II
111th CONGRESS
1st Session
S. 245
IN THE SENATE OF THE UNITED STATES
January 14, 2009
Mr. Kohl (for himself, Mrs. Lincoln, and Mr. Casey) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions
A BILL
To expand, train, and support all sectors of the health care workforce to care for the growing population of older individuals in the United States.
Short title; table of contents
Short title
This Act may be cited
as the Retooling the Health Care
Workforce for an Aging America Act of 2009
.
Table of contents
The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
TITLE I—Amendments to the Public Health Service Act
Subtitle A—Health professions education related to geriatrics
Sec. 101. Geriatric education centers.
Sec. 102. Improving geriatric training for physicians, dentists, and behavior and mental health professionals.
Sec. 103. Geriatric academic career awards.
Sec. 104. Geriatric Career Incentive Awards.
Sec. 105. National Center for Health Workforce Analysis.
Subtitle B—Improved nursing services
Sec. 121. Comprehensive geriatric education nursing grant program.
TITLE II—Amendments to the Workforce Investment Act of 1998
Sec. 201. Core services.
Sec. 202. Individual training accounts.
Sec. 203. Collaboration between State boards and the veterans agencies of the States.
Sec. 204. Collaboration between Department of Labor and Department of Veterans Affairs.
Sec. 205. Training opportunities for direct care workers.
TITLE III—Amendments to the Older Americans Act of 1965
Sec. 301. Family caregiver training.
Sec. 302. Redesignations in provisions for multigenerational and civic engagement activities.
Sec. 303. National Resource Center on Volunteers, Students, and Seniors.
TITLE IV—Amendments to the Social Security Act
Sec. 401. Demonstration program for personal or home care aides, nurse aides, and home health aides in long-term care settings.
Sec. 402. Medicare family caregiver information and referral.
Sec. 403. Medicaid assessment of family caregiver support needs.
TITLE V—Studies and reports
Sec. 501. Studies and reports.
Findings
Congress finds the following:
The United States will not be able to meet near-term demands for chronic, geriatric, and long-term care without a workforce that is prepared for the job.
Between 2005 and 2030, it is estimated that the number of adults aged 65 and older will almost double from 37,000,000 to over 70,000,000, increasing from 12 percent of the population of the United States to almost 20 percent of the population.
Because the overall size of the population of older adults in the United States will increase rapidly, the number of older adults in the United States who are disabled will soar in the coming decades. Between 2000 and 2040 the number of older adults who are disabled will more than double, increasing from an estimated 10,000,000 to an estimated 21,000,000.
A 2008 report by the Institute of Medicine of the National Academies, entitled, “Retooling for an Aging America” concludes that the health care workforce will lack the capacity, in both size and ability, to meet the needs of older patients in the future unless action is taken immediately.
Inadequate training in geriatrics, gerontology, chronic care management, and long-term care is known to result in misdiagnoses, medication errors, and inadequate coordination of services and treatments that result in poor care and is costly for the health care system as a whole.
Currently, only 1 percent of all physicians (approximately 7,000) in the United States are certified geriatricians, even as the population of older adults is on track to double by 2030.
Inadequate amounts of time devoted to geriatric training are reported by ¼ of graduating medical students, and close to ½ of graduating medical students say they are unprepared to care for residents in nursing homes.
Less than 1 percent of all nurses are certified gerontological nurses. Absent any change, by the year 2020, the total supply of nurses in the United States is projected to fall 29 percent below requirements, resulting in a severe shortage of nursing expertise relative to the demand for care of medically complex, frail older adults.
Estimates suggest that there are currently only 700 practicing geropsychologists in the United States, falling far short of the current need for 5,000 to 7,500 geropsychologists.
The Bureau of Labor Statistics of the Department of Labor predicts that personal or home care aides and home health aides will represent the second and third fastest-growing occupations between 2006 and 2016. Yet personal or home care aides are not subject to any Federal requirements related to training or education, and States have very different requirements for personal or home care aides.
Research shows that inadequate training is a major contributor to high turnover rates among direct care workers and more training is correlated with better staff recruitment and retention rates.
An estimated 44,000,000 family caregivers are being asked to provide increasingly complex medical services to frail and elderly loved ones wishing to live at home. Multiple surveys have documented that basic training and access to other targeted services are necessary for family caregivers to provide consistent quality care on an ongoing basis.
Amendments to the Public Health Service Act
Health professions education related to geriatrics
Geriatric education centers
Section 753 of the Public Health Service Act (42 U.S.C. 294) is amended by adding at the end the following:
Grants To expand and improve geriatric education centers
In general
The Secretary shall award grants or contracts under this subsection to entities that operate a geriatric education center pursuant to subsection (a)(1).
Application
To be eligible for an award under paragraph (1), an entity described in such paragraph shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
Use of funds
Amounts awarded under a grant or contract under paragraph (1) shall be used to—
carry out the fellowship program described in paragraph (4); and
carry out 2 of the 3 activities described in paragraph (5).
Fellowship program
In general
Pursuant to paragraph (3), a geriatric education center
that receives an award under this subsection shall use such funds to offer
short-term intensive courses (referred to in this subsection as a
fellowship
) that focus on geriatrics, chronic care management,
and long-term care that provide supplemental training for faculty members in
medical schools and other health professions schools with programs in
psychology, pharmacy, nursing, social work, dentistry, public health, or other
health disciplines, as approved by the Secretary. Such a fellowship shall be
open to current faculty, and appropriately credentialed volunteer faculty and
practitioners, who do not have formal training in geriatrics, to upgrade their
knowledge and clinical skills for the care of older adults and adults with
functional limitations and to enhance their interdisciplinary teaching
skills.
