jewish social services provide support for 
     more than one million vulnerable individuals each year, 
     Jewish and non-Jewish alike, with our clients spanning the 
     age range and including approximately 100,000 older adults.
       For more than 50 years, the Older Americans Act (OAA) has 
     been essential in developing, coordinating, and delivering 
     home and community-based services that help older adults age 
     with independence and dignity in their homes and communities. 
     Without these crucial services, many individuals served by 
     OAA-funded programs in our network are at significant risk of 
     hunger, isolation, and losing their ability to live with 
     health and independence.
       The Jewish community is disproportionately older than the 
     general population in this country with more than 25% of 
     American Jews already over the age of 65, and the fastest 
     growing demographic in the Jewish community is those over the 
     age of 85. Jewish family service agencies, Jewish vocational 
     service agencies and Jewish community centers are a key 
     component of the country's Aging Services Network and, in a 
     classic public-private partnership, provide many services 
     funded through the OAA, including case management, 
     transportation, congregate and home-delivered meals, adult 
     day care, elder abuse prevention and intervention, family 
     caregiver support, home care, legal conservatorship, and 
     support groups.
       This year's reauthorization process produced a bill that, 
     if passed by the full House of Representatives on Monday, 
     will significantly move the ball forward in how our country 
     and its Aging Services Network treat and care for seniors. 
     The very first provision of the Dignity in Aging Act 
     incorporates ``person-centered, trauma-informed care'' as a 
     new objective of the Older Americans Act. This principle, 
     which is subsequently defined in the bill, represents a new 
     trend in service delivery that will positively impact both 
     clients and agencies. It incorporates a holistic approach to 
     service provision that promotes the dignity, strength, and 
     empowerment of trauma victims by referencing knowledge about 
     the role of trauma in trauma victims' lives. The inclusion of 
     the PCTI approach in this bill is indicative of the forward 
     and necessary progress embedded in the Dignity in Aging Act.
       The Dignity in Aging Act authorizes a technical assistance 
     center to serve older adults experiencing the long-term and 
     adverse consequences of trauma, including but not-limited to 
     Holocaust survivors. Holocaust survivors are also 
     specifically mentioned for the first time within the Older 
     Americans Act in the context of providing additional outreach 
     to older individuals ``including Holocaust survivors'' who 
     are at risk of institutional placement. The bill also 
     emphasizes cultural considerations (including religious and 
     ethnic requirements) in the provision of congregate and home-
     delivered meals.
       This Older American Act reauthorization incorporates new 
     support for age-friendly communities, a major new focus on 
     social isolation in older adults, recognition of the 
     emergency confronting our direct care workforce, an updating 
     of, recognition and support for multigenerational families, 
     and assistance to family caregivers with an extension of the 
     RAISE Family Caregivers Act. Each of these provisions and 
     many others contained in the bill will serve our nation well. 
     JFNA also commends the Education and Labor Committee for 
     supporting a five year reauthorization period for the Older 
     Americans Act, which helps safeguard support and removes 
     uncertainty for the growing aging population.
       Finally, and very importantly, this bill provides 
     relatively robust funding increases of 7% for FY 2020 and 6% 
     for each of the next four years.
       While the Older American Act formally expired on September 
     30, 2019, this year's process to reauthorize it was the most 
     efficient, transparent, bipartisan and productive of the five 
     similar reauthorizations that I have worked on going back to 
     1999. The result is a reauthorization vehicle that is very 
     worthy of support, and JFNA looks forward to the House of 
     Representatives passage of the Dignity in Aging Act and the 
     enactment of the reauthorization.
           Sincerely,

                                             Stephan O. Kline,

              Associate Vice President, Public Policy, The Jewish 
     Federations of North America.
                                  ____



