text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``In-Home Caregiver Assessment 
  Resources and Education Act'' or the ``In-Home CARE Act''.
  
  SEC. 2. FINDINGS.
  
      Congress finds the following:
              (1) More than 43,000,000 unpaid caregivers provide care for 
          a chronically ill, disabled, or aged family member or friend 
          during any given year.
              (2) Sixty percent of unpaid caregivers are women. More than 
          37 percent of caregivers live with children or grandchildren 
          who are under 18 years old.
              (3) Ethnic minority caregivers, particularly African-
          American and Hispanic-American caregivers, experience greater 
          strain and worse physical health than their counterparts. More 
          than 50 percent of African Americans are ``sandwiched'' between 
          caring for an older person and a younger person under age 18.
              (4) The needs of caregivers and care recipients vary by 
          several factors such as race and ethnicity, age, social class, 
          sexual orientation, geographical location, gender, military or 
          veteran status, relationship between caregiver and care 
          recipient, health status, and other factors.
              (5) Unpaid family caregivers spend an average of 24 hours 
          per week caring for their loved ones, and about 23 percent of 
          family caregivers provide 41 or more hours of care per week.
              (6) Forty-nine percent of caregivers care for a parent.
              (7) Fourteen percent of caregivers provide care for a 
          special needs child, including an estimated 16,800,000 
          caregivers who care for a special needs child under 18 years of 
          age.
              (8) In 2016, the average caregiver for someone 18 years or 
          older spent $6,954 per year on out-of-pocket caregiving 
          expenses, which is nearly 20 percent of the average annual 
          income of caregivers.
              (9) Sixty percent of caregivers who provide care for an 
          individual over the age of 18 are currently working or have 
          worked while providing care. Three in five caregivers have had 
          to make some modifications to their work schedule, from 
          arriving late to work to leaving their job entirely. Almost 
          half of employed caregivers have had to take time off from 
          work.
              (10) Fifty-three percent of caregivers have experienced a 
          decline in their health as a result of caregiving, which has 
          affected their ability to provide care. Thirty-five percent of 
          caregivers report having difficulty finding time for oneself, 
          and 29 percent report difficulty managing emotional and 
          physical stress or balancing work and family responsibilities.
              (11) Forty-six percent of caregivers of adults perform 
          medical or nursing tasks for patients with multiple physical 
          and chronic conditions. Of these caregivers, 78 percent were in 
          charge of managing a patient's medications, administering 
          fluids, or administering injections.
              (12) Nearly 20 percent of caregivers of adults who assisted 
          with medication management and 33 percent who assisted with 
          changing dressings or bandages received no training about how 
          to perform these tasks.
              (13) The vast majority of caregivers (84 percent) indicated 
          they need more support related to caregiving.
              (14) Home visiting programs are cost-effective and have 
          been proven to improve outcomes for children and parents in 
          different domains ranging from child development to family 
          violence.
  
  SEC. 3. PURPOSES.
  
      The purposes of this Act are--
              (1) to improve the ability of unpaid caregivers to care for 
          individuals in the home; and
              (2) to increase opportunities for individuals who are in 
          need of care to remain at home and reduce or postpone the need 
          for such individuals to receive care at an institution or 
          hospital.
  
  SEC. 4. CAREGIVER GRANTS.
  
      Subpart IV of part D of title III of the Public Health Service Act 
  (42 U.S.C. 255 et seq.) is amended by adding at the end the following:
  
  ``SEC. 339A. CAREGIVER GRANTS.
  