Location
A fellowship shall be offered either at the geriatric education center that is sponsoring the course, in collaboration with other geriatric education centers, or at medical schools, schools of nursing, schools of pharmacy, schools of social work, graduate programs in psychology, or other health professions schools approved by the Secretary with which the geriatric education centers are affiliated.
CME credit
Participation in a fellowship under this paragraph shall be accepted with respect to complying with continuing medical education requirements. As a condition of such acceptance, the recipient shall agree to subsequently provide a minimum of 18 hours of voluntary instructional support through a geriatric education center that is providing clinical training to students or trainees in long-term care settings.
Additional required activities described
Pursuant to paragraph (3), a geriatric education center that receives an award under this subsection shall use such funds to carry out 2 of the 3 activities:
Family caregiver training
A geriatric education center that receives an award under this subsection shall offer at least 2 courses each year, at no charge or nominal cost, to family caregivers that are designed to provide practical training for supporting frail elders and individuals with disabilities. The Secretary shall require such Centers to work with appropriate community partners, including family caregivers and family caregiver organizations, to develop training program content and to publicize the availability of training courses in their service areas. All family caregiver training programs shall include instruction on the management of psychological and behavioral aspects of dementia, communication techniques for working with individuals who have dementia, and the appropriate, safe, and effective use of medications for older adults.
Direct care working training
A geriatric education center that receives an
award under this subsection shall offer at least 2 courses each year to
certified nurse aides, home health aides, personal or home care aides and other
types of direct care workers on best practices
for working with
frail elders and individuals with disabilities, including individuals with
dementia, urinary incontinence, and problems with balance or mobility, and
raising awareness of medication issues for older adults.
Incorporation of best practices
A geriatric education center that receives an award under this subsection shall develop and include material on depression and other mental disorders common among older adults, medication safety issues for older adults, and management of the psychological and behavioral aspects of dementia and communication techniques with individuals who have dementia in all training courses, where appropriate.
Targets
A geriatric education center that receives an award under this subsection shall meet targets approved by the Secretary for providing geriatric training to a certain number of faculty or practitioners during the term of the grant, as well as other parameters established by the Secretary, including guidelines for the content of the fellowships.
Amount of award
An award under this subsection shall be in an amount of $150,000. Not more than 24 geriatric education centers may receive an award under this subsection.
Maintenance of effort
A geriatric education center that receives an award under this subsection shall provide assurances to the Secretary that funds provided to the geriatric education center under this subsection will be used only to supplement, not to supplant, the amount of Federal, State, and local funds otherwise expended by the geriatric education center.
Authorization of appropriations
In addition to any other funding available to carry out this section, there is authorized to be appropriated to carry out this subsection, $10,800,000 for the period of fiscal year 2011 through 2013.
.
Improving geriatric training for physicians, dentists, and behavior and mental health professionals
Section 753 of the Public Health Service Act (42 U.S.C. 294), as amended by section 101, is amended by adding at the end the following:
Geriatric training for physicians, dentists, and behavior and mental health professionals
An accredited school of medicine or osteopathic medicine, an accredited psychology program, a teaching hospital, or a graduate medical education program that receives an award under subsection (c) may use the funds under such award to carry out a program to train individuals for either 1 year, 2 years, or both, who are seeking a certificate of added qualification or specialization in geriatrics for either 1 year, 2 years, or both. Such a program may be located in a medical school or academic health center that offers programs in 2 of the 3 disciplines described in subsection (c)(5). Such program may fund the training of psychologists, psychiatric nurse practitioners, and clinical social workers as part of the behavior and mental health training programs.
.
Geriatric academic career awards
Expansion of eligibility for geriatric academic career awards; payment to institution
Section 753(c) of the Public Health Service Act (42 U.S.C. 294(c)) is amended—
by striking paragraph (2) through paragraph (3) and inserting the following:
Eligible individuals
To be eligible to receive an Award under paragraph (1), an individual shall—
be board certified or board eligible in internal medicine, family practice, or psychiatry or have completed any required training in a discipline and employed in an accredited health professions school that is approved by the Secretary, including dentistry, pharmacy, nursing, social work, and psychology;
have completed an approved fellowship program in geriatrics; and
have a junior (non-tenured) faculty appointment at an accredited (as determined by the Secretary) school of medicine, osteopathic medicine, nursing, social work, psychology, dentistry, pharmacy, or other allied health disciplines in an accredited health professions school that is approved by the Secretary.
Limitations
No Award under paragraph (1) may be made to an eligible individual unless the individual—
has submitted to the Secretary an application, at such time, in such manner, and containing such information as the Secretary may require, and the Secretary has approved such application;
provides, in such form and manner as the Secretary may require, assurances that the individual will meet the service requirement described in paragraph (5); and
provides, in such form and manner as the Secretary may require, assurances that the individual has a full-time faculty appointment in a health professions institution and documented commitment from such institution to spend 75 percent of the total time of such individual on teaching and developing skills in interdisciplinary education in geriatrics.
Maintenance of effort
An eligible individual that receives an Award under paragraph (1) shall provide assurances to the Secretary that funds provided to the eligible individual under this subsection will be used only to supplement, not to supplant, the amount of Federal, State, and local funds otherwise expended by the eligible individual.
; and
in paragraph (4)—
in subparagraph (A)—
by
inserting for individuals who are physicians
after this
section
; and
by
inserting after the period at the end the following: The Secretary shall
determine the amount of an Award under this section for individuals who are not
physicians.