                                  Alzheimer's Impact Movement,

                                                 October 25, 2019.
     Hon. Bobby Scott,
     Chairman, House Education and Labor Committee, Washington DC.
     Hon. Virginia Foxx,
     Ranking Member, House Education and Labor Committee, 
         Washington, DC.
       Dear Chairman Scott and Ranking Member Foxx: On behalf of 
     the Alzheimer's Association and the Alzheimer's Impact 
     Movement (AIM), including our nationwide network of 
     advocates, thank you for your continued leadership on issues 
     and legislation important to Americans living with 
     Alzheimer's and other dementias and to their caregivers. In 
     addition, thank you for working together in a bipartisan 
     manner to reauthorize the Older Americans Act (OAA). We are 
     proud to support the Dignity in Aging Act of 2019 (H.R. 4334) 
     and are pleased to highlight several provisions that are 
     critical to persons living with dementia, their families and 
     their caregivers.
       We strongly support the inclusion of language codifying 
     existing authority to provide services to individuals living 
     with younger-onset Alzheimer's disease under the National 
     Family Caregiver Support Program and the Long-Term Care 
     Ombudsman Program. We are very appreciative for the 
     Committee's inclusion of parts of the Younger-Onset 
     Alzheimer's Disease Act (S. 901/H.R. 1903).
       There are approximately 5.8 million Americans living with 
     Alzheimer's disease. The vast majority of those individuals 
     are over the age of 65; however, approximately 200,000 
     Americans are under the age of 65 living with younger-onset 
     Alzheimer's disease. Individuals living with younger-onset 
     face unique challenges when it comes to family, work, and 
     finances. They may be parenting young children at home, or 
     may still be working as the primary income provider for their 
     families. Due to their young age, they may have more trouble 
     receiving an accurate diagnosis, and even family and friends 
     might question their diagnosis. The stigma associated with 
     younger-onset Alzheimer's can have a significant impact on 
     their well-being and quality of life.
       Since 97 percent of all people living with Alzheimer's are 
     age 65 or older, current Alzheimer's support infrastructure 
     focuses exclusively on seniors. As a result, few supportive 
     services are available to those with younger-onset. With 
     other diseases--like heart disease, diabetes, and even 
     cancer--many people living with them are middle-aged and 
     there is a large support structure available to them. Those 
     same support structures are not available for the individuals 
     living with younger-onset Alzheimer's disease. The services 
     provided under the OAA are particularly helpful for 
     individuals with younger-onset Alzheimer's disease and 
     related dementias who need assistance with activities of 
     daily living.
       The Younger-Onset Alzheimer's Disease Act is consistent 
     with the National Plan to Address Alzheimer's Disease. The 
     Advisory Council on Alzheimer's Research, Care, and Services, 
     which is responsible for updating and implementing the Plan, 
     has noted that persons living with younger-onset Alzheimer's 
     face unique challenges in accessing care. In the 2017 
     National Plan, the Advisory Council recommended that Congress 
     amend the OAA to allow additional services to be provided to 
     younger adults living with dementia.
       The Alzheimer's Association and AIM also deeply appreciate 
     the Committee's extension of the RAISE Family Caregivers Act 
     from 3 to 4 years. We have been strong advocates for the 
     RAISE Family Caregivers Act since it was introduced in 
     Congress. There has been a delay in the implementation of the 
     Act and the decision to extend the authorization allows the 
     Department of Health and Human Services to better develop a 
     national strategy for education and training, longterm 
     services and supports, and financial stability and security 
     for caregivers.
       For millions of Americans caring for individuals with 
     Alzheimer's and other dementias the emotional, physical, and 
     financial costs can be overwhelming. Caregivers of people 
     with dementia report higher levels of stress, depression, and 
     worse health outcomes than those providing care to 
     individuals without dementia. As a result, Alzheimer's 
     caregivers incurred $11.8 billion in