      ``(a) In General.--The Secretary, acting through the Administrator 
  of the Administration for Community Living, shall award 3-year grants, 
  on a competitive basis, to eligible organizations to carry out home 
  visiting programs for unpaid caregivers.
      ``(b) Definitions.--In this section:
              ``(1) Caregiver.--The term `caregiver' means an unpaid 
          family member, foster parent, or other unpaid adult who 
          provides consistent in-home monitoring, management, 
          supervision, or treatment of a child or adult with a special 
          need, such as a disease, disability, or the frailties of old 
          age.
              ``(2) Caregiver assessment.--The term `caregiver 
          assessment' means an assessment that includes talking directly 
          to caregivers to better understand their needs, problems, 
          resources, and strengths.
              ``(3) Child or adult with a special need.--The term `child 
          or adult with a special need' means an individual for whom care 
          or supervision is required to--
                      ``(A) meet the basic needs of the individual;
                      ``(B) prevent physical self-injury or injury to 
                  others; or
                      ``(C) avoid placement in an institutional facility.
              ``(4) Eligible organization.--The term `eligible 
          organization' means--
                      ``(A) a local government agency;
                      ``(B) a health care entity; or
                      ``(C) any other nonprofit or community 
                  organization,
          that has experience providing the services described in 
          subsection (f).
      ``(c) Coordination.--In carrying out this section, the Secretary 
  shall coordinate with--
              ``(1) the heads of the National Family Caregiver Support 
          Program of the Administration on Aging and other programs 
          within the Department of Health and Human Services (such as the 
          Lifespan Respite Care Program) and the Secretary of Veterans 
          Affairs, to ensure coordination of caregiver services for 
          caregivers of children or adults with special needs; and
              ``(2) the Administrator of the Centers for Medicare & 
          Medicaid Services, to avoid duplicative services and payments.
      ``(d) Application.--An eligible organization that desires a grant 
  under this section shall submit an application at such time, in such 
  manner, and containing such information as the Secretary may require, 
  including, at a minimum--
              ``(1) an outreach plan that identifies how the eligible 
          organization will ascertain which caregivers in the community--
                      ``(A) are most in need of support and education, 
                  particularly caregivers who have had no training and 
                  provide complex chronic care activities or perform 
                  medical or nursing tasks in addition to assisting with 
                  activities of daily living;
                      ``(B) are caring for individuals who are at the 
                  greatest risk of needing institutional care; and
                      ``(C) desire to participate in the caregiver home 
                  visiting program;
              ``(2) a description of the services that the eligible 
          organization will provide directly using grant funds, and a 
          description of the services that the eligible organization will 
          use grant funds to provide through contracts or referrals;
              ``(3) a description of how the eligible organization will 
          identify gaps in the services that caregivers and children or 
          adults with a special need who receive care from a caregiver in 
          the community are receiving;
              ``(4) a description of how the eligible organization can 
          provide--
                      ``(A) an initial visit to caregivers in order to 
                  complete a caregiver assessment, including a 
                  description of the eligible organization's expertise in 
                  conducting caregiver assessments;
                      ``(B) education and training, based on evidence-
                  based models, to help the caregiver learn how to best 
                  care for a child or adult with a special need, by an 
                  individual with expertise in the tasks for which the 
                  caregiver requires education and training, including 
                  education and training regarding, as applicable--
                              ``(i) medication management;
                              ``(ii) wound care;
                              ``(iii) nutrition and food preparation for 
                          special diets;
                              ``(iv) fall prevention;
                              ``(v) management of depression, anxiety, 
                          stress, trauma, and other behavioral health 
                          conditions, including ways to minimize negative 
                          mental health effects;
                              ``(vi) assistance with activities of daily 
                          living;
                              ``(vii) ways to engage other family members 
                          in providing care;
                              ``(viii) ways to identify and utilize 
                          available community resources; and
                              ``(ix) abuse and neglect prevention; and
                      ``(C) recommendations for home modifications or 
                  physical environmental changes that could improve the 
                  health or quality of life of a child or adult with a 
                  special need who is receiving care from a caregiver;
              ``(5) a description of the eligible organization's ability 
          to provide, or refer caregivers to local resources or 
          appropriate programs of the Department of Health and Human 
          Services or the Department of Veterans Affairs that will 
          provide--
                      ``(A) physical and mental health care, including 
                  home health care and long-term support services;
                      ``(B) transportation;
                      ``(C) home modification services;
                      ``(D) respite care;
                      ``(E) adult day care;
                      ``(F) support groups; and
                      ``(G) legal assistance;
              ``(6) a description of the eligible organization's ability 
          to coordinate with other State and community-based agencies;
              ``(7) a description of the eligible organization's 
          understanding of caregiver issues--
                      ``(A) across demographic groups, including age, 
                  gender, race and ethnicity, socioeconomic status, 
                  sexual orientation, military status, and geographical 
                  region; and
                      ``(B) including disabilities and chronic conditions 
                  that affect the populations that the eligible 