; and
by adding at the end the following:
Payment to institution
The Secretary shall transfer funds awarded to an individual under this section to the institution where such individual will carry out the award, in order to facilitate financial management of the reward pursuant to guidelines of the Health Resources and Services Administration.
.
Authorization of appropriations
There are authorized to be appropriated to carry out the amendments made by this section $6,000,000 for each of fiscal years 2011, 2012, and 2013.
Geriatric Career Incentive Awards
Section 753 of the Public Health Service Act (42 U.S.C. 294), as amended by section 102, is amended by adding at the end the following:
Geriatric Career Incentive Awards
In general
The Secretary shall award grants or contracts under this section to individuals described in paragraph (2) to foster greater interest among a variety of health professionals in entering the field of geriatrics, long-term care, and chronic care management.
Eligible individuals
To be eligible to received an award under paragraph (1), an individual shall—
be an advanced practice nurse (such as a clinical nurse specialist or nurse practitioner), a clinical social worker, a pharmacist, or student of psychology who is pursuing a doctorate or other advanced degree approved by the Secretary in geriatrics, long-term care, geropsychology, or chronic care management in an accredited health professions school that is approved by the Secretary; and
submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
Condition of award
As a condition of receiving an award under this subsection, an individual shall agree that, following completion of the award period, the individual will teach or practice in the field of geriatrics, long-term care, or chronic care management for a minimum of 5 years under guidelines set by the Secretary.
Authorization of appropriations
There is authorized to be appropriated to carry out this subsection, $10,000,000 for the period of fiscal years 2011 through 2013.
.
National Center for Health Workforce Analysis
Part E of Title VII of the Public Health Service Act (42 U.S.C. 294n et seq.) is amended by adding at the end the following:
National Center for Health Workforce Analysis
Activities of the National Center for Health Workforce Analysis
In addition to any activities being carried out at the National Center for Health Workforce Analysis of the Health Resources and Services Administration as of the day before the date of enactment of the Retooling the Health Care Workforce for an Aging America Act of 2009, the head of such Center shall analyze—
current and projected needs for health and long-term care workforce demand and supply, and training and education needs specific to older adults and adults with functional limitations;
turnover and retention for professionals and paraprofessionals in these fields, including administrators, medical directors and direct care staff of nursing homes, assisted living facilities and home and community-based settings, or any other setting or provider the Secretary determines appropriate; and
diversity of racial and ethnic minority groups represented by professionals and paraprofessionals in these fields.
Authorization of appropriations
There is authorized to be appropriated to the National Center for Workforce Analysis to carry out this subpart $6,000,000 for the period of fiscal years 2011 through 2013.
.
Improved nursing services
Comprehensive geriatric education nursing grant program
Section 855 of the Public Health Service Act (42 U.S.C. 298) is amended—
in subsection (b)—
in paragraph (3), by striking
or
;
in paragraph (4),
by striking the period and inserting ; or
; and
by inserting after paragraph (4) the following:
establish Federal traineeships to individuals who are preparing for advanced degrees in geriatric nursing, long-term care, and gero-psychiatric nursing.
; and
in subsection (e), by inserting before the
period the following: , $12,000,000 for each of fiscal years 2011
through 2013 to provide assistance under this section to support additional
training for nurses who care for the elderly and individuals with disabilities
and for the development and dissemination of curricula relating to geriatric
nursing care, the training of nursing faculty in geriatrics, and the provision
of continuing education for nurses practicing in geriatrics, and $25,000,000
for each of fiscal years 2011 through 2013 to provide assistance under this
section to support the Federal traineeships established under subsection
(b)(5)
.
Amendments to the Workforce Investment Act of 1998
Core services
Section 134(d)(2)(E)(iii) of the Workforce Investment Act of 1998 (29 U.S.C. 2864(d)(2)(E)(iii)) is amended to read as follows:
information relating to local occupations in demand, including health care and long-term care occupations, and the earnings and skill requirements for such local occupations;
.
Individual training accounts
Section 134(d)(4)(G)(iii) of the Workforce Investment Act of 1998 (29 U.S.C. 2864(d)(4)(G)(iii)) is amended to read as follows:
Linkage to occupations in demand
Training services provided under this paragraph shall be directly linked to occupations, including health care and long-term care occupations, that are in demand in the local area, or in another area to which an adult or dislocated worker receiving such services is willing to relocate, except that a local board may approve training services for occupations determined by the local board to be in sectors of the economy that have a high potential for sustained demand or growth in the local area. In making determinations of demand or potential demand or growth under this clause, a local board shall consult local and State health agencies, employers, and other organizations that the local board determines to be appropriate.
.
Collaboration between State boards and the veterans agencies of the States
Section 112(b) of the Workforce Investment Act of 1998 (29 U.S.C. 2822(b)) is amended—
in paragraph
(17), by striking and
at the end;
in paragraph
(18), by striking the period and inserting ; and
; and
by adding at the end the following new paragraph:
a description of how the State board will collaborate with the veterans agency of the State, including entering into a memorandum of understanding with the veterans agency of the State specifying—
the manner in which the State board and the veterans agency of the State will provide information on health care workforce employment and training opportunities available to individuals, including veterans who are receiving core services described in section 134(d)(2) at a one-stop center and are receiving assistance from the Veterans' Employment and Training Service of the Department of Labor; and
the manner in which the State board and the veterans agency of the State will obtain and provide information to one-stop operators in the State, for distribution through one-stop centers, about training, internship, and employment opportunities in geriatrics, gerontology, and long-term care, including, as available, opportunities at geriatric research, education and clinical centers operated by the Department of Veterans Affairs.