[[Page H8478]]

     additional health costs last year. We appreciate the 
     Committee prioritizing this important program.
       We also applaud the Committee's strengthening of Caregiver 
     Assessments. In 2018, more than 16 million unpaid caregivers 
     provided 18.5 billion hours of care valued at nearly $234 
     billion and face the challenges noted above. Eighty-three 
     percent of the help provided to older adults in the United 
     States comes from family members, friends, or other unpaid 
     caregivers. Nearly half of all caregivers who provide help to 
     older adults do so for someone living with Alzheimer's or 
     another dementia. Alzheimer's takes a devastating toll on 
     caregivers. Compared with caregivers of people without 
     dementia, twice as many caregivers of those with dementia 
     indicate substantial emotional, financial, and physical 
     difficulties. Of the total lifetime cost of caring for 
     someone with dementia, 70 percent is borne by families--
     either through out-of-pocket health and longterm care 
     expenses or from the value of unpaid care.
       These dedicated caregivers would greatly benefit from 
     increased resources, training and support to help them 
     navigate the strain of caregiving and improve their health 
     and quality of life. The proposed changes would provide these 
     caregivers much-needed resources, increase the use of 
     caregiver assessments, and identify best practices relating 
     to the programs. These important actions will enhance support 
     for caregivers through skills building, increased resources 
     and information, respite care, counseling, and other helpful 
     benefits.
       Finally, the Alzheimer's Association and AIM appreciate 
     your commitment to supporting individuals facing social 
     isolation. Social isolation is an issue within the aging 
     community as a whole, and particularly in the Alzheimer's and 
     related dementias community. Studies have found that support 
     groups can decrease social isolation and increase social 
     support, the ability to accept the diagnosis, cope with 
     symptoms, improve quality of life, and enhance family 
     communication. (Alzheimer's Association Dementia Care 
     Practice Recommendations, 2018). Support programs offered 
     through the National Family Caregiver Support Program can 
     work to decrease social isolation. We appreciate the bill's 
     inclusion of an advisory council dedicated to identifying the 
     challenges, solutions, and best practices to address social 
     isolation.
       Again, thank you for your leadership in ensuring OAA's 
     reauthorization, which will improve the quality of care for 
     people living with Alzheimer's.
           Sincerely,
     Robert Egge,
       Chief Public Policy Officer, Executive Vice President, 
     Government Affairs, Alzheimer's Association.
                                  ____