                  organization will serve;
              ``(8) a description of the capacity of the eligible 
          organization to engage caregivers, family members, and children 
          or adults with a special need who receive care from a 
          caregiver; and
              ``(9) with respect to the population of caregivers to whom 
          caregiver visits or services will be provided, or for whom 
          workers and volunteers will be recruited and trained, a 
          description of--
                      ``(A) the population of caregivers;
                      ``(B) the extent and nature of the needs of that 
                  population; and
                      ``(C) existing caregiver services for that 
                  population, including the number of caregivers served 
                  and the extent of unmet need.
      ``(e) Priority.--In awarding grants under this section, the 
  Secretary shall give priority to eligible organizations that--
              ``(1) the Secretary determines show the greatest likelihood 
          of implementing or enhancing caregiver home visiting services 
          that best meet the needs of the community;
              ``(2) will allow caregivers to contact the eligible 
          organization by phone, email, or 2-way interactive video for up 
          to 6 months after home visits have ended, or to otherwise 
          contact the organization at any time if a caregiver has 
          questions or concerns;
              ``(3) have a proven record of caregiver support;
              ``(4) will use evidence-based programs; or
              ``(5) will provide matching funds or can demonstrate that 
          the program funded by a grant under this section will be 
          sustainable after grant funds are no longer provided.
      ``(f) Authorized Activities.--An eligible organization receiving a 
  grant under this section shall use grant funds to--
              ``(1) conduct an initial home visit for each caregiver 
          participating in the program, during which a representative 
          from the eligible organization who has expertise in care 
          management in the home and caregiving will perform a caregiver 
          assessment and determine what follow-up services may benefit 
          the caregiver and the child or adult with a special need who 
          receives care from the caregiver;
              ``(2) conduct home visits for the purpose of caregiver 
          education and training;
              ``(3) provide, or provide referrals for, the services 
          described in subsection (d)(5);
              ``(4) provide an assessment and referral for physical and 
          mental health services for the caregiver and for the child or 
          adult with a special need who receives care from the caregiver, 
          as needed; and
              ``(5) carry out any other activities that are described in 
          the grant application submitted under subsection (d).
      ``(g) Technical Assistance Center.--The Secretary shall establish, 
  or contract to establish, a technical assistance center through which 
  the Secretary shall--
              ``(1) provide evidence-based models for programs funded by 
          grants under this section;
              ``(2) provide training for grantees;
              ``(3) answer questions from grantees; and
              ``(4) facilitate an exchange of information among grantees, 
          and between grantees and other programs within the Department 
          of Health and Human Services, including through use of the 
          Technical Assistance Exchange of the Administration for 
          Community Living, in order to maximize the use of existing 
          resources and services for caregivers and to avoid the 
          duplication of such services.
      ``(h) Evaluation.--
              ``(1) In general.--Not later than 2 years after the date of 
          enactment of this section, and annually thereafter, the 
          Secretary shall evaluate the success of the grant program 
          carried out under this section, based on criteria that the 
          Secretary may develop for such evaluation.
              ``(2) Optional contents of evaluation.--The evaluation 
          described in paragraph (1) may include an evaluation of--
                      ``(A) the extent to which children or adults with a 
                  special need who are cared for by a participating 
                  caregiver have--
                              ``(i) a reduction in the potential number 
                          of hospitalizations;
                              ``(ii) a reduction in the potential number 
                          of institutionalizations;
                              ``(iii) cost reductions across the health 
                          care system;
                              ``(iv) improved connection to community 
                          resources;
                              ``(v) improved care; and
                              ``(vi) improved quality of life (including 
                          a reduction of stress and anxiety and improved 
                          relationships and mood); and
                      ``(B) the extent to which participating caregivers 
                  have improved quality of life (including a reduction of 
                  stress and anxiety and improved health, relationships, 
                  mood, and connection to community resources).
      ``(i) Reports and Recommendations.--Not later than 1 year before 
  the expiration of the grants awarded under this section, the Secretary 
  shall prepare and submit a report to Congress that includes 
  recommendations, based on the evaluation described in subsection (h), 
  about--
              ``(1) changes to the grant program under this section;
              ``(2) the potential for expanding the number and scope of 
          caregiver home visiting program grants distributed by the 
          Secretary; and
              ``(3) extending the length of the grant program.
      ``(j) Authorization of Appropriations.--There are authorized to be 
  appropriated to carry out this section such sums as may be 
  necessary.''.
target: In-Home Caregiver Assessment Resources and Education Act or the In-Home CARE Act This bill amends the Public Health Service Act to require the Administration for Community Living to award grants to carry out home visiting programs for unpaid caregivers. The Department of Health and Human Services must coordinate with the National Family Caregiver Support Program, the Centers for Medicare &amp; Medicaid Services, the Department of Veterans Affairs, and others on this grant program. Grantees must provide:  caregiver education and training regarding medication management, food preparation, falls prevention, and other subjects; services or referrals for services related to home care, such as transportation, home modification, or respite care; and an assessment and referral for physical and mental health services for the caregiver or person receiving care from the caregiver.  
feat_title: In-Home Caregiver Assessment Resources and Education Act