.
Collaboration between Department of Labor and Department of Veterans Affairs
The Secretary of Labor, acting through the Assistant Secretary for Veterans' Employment and Training, and the Secretary of Veterans Affairs, shall develop memoranda of understanding outlining how veterans seeking employment information through the Local Veterans' Employment Representative Program and the Transition Assistance Program will be provided with information about training, internship, and employment opportunities in geriatrics, gerontology, and long-term care, including opportunities at geriatric research, education and clinical centers operated by the Department of Veterans Affairs.
Training opportunities for direct care workers
In general
Section 171 of the Workforce Investment Act of 1998 (29 U.S.C. 2916) is amended by adding at the end the following new subsection:
Training opportunities for direct care workers
In general
The Secretary shall award grants to eligible entities to enable such entities to provide new training opportunities for direct care workers (including certified nursing assistants, home health aides, and personal or home care aides) who are employed in long-term care settings such as nursing homes (as defined in section 1908(e)(1) of the Social Security Act (42 U.S.C. 1396g(e)(1)), assisted living facilities, home care settings, and any other setting the Secretary determines to be appropriate.
Eligibility
To be eligible to receive a grant under paragraph (1), an entity shall—
be an institution of higher education (as defined in section 102 of the Higher Education Act of 1965 (20 U.S.C. 1002)) that—
is accredited by a nationally recognized accrediting agency or association listed under section 101(c) of the Higher Education Act of 1965 (20 U.S.C. 1001(c)); and
has established a public-private educational partnership with a nursing home, home health agency, or other long-term care provider; and
submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
Priority
In making grants to eligible entities, the Secretary shall give priority to entities that demonstrate that the entities will coordinate activities with one-stop operators and one-stop partners at local one-stop centers referred to in section 134(c).
Use of funds
An eligible entity shall use amounts awarded under a grant under paragraph (1) to provide assistance to eligible individuals to offset the cost of tuition and required fees for enrollment in academic programs provided by such entity, including—
the provision of stipends to such individuals for a period of not to exceed 2 years;
the lowering of fees assessed with respect to eligible individuals who are enrolled in programs leading to a licensed practical nursing degree, a registered nursing degree, or any other advanced nursing degree; and
the lowering of fees assessed with respect to eligible individuals who are enrolled in courses aimed at improving direct care skills for the treatment of specialized conditions that are common in the long-term care sector, such as wound care, brain trauma, immobility, incontinence, functional impairment, and dementia.
Eligible individual
Eligibility
To be eligible for assistance under paragraph (4), an individual shall be enrolled in courses provided by a grantee under this subsection and maintain satisfactory academic progress in such courses.
Condition of assistance
As a condition of receiving assistance under paragraph (4), an individual shall agree that, following completion of the assistance period, the individual will work in the field of geriatrics, long-term care, or chronic care management for a minimum of 2 years under guidelines set by the Secretary.
Authorization of appropriations
There is authorized to be appropriated to carry out this subsection, $10,000,000 for the period of fiscal years 2011 through 2013.
.
Conforming amendments
Section 174(b)(1)
of the Workforce Investment Act of 1998 (29 U.S.C. 2919(b)(1)) is amended by
inserting and except as provided in section 171(f),
after
paragraph (2),
.
Section 174(b)(2)(B)(ii) of the Workforce Investment Act (29 U.S.C. (b)(2)(B)(ii)) is amended to read as follows:
except as provided in section 171(f), for each of the fiscal years 2000 through 2003, reserve not less than 45 percent for carrying out section 171;
.
Amendments to the Older Americans Act of 1965
Family caregiver training
In general
Part E of title III of the Older Americans Act of 1965 (42 U.S.C. 3030s et seq.) is amended by adding at the end the following:
Family caregiver training
Development of materials
In general
The Assistant Secretary shall, directly or by contract, develop family caregiver training materials, working with an advisory committee, comprised of experts on matters related to family caregivers, including researchers, clinicians, representatives of nursing homes and State Long-Term Care Ombudsman programs, representatives of community colleges and vocational schools, family caregivers, and representatives of organizations for family caregivers. The materials shall be suitable to provide online training for family caregivers, and grandparents or older individuals who are relative caregivers, in providing personal care to care recipients.
Content
The materials shall include written materials and videos, designed to be easily downloaded, that demonstrate techniques for key personal care activities. The materials shall demonstrate ways of safely lifting and transferring individuals with disabilities, means of preventing falls, and other means of providing assistance with activities of daily living, and instrumental activities of daily living such as medication management. The materials shall provide information on behavioral management and communication techniques for care recipients that are individuals with Alzheimer's disease or a related disorder with neurological and organic brain dysfunction.
Distribution of materials
The Assistant Secretary shall make the training described in subsection (a)(1) available online, free of cost to users.
Definitions
In this section:
Care recipient
The term care recipient—
used with respect to a family caregiver, means an older individual or an individual with Alzheimer's disease or a related disorder with neurological and organic brain dysfunction; and
used with respect to a grandparent or older individual who is a relative caregiver, means an individual with a disability.
Community college
The term community college means an institution of higher education (as defined in section 101(a) of the Higher Education Act of 1965 (20 U.S.C. 1001(a))) that offers a 2-year program of study.
Individual with a disability
The term individual with a disability means an individual with a disability, within the meaning of section 372(a)(1).
Vocational school
The term vocational school means an area career and technical education school, as defined in section 3 of the Carl D. Perkins Career and Technical Education Act of 2006 (20 U.S.C. 2302).