                                                 October 28, 2019.
     Hon. Nancy Pelosi, Speaker,
     Hon. Kevin McCarthy, Minority Leader,
     House of Representatives,
     Washington, DC.
     Hon. Bobby Scott, Chairman,
     Hon. Virginia Foxx, Ranking Member,
     Committee on Education and Labor, House of Representatives, 
         Washington, DC.
       Dear Speaker Pelosi, Leader McCarthy, Chairman Scott and 
     Ranking Member Foxx: On behalf of the undersigned 72 national 
     organizations with a vested interest in the well-being of 
     America's older adults and caregivers, we write to you today 
     in support of the House-proposed Dignity in Aging Act (H.R. 
     4334) to reauthorize the Older Americans Act (OAA). We urge 
     Members of the House to support this important five-year OAA 
     reauthorization. Reauthorization of this critical Act, which 
     expired on September 30, will ensure the sustainability of 
     vital OAA programs, as well as the health, dignity, and 
     independence of older Americans and their caregivers.
       The OAA is essential to developing, coordinating, and 
     delivering home and community-based services that help older 
     adults age with independence and dignity. Many individuals 
     served by OAA-funded programs are at significant risk of 
     hunger, isolation, abuse, and losing their ability to live 
     with health and independence. OAA-supported programs are 
     provided to more than 11 million seniors and their caregivers 
     annually. These vital supports include, but are not limited 
     to, home-delivered and congregate nutrition services, in-home 
     supportive services, multipurpose senior centers, 
     transportation, caregiver support, disease prevention and 
     health promotion, community service employment, the long-term 
     care ombudsman program, and services to prevent the abuse, 
     neglect, and exploitation of older adults.
       By keeping seniors healthy and in their communities for 
     more than 50 years, OAA programs have delayed or prevented 
     the need for more expensive institutional care for many older 
     adults, which is often paid for through Medicare or Medicaid. 
     OAA services can effectively save taxpayer, state, and 
     federal dollars. In addition to helping older adults age in 
     place where they most often want to be, OAA programs have 
     improved our country's fiscal future and promoted 
     efficiencies within the health care system by preventing 
     unnecessary hospital stays, reducing readmission rates, 
     coordinating care, and managing care transitions.
       We appreciate that the Dignity in Aging Act, H.R. 4334 
     builds upon the early bipartisan Senate draft bill and 
     incorporates a number of important priorities articulated by 
     stakeholder organizations. Most importantly, the Dignity in 
     Aging Act calls for much-needed and necessary investments in 
     the OAA by increasing funding authorizations over the next 
     five years--a top priority of the undersigned organizations 
     and the most critical need of the Aging Services Network 
     authorized by the OAA.
       Other priority areas include research innovation and 
     demonstrations, Native American services, local planning and 
     development, supports for those suffering from dementias and 
     social isolation, legal services, nutrition, in-home 
     supportive services, disease prevention and health promotion, 
     multigenerational collaboration, and family caregiver 
     supports. We appreciate that the House proposal to 
     reauthorize the OAA has preserved the numerous ways in which 
     this Act works so well at the federal, state, and local 
     levels, on behalf of the older adults and caregivers for whom 
     it is a lifeline to dignity, independence, health, safety, 
     and economic security.
       Thank you for your commitment to this important issue. The 
     undersigned organizations represent a diverse set of 
     stakeholders, and we urge Members of the House to swiftly 
     advance this bill to reauthorize the Older Americans Act.
           Sincerely,
       AARP, Academy of Geriatric Physical Therapy, Advancing 
     States, Aging and Vision Loss National Coalition, AHEPA 
     Management Company (AMC), Alliance for Aging Research, 
     Alliance for Retired Americans, Alliance to End Hunger, 
     Allies for Independence, Alzheimer's Association and the 
     Alzheimer's Impact Movement, American Association of Service 
     Coordinators, American Association on Health and Disability, 
     American Geriatrics Society, American Hellenic Educational 
     Progressive Association (Order of AHEPA), American Music 
     Therapy Association.
       American Physical Therapy Association, American Public 
     Health Association, American Society of Consultant 
     Pharmacists (ASCP), American Society on Aging, Blinded 
     Veterans Association, Bread for the World, Caregiver Action 
     Network, Caregiver Voices United, Caring with Grace, LLC, 
     CaringKind, the Heart of Alzheimer's Caregiving, Center for 
     Medicare Advocacy, Center to Advance Palliative Care, 
     Collective Action Lab, Congregation of Our Lady of Charity of 
     the Good Shepherd, U.S. Provinces, Corporation for Supportive 
     Housing (CSH).
       Daughters of Penelope, Dementia Alliance International, 
     Easterseals, Evangelical Lutheran Church in America, Feeding 
     America, Home Instead Senior Care, International Association 
     for Indigenous Aging, Jewish Council for Public Affairs, 
     Justice in Aging, Lakeshore Foundation, LeadingAge, Lutheran 
     Services in America, MAZON: A Jewish Response to Hunger, 
     Meals on Wheels America, Medicare Rights Center.
       Mercy Housing, Inc., Michigan State College of Human 
     Medicine Alzheimer's Alliance, National Adult Protective 
     Services Association, National Alliance for Caregiving, 
     National Asian Pacific Center on Aging (NAPCA), National 
     Association of Activity Professionals, National Association 
     of Area Agencies on Aging (n4a), National Association of 
     Development Organizations (NADO), National Association of 
     Long-Term Care Ombudsman Programs (NASOP), National 
     Association of Nutrition and Aging Services Programs 
     (NANASP), National Certification Council for Activity 
     Professionals, National Council on Aging, National Health 
     Council, National Recreation and Park Association, National 
     Respite Coalition.
       NETWORK Lobby, Network of Jewish Human Service Agencies, 
     Inc., PHI, RESULTS, Society for the Blind, The Gerontological 
     Society of America, The Jewish Federations of North America, 
     United Church of Christ Justice and Witness Ministries, 
     United Spinal Association, USF Health Byrd Alzheimer's 
     Institute, Village to Village Network, VisionServe Alliance, 
     Volunteers of America.
                                  ____