.
Authorization of appropriations
Section 303(e) of the Older Americans Act of 1965 (42 U.S.C. 3023(e)) is amended—
in paragraph (2),
by inserting , other than section 375
after part
E
; and
by adding at the end the following:
There is authorized to be appropriated to carry out section 375, $5,000,000 for the period of fiscal years 2011 through 2013.
.
Redesignations in provisions for multigenerational and civic engagement activities
Redesignations
Section 417 of the Older Americans Act of 1965 is amended—
in subsection (a)—
in paragraph (1), by redesignating subparagraphs (A) and (B) as clauses (i) and (ii), respectively, and indenting accordingly;
by redesignating paragraphs (1) and (2) as subparagraphs (A) and (B), respectively, and indenting accordingly; and
by inserting all
that precedes The Assistant Secretary
and inserting the
following:
Demonstration, support, and research projects
Grants and contracts
;
in subsection (b)—
by redesignating paragraphs (1) and (2) as subparagraphs (A) and (B), respectively, and indenting accordingly; and
by inserting all
that precedes An eligible
and inserting the following:
Use of funds
;
in subsection (c)—
by redesignating paragraphs (1) through (4) as subparagraphs (A) through (D), respectively, and indenting accordingly; and
by striking all
that precedes In awarding
and inserting the following:
Preference
;
in subsection
(d), by striking all that precedes To be
and inserting the
following:
Application
;
in subsection (e)—
by redesignating paragraphs (1) and (2) as subparagraphs (A) and (B), respectively, and indenting accordingly; and
by inserting all
that precedes Organizations
and inserting the following:
Eligible organizations
;
in subsection (f)—
in paragraph (1), by redesignating subparagraphs (A), (B), and (C) as clauses (i), (ii), and (iii), respectively, and indenting accordingly;
by redesignating paragraphs (1) and (2) as subparagraphs (A) and (B), respectively, and indenting accordingly; and
by inserting all that precedes subparagraph (A) (as redesignated by subparagraph (B) of this paragraph) and inserting the following:
Local evaluation and report
;
in subsection (g)—
by redesignating paragraphs (1) through (8) as subparagraphs (A) through (H), respectively, and indenting accordingly; and
by inserting all
that precedes Not later
and inserting the following:
Report to congress
; and
in subsection (h)—
in paragraph (2)—
in subparagraph (B), by redesignating clauses (i) and (ii) as subclauses (I) and (II), respectively, and indenting accordingly; and
by redesignating subparagraphs (A) and (B) as clauses (i) and (ii), respectively, and indenting accordingly;
by redesignating paragraphs (1) and (2) as subparagraphs (A) and (B), respectively, and indenting accordingly; and
by inserting all
that precedes As used
and inserting the following:
Definitions
.
Conforming amendments
Section 417 of the Older Americans Act of 1965 is amended—
by striking
this section
each place it appears and inserting this
subsection
;
by striking
subsection (a)(1)
each place it appears and inserting
paragraph (1)(A)
;
by striking
subsection (a)(2)
each place it appears and inserting
paragraph (1)(B)
;
except as
provided in paragraphs (2) and (3), by striking subsection (a)
each place it appears and inserting paragraph (1)
; and
in subsection (a) (as redesignated by subsection (a) of this section)—
in paragraph
(2)(B), by striking subsection (f)
and inserting
paragraph (6)
; and
in paragraph (7)—
in
the matter preceding subparagraph (A), by striking subsection
(f)(2)
and inserting paragraph (6)(B)
; and
in
subparagraph (G), by striking paragraph (1)
and inserting
subparagraph (A)
.
National Resource Center on Volunteers, Students, and Seniors
Section 417 of the Older Americans Act of 1965 (42 U.S.C. 3032f), as amended by section 302, is further amended by adding at the end the following:
National Resource Center on Volunteers, Students, and Seniors
In general
Grant
The Assistant Secretary shall award a grant
for the establishment and operation of a National Resource Center on
Volunteers, Students, and Seniors (referred to in this subsection as the
Center
). The Center shall—
promote partnerships between entities in the aging network, and institutions of higher education and secondary schools, in order to expand the capacity of individuals to serve in, and in order to attract new leaders for and professionals into, the aging network; and
encourage projects that involve underserved communities, including rural communities and racial and ethnic minority communities.
Partnerships
Such partnerships may involve—
State agencies, area agencies on aging, or other local government agencies, Aging and Disability Resource Centers, tribal organizations, nonprofit health or social service organizations, community clinics, adult day care centers, senior housing providers, and other providers that provide direct services to older individuals and that are determined to be appropriate by the Assistant Secretary; and
local institutions of higher education and secondary schools.
Center
The Center shall use the funds made available through the grant to—
identify and disseminate information (including information about best practices) concerning how entities described in paragraph (1)(B) can establish partnerships in a manner that provides volunteers and students in nursing, social work, gerontology, psychology, dental hygiene, music and recreational therapy, nutrition, and other disciplines identified by the Assistant Secretary with opportunities, approved by the Assistant Secretary, to gain experience working with older individuals, including older individuals with dementia or cognitive impairment, receiving services under this Act;
develop and implement a model demonstration grant program to—
promote new partnerships between the entities described in paragraph (1)(B) and incorporate activities of the partnerships into established curricula of institutions of higher education and secondary schools; and
promote and sponsor internship programs, career development seminars, and continuing education and lifelong learning programs; and
develop and implement a model career ladder program that will disseminate information on best practices designed to enable mid-level professionals to advance in the field of aging.
Definition
In this subsection, the term secondary school has the meaning given the term in section 9101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 8801).
Authorization of appropriations
There is authorized to be appropriated to carry out this subsection $3,000,000 for fiscal year 2011, $3,500,000 for fiscal year 2012, and $4,000,000 for fiscal year 2013.
.
Amendments to the Social Security Act
Demonstration program for personal or home care aides, nurse aides, and home health aides in long-term care settings
Establishment
In general
The Secretary shall establish a demonstration program (in
this section referred to as the program
) to make grants to
participating States to develop core training competencies for eligible
personal or home care aides and additional training content for nurse aides and
home health aides to supplement training for nurse aides and home health aides
that is required under Federal law or regulation, and to evaluate the
effectiveness of such competencies and additional training content. Such
program shall evaluate the efficacy of—
the core training competencies developed under subsection (b)(2)(A);
the additional training content developed under subsection (b)(2)(B); and
the method of
implementation of such core training competencies and additional training
content against a control
group being trained under a
participating State’s existing training protocols.
Duration
The program shall be conducted for not less than 4 years.
Establishment of expert panel
In general
Not later than 120 days after the date of enactment of
this Act, the Secretary shall establish a panel of long-term care workforce
experts (in this section referred to as the expert
panel
).
Duties
The expert panel shall carry out the following duties:
Subject to clause (ii), developing core training competencies for personal or home care aides, including such competencies with respect to the following areas:
The role of the personal or home care aide (including differences between a personal or home care aide employed by an agency and a personal or home care aide employed directly by the health care consumer or an independent provider).
Consumer rights, ethics, and confidentiality (including the role of proxy decision-makers in the case where a health care consumer has impaired decision-making capacity).
Communication, cultural and linguistic competence and sensitivity, problem solving, behavior management, and relationship skills.
Personal care skills.
Health care support.
Nutritional support.
Infection control.
Safety and emergency training.
Training specific to an individual consumer’s needs (including older individuals, younger individuals with disabilities, individuals with developmental disabilities, individuals with dementia, and individuals with mental and behavioral health needs).
Self-Care.
For purposes of the program, the core training competencies developed under clause (i) shall only apply with respect to newly hired personal or home care aides.
Subject to clause (ii), developing additional training content for home health aides and nurse aides which is not required under Federal law as of the date of enactment of this Act, including such content with respect to the following areas:
Culturally and linguistically competent practice.
Standardized direct care worker communication protocols (such as Situation, Background, Assessment, and Recommendation communication tools).
Palliative and end-of-life care.
Injury prevention.
Wound and decubitus care.
Medication management, adherence, and safe disposal.
Mental and behavioral health.
Additional aspects of dementia care training (such as understanding dementia and Alzheimer's disease, dealing with challenging behavior, developing communication skills, working with family caregivers, and ensuring physical health and safety).
Prevention and reporting of abuse and caregiver burnout.
For purposes of the program, the additional training content developed under clause (i) shall only apply with respect to newly hired home health aides and nurse aides.
Subject to clause (ii), making recommendations regarding how training shall be provided under the program, including recommendations with respect to the following:
The length of the training.
The appropriate trainer to student ratio.
The amount of instruction time spent in the classroom as compared to on-site in the home or a facility.
Trainer qualifications.
Content for a hands-on
and
written certification exam.
Continuing education requirements.
Ways to integrate the core training competencies developed for personal and home care aides under subparagraph (A) with the additional training content developed for home health aides and nurse aides under subparagraph (B).
The recommendations under clause (i) shall ensure that the number of hours of training provided under the program are not less than the number of hours of training required under any applicable State or Federal law or regulation.
Membership
In general
Subject to subparagraph (B), the expert panel shall be composed of 11 members appointed by the Secretary from among leading experts in the long-term care field, including representatives of—
personal or home care agencies;
home health care agencies;
nursing homes and residential care facilities;
the disability community (including the mental retardation and developmental disability communities);
the nursing community;
national advocacy organizations and unions that represent direct care workers;
older individuals and family caregivers;
State Medicaid waiver program officials;
curriculum developers with expertise in adult learning;
researchers on direct care workers and the long-term care workforce; and
geriatric pharmacists.
Inclusion of representatives of certain individuals
Not less than 2 of the 11 members appointed by the Secretary under subparagraph (A) shall represent the interests of individuals who rely on long-term care services, including the interests of those individuals described in clause (vii) of such subparagraph.
Report
Not later than 1 year after the date of enactment of this Act, the expert panel shall submit to the Secretary a report containing—
the core training competencies developed under paragraph (2)(A);
the additional training content developed under paragraph (2)(B);
any recommendations of the expert panel under paragraph (2)(C); and
recommendations for such legislation or administrative action as the expert panel determines appropriate.
Termination
The expert panel shall terminate 180 days after it submits the report under paragraph (4).
Application and selection criteria
In general
Solicitation
Not later than 2 years after the date of enactment of this Act, the Secretary shall issue a proposal soliciting States to voluntarily participate in the program.
Agreements
The Secretary shall enter into agreements with not more than 4 States to conduct the program in such States.
Requirements for States
An agreement entered into under subparagraph (B) shall require that a participating State—
use grant funds made available to the State under the program to recruit eligible health and long-term care providers to—
participate in the program; and
implement the core training competencies developed under subsection (b)(2)(A) and the additional training content developed under subsection (b)(2)(B); and
develop written materials and protocols for such core training competencies and such additional training content, including the development of a certification test for personal or home care aides who have completed such training competencies and, if applicable, additional training content.