                                      Meals on Wheels America,

                                  Arlington, VA, October 28, 2019.
     Hon. Nancy Pelosi,
     Speaker, House of Representatives,
     Washington, DC.
     Hon. Kevin McCarthy,
     Minority Leader, House of Representatives,
     Washington, DC.
     Hon. Bobby Scott,
     Chairman, Committee on Education & Labor, House of 
         Representatives, Washington, DC.
     Hon. Virginia Foxx,
     Ranking Member, Committee on Education & Labor, House of 
         Representatives,
     Washington, DC.
       Dear Speaker Pelosi, Leader McCarthy, Chairman Scott and 
     Ranking Member Foxx: On behalf of Meals on Wheels America, 
     the nationwide network of community-based senior nutrition 
     programs and the individuals they serve, we write to express 
     our support for H.R. 4334, the Dignity in Aging Act of 2019 
     and urge swift and bipartisan passage in the House of 
     Representatives. We commend the efforts of the Education and 
     Labor Committee for receiving unanimous approval following 
     the September markup, as well as the leadership of 
     Subcommittee Chairwoman Bonamici (D-OR) and Ranking Member 
     Comer (R-KY), and Representatives Stefanik (R-NY), Lee (D-
     NV), Wild (D-PA) and Johnson (R-SD) in the introduction of 
     this legislation.
       For over five decades, the OAA has been the primary piece 
     of federal legislation focused on establishing, coordinating 
     and

[[Page H8479]]

     strengthening community and home-based social and nutrition 
     services for adults age 60 and older, their families and 
     their caregivers. OAA services like Meals on Wheels, 
     transportation, caregiver assistance, senior employment and 
     training and elder rights protection are just some of the 
     vital functions the OAA delivers to more than 11 million 
     seniors annually.
       As you and many of your colleagues know firsthand, OAA 
     services and supports, including the three nutrition programs 
     authorized under Title III of the Act, help keep our nation's 
     most vulnerable, isolated and food insecure seniors healthier 
     and in their own homes and communities longer. This in turn 
     delays and/or prevents altogether the need for more expensive 
     institutional care often paid for through Medicare or 
     Medicaid. OAA programs are not only extremely cost-effective, 
     but they are longstanding examples of public-private 
     partnerships that help save taxpayers at the local, state and 
     federal levels in reduced healthcare expenditures.
       We specifically want to recognize the effort undertaken to 
     increase authorization of appropriations in this legislation. 
     With nearly half of our membership having a documented 
     waiting list for nutrition services, the 7% increase in 
     authorization of funding levels in Fiscal Year 2020--and 6% 
     in subsequent years for all OAA programs over the five-year 
     reauthorization period--will significantly improve the senior 
     nutrition network's ability to address these gaps.
       We also applaud the attention to and inclusion of 
     additional research and innovation established through a new 
     National Research, Demonstration, and Evaluation Center for 
     aging services research and development. We already know the 
     difference that OAA services and supports are making in the 
     lives of those served each day, and this additional support 
     will help identify where the greatest needs and opportunities 
     are to produce substantial savings to Medicare and Medicaid 
     and support our nation's most at-risk seniors.
       Furthermore, we are grateful for the Dignity in Aging Act's 
     acknowledgement of the components of our network's 
     comprehensive service model, particularly around the areas of 
     social isolation and loneliness; in-home safety; screenings 
     and prevention; and community connections and support. This 
     network has been addressing the social determinants of health 
     (SDOH) for seniors long before it was a common definition 
     used among policymakers, advocates and healthcare entities. 
     Thanks to the foresight of this body in establishing the OAA 
     Nutrition Program and its goals and purposes decades ago, the 
     focus has transcended beyond just the meal to include an 
     emphasis on socialization, overall health, well-being and 
     safety.
       As with each reauthorization, we have a new opportunity to 
     evolve the OAA in ways that will help it better meet the 
     inherent changes in our country's aging population and serve 
     more of those in need. We are pleased that H.R. 4334, the 
     Dignity in Aging Act of 2019, helps to address these shifts, 
     and as such, we urge your support and swift passage in the 
     House of Representatives. Meals on Wheels America and the 
     network of senior nutrition programs across the county have 
     appreciated contributing feedback and policy recommendations 
     throughout this reauthorization process and look forward to 
     continuing to work with you to build upon the ongoing 
     successes of the OAA.
       Thank you again for your leadership, public service and 
     support for our nation's older adults.
           Sincerely,
                                                  Ellie Hollander,
                                                President and CEO.