Consultation and collaboration with community and vocational colleges
The Secretary shall encourage participating States to consult with community and vocational colleges regarding the development of curricula to implement the program, which may include consideration of such colleges as partners in such implementation.
Application and eligibility
A State seeking to participate in the program shall—
submit an application to the Secretary containing such information and at such time as the Secretary may specify;
meet the selection criteria established under paragraph (3); and
meet such additional criteria as the Secretary may specify.
Selection criteria
In selecting States to participate in the program, the Secretary shall establish criteria to ensure—
geographic and demographic diversity;
that participating States offer medical assistance for personal care services under the State Medicaid plan;
that the existing training standards for personal or home care aides, home health aides, and nurse aides in each participating State—
are different from such standards in the other participating States; and
are different from the core training competencies developed under subsection (b)(2)(A) and the additional training content developed under subsection (b)(2)(B);
that participating States do not reduce the number of hours of training required under applicable State law or regulation after being selected to participate in the program; and
that States recruit a minimum number of eligible health and long-term care providers to participate in the program.
Technical assistance
The Secretary shall provide technical assistance to States in developing written materials and protocols for such core training competencies and such additional training content under paragraph (1)(C)(ii).
Evaluation and report
Evaluation
The Secretary shall develop an experimental or control group testing protocol in consultation with an independent evaluation contractor selected by the Secretary. Such contractor shall evaluate—
the impact of core training competencies developed under subsection (b)(2)(A), including curricula developed to implement such core training competencies, for personal or home care aides within each participating State on job satisfaction, mastery of job skills, beneficiary and family caregiver satisfaction with services, and additional measures determined by the Secretary in consultation with the expert panel established under subsection (b);
the impact of incorporating the additional training content developed under subsection (b)(2)(B) into existing training standards for home health aides and certified nurse aides within each participating State;
the impact of providing such core training competencies and additional training content on the existing training infrastructure and resources of States;
whether the minimum number of hours of initial training required for nurse aides under sections 1819(f)(2)(A)(i)(II) and 1919(f)(2)(A)(i)(II) of the Social Security Act (42 U.S.C. 1395i–3(f)(2)(A)(i)(II); 1396r(f)(2)(A)(i)(II)) should be increased; and
whether a minimum number of hours of initial training should be required for personal or home care aides and, if so, what minimum number of hours should be required.
Report
Not later than 1 year after the completion of the program, the Secretary shall submit to Congress a report containing the results of the evaluations conducted under paragraph (1), together with such recommendations for legislation or administrative action as the Secretary determines appropriate.
Funding
Out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary to carry out the program under this section for the period of fiscal years 2011 through 2016, $14,000,000.
Definitions
In this section:
Eligible health and long-term care provider
The term eligible health and long-term care provider means a personal or home care agency (including personal or home care public authorities), a nursing home, a home health agency (as defined in section 1861(o)) of the Social Security Act (42 U.S.C. 1395x(o)), or any other health care provider the Secretary determines appropriate which—
is licensed or authorized to provide services in a participating State; and
receives payment for services under title XVIII or XIX of the Social Security Act.
Home health aide
The term home health aide has the meaning given such term in section 1891(a)(3)(E) of the Social Security Act (42 U.S.C. 1395bbb(a)(3)(E)).
Nurse aide
The term nurse aide has the meaning given such term in section 1819(b)(5)(F) of the Social Security Act (42 U.S.C. 1395i–3(b)(5)(F)).
Personal care services
The term personal care services has the meaning given such term for purposes of title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).
Personal or home care aide
The term personal or home care aide means an individual who helps individuals who are elderly, disabled, ill, or mentally disabled (including an individual with Alzheimer's disease or other dementia) to live in their own home or a residential care facility (such as a nursing home, assisted living facility, or any other facility the Secretary determines appropriate) by providing routine personal care services and other appropriate services to the individual.
Secretary
The term Secretary means the Secretary of Health and Human Services.
Medicare family caregiver information and referral
State health insurance assistance programs, the Administrator of the Centers for Medicare & Medicaid Services, and the Assistant Secretary of the Administration on Aging shall, in collaboration with each other, directly or by contract, develop practical, easy-to-understand information and referral protocols for health care providers, social workers, and other appropriate individuals to provide to family caregivers of Medicare beneficiaries either on admission to or discharge from a hospital (including a discharge from a hospital emergency room or a hospital outpatient department which has furnished a surgical service) or a post-acute care setting (including a skilled nursing facility (as defined in section 1819(a) of the Social Security Act (42 U.S.C. 1395i–3(a)), a comprehensive rehabilitation facility (as defined in section 1861(cc)(2) of such Act (42 U.S.C. 1395x(cc)(2)) or a rehabilitation agency, a provider of long-term care services, and a home health agency (as defined in section 1861(o) of such Act (42 U.S.C. 1395x(o)). Information developed under the preceding sentence shall—
include information on national, State, and community-based resources for seniors, individuals with disabilities and their caregivers, which shall be updated on a semi-annual basis (or as frequently as practicable);
be disseminated by health care providers, social workers, and other appropriate individuals as printed materials (including materials in Spanish and other languages (other than English) as appropriate); and
be made available on the Internet websites of State health insurance assistance programs, the Centers for Medicare & Medicaid Services, and the Administration on Aging.
Medicaid assessment of family caregiver support needs
In general
Section 1915 of the Social Security Act (42 U.S.C. 1396n) is amended—
in subsection (c)(2)—
in subparagraph
(D), by striking and
at the end;
in subparagraph
(E), by striking the period at the end and inserting ; and
;
and
by adding at the end the following new subparagraph:
under such waiver the State may provide for an assessment of family caregiver support needs (in accordance with subsection (k)).