  Ms. BONAMICI. Mr. Speaker, I reserve the balance of my time.
  Ms. STEFANIK. Mr. Speaker, I yield myself the balance of my time.
  In closing, I would like to again thank my good friend, the 
gentlewoman from Oregon (Ms. Bonamici), and our colleagues and our 
staff on the Education and Labor Committee for all of their work on 
this bipartisan bill that will help improve the lives of millions of 
seniors across the country.
  As I said at the beginning of this debate, my district is home to one 
of the largest constituencies of older Americans, so I could not be 
prouder to have led the reauthorization of the Older Americans Act, 
which will directly and tangibly benefit the seniors in New York's 21st 
District and seniors across the country.
  Our Nation's seniors deserve to age with health, dignity, and 
independence in the communities of their choosing. Again, I urge a 
``yes'' vote. Mr. Speaker, I yield back the balance of my time.
  Ms. BONAMICI. Mr. Speaker, I yield myself the balance of my time. I 
urge all of my colleagues to support the bipartisan Dignity in Aging 
Act of 2019. We know that the OAA programs--Meals on Wheels, community 
meal programs, caregiver support, protection against elder abuse--help 
older Americans live their lives with dignity.
  Once again, I thank Representatives Stefanik, Lee, Comer, Wild, and 
Johnson for joining me in leading this effort. Again, I thank Chairman 
Scott and Ranking Member Foxx for supporting this legislation as it 
moved through the committee process. The bipartisan engagement and the 
involvement of many committee members was crucial to achieving this 
legislation to successfully address many priorities and incorporate the 
input of numerous stakeholders.
  I am sincerely grateful for the contributions of all involved, and I 
am eager to support the passage of this bill today so we can better 
empower every older American to age with dignity.
  I urge my colleagues to support this legislation, and I yield back 
the balance of my time.
  Mr. LEVIN of Michigan. Mr. Speaker, I urge my colleagues to support 
the Dignity in Aging Act. As vice chair of the House Education and 
Labor Committee, I am honored to be a part of this bipartisan effort to 
respond to the challenges facing a generation of aging Americans.
  I'm also proud that this package includes my bill, the Supporting 
Family Caregivers Act, which will facilitate the assessment of in-home 
caregivers' needs to determine what resources would help them provide 
care. I want to thank Congresswoman Elise Stefanik for partnering on 
this bipartisan legislation to support in-home caregivers.
  Americans across the country rely on family caregivers, whose 
contributions range from bathing and dressing their loved ones, to 
coordinating care across multiple health care providers, to managing 
the payment of household and medical bills, and more. Each year, this 
adds up to roughly $470 billion in unpaid care provided by 40 million 
family caregivers.
  I believe one of the best ways to improve home health care is to 
protect the health and wellbeing of the caregivers who provide it. The 
Supporting Family Caregivers Act encourages the use of assessments to 
identify caregivers' individual needs and challenges, thereby allowing 
services to be targeted to each person more effectively and 
efficiently. Although resources are currently available to family 
caregivers, direct feedback through assessments would improve the 
quality of the support they receive.
  I am so pleased to see this body take a needed step towards more 
person- and family-centered care. Again, I am grateful to my partner on 
this bill, Congresswoman Stefanik, as well as Chairman Scott, Ranking 
Member Foxx and Dignity in Aging Act sponsor Bonamici for their 
support.
  I urge my colleagues to join me in supporting America's seniors, and 
to vote for the Dignity in Aging Act.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentlewoman from Oregon (Ms. Bonamici) that the House suspend the rules 
and pass the bill, H.R. 4334, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

                          ____________________