;
in subsection (d)(2)—
in subparagraph
(B), by striking and
at the end;
in subparagraph
(C), by striking the period at the end and inserting ; and
;
and
by adding at the end the following new subparagraph:
under such waiver the State may provide for an assessment of family caregiver support needs (in accordance with subsection (k)).
;
in subsection (i)(1)(F), by adding at the end the following new clause:
Where appropriate, an assessment of family caregiver support needs (in accordance with subsection (k)).
; and
by adding at the end the following new subsection:
Assessment of family caregiver support needs
In general
In the case of an individual who is determined to be eligible for home and community-based services under a waiver under subsection (c) or (d) or under section 1115, under a State plan amendment under subsection (i), under an MFP demonstration project established under section 6071 of the Deficit Reduction Act of 2005, or as part of self-directed personal assistance services provided pursuant to a written plan of care in accordance with the requirements of subsection (j), and who is dependent upon the assistance of a family caregiver, the State may provide for an assessment of the family caregiver support needs of the individual. Such assessment shall, to the extent feasible, be conducted at the same time as, or closely coordinated with, the determination of the eligibility of the individual for such services.
Questionnaire
In general
Such assessment shall include asking the family caregiver of the individual questions in order to determine whether they would benefit from targeted support services (such as those services described in paragraph (3)).
Completion on a voluntary basis
The answering of questions under subparagraph (A) by a family caregiver shall be on a voluntary basis.
Targeted support services described
The following targeted support services are described in this paragraph:
Respite care and emergency back-up services (including short-term help for the individual that gives the family caregiver a break from providing such care).
Individual counseling (including advice and consultation sessions to bolster emotional support for the family caregiver to make well-informed decisions about how to cope with the strain of supporting the individual).
Support groups, including groups which provide help for family caregivers to—
locate a support group either locally or online to share experiences and reduce isolation;
make well-informed decisions about caring for the individual; and
reduce isolation.
Information and assistance (including brochures and online resources for researching a disease or disability or learning and managing a regular caregiving role, new technologies that can assist family caregivers, and practical assistance for locating services).
Chore services (such as house cleaning).
Personal care (including outside help).
Education and training (including workshops and other resources available with information about stress management, self-care to maintain good physical and mental health, understanding and communicating with individuals with dementia, medication management, normal aging processes, change in disease and disability, the role of assistive technologies, and other relevant topics).
Legal and financial planning and consultation (including advice and counseling regarding long-term care planning, estate planning, powers of attorney, community property laws, tax advice, employment leave advice, advance directives, and end-of-life care).
Transportation (including transportation to medical appointments).
Other targeted support services the Secretary or the State determines appropriate.
Referrals
In the case where a questionnaire completed by a family caregiver under paragraph (2) indicates that the family caregiver would benefit from 1 or more of the targeted support services described in paragraph (3), the State shall provide referrals to the family caregiver for local, State, and private-sector family caregiver programs and other resources that provide such targeted support services.
.
Effective date
The amendments made by subsection (a) shall apply to medical assistance for home and community-based services that is provided on or after the date of enactment of this Act.
Studies and reports
Studies and reports
IOM study and report on mental health workforce needs
Study
Not later than 90 days after the date of enactment of this Act, the Secretary of Health and Human Services shall enter into a contract with the Institute of Medicine of the National Academies (in this section referred to as the “Institute”) under which the Institute shall conduct a study on the specific policy, workforce, economic, and implementation issues relevant to the mental health workforce that need to be addressed to meet the current needs of older individuals and the future needs of the aging boomer generation.
Report
Not later than 24 months after the effective date of the contract under paragraph (1), the Institute, as part of such contract, shall submit a report to the Secretary of Health and Human Services and the appropriate committees of jurisdiction of Congress containing the results of the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Institute determines appropriate.
Authorization
There is authorized to be appropriated to carry out this subsection, $1,200,000 for the period of fiscal years 2011 through 2012.
GAO study and report on the needs of the aging network
Study
The
Comptroller General of the United States (in this section referred to as the
Comptroller General
) shall conduct a study on the aging network,
focusing on State agencies and area agencies on aging (as defined in section
102 of the Older Americans Act of 1965 (42 U.S.C. 3002)) to determine the
current capacity of such network and to identify challenges in providing
services to older adults, including older adults who are low-income and older
adults with functional disabilities, during the 10-year period beginning on the
date of enactment of this Act.
Report
Not later than 18 months after the date of enactment of this Act, the Comptroller General shall submit to Congress a report containing the results of the study conducted under paragraph (1), together with recommendations—
on the workforce supply and capitol resources needed by the aging network in order to meet the demand for services by older adults during such 10-year period; and
for such legislation and administrative action as the Comptroller General determines appropriate.
GAO study and report on the direct case workforce in long-term care settings
Study
The Comptroller General shall conduct a study on the use of practices to reduce turnover and improve retention and tenure of nurse aides and home health aides in nursing homes, assisted living facilities, and home health agencies (as defined in section 1861(o) of the Social Security Act (42 U.S.C. 1395x(o)). Such study shall include an analysis of the reasons for the success of such practices and how such practices could be replicated in other facilities.
Report
Not later than 18 months after the date of enactment of this Act, the Comptroller General shall submit to Congress a report containing the results of the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.
Definitions
In this subsection:
Home health aide
The term home health aide has the meaning given such term in section 1891(a)(3)(E) of the Social Security Act (42 U.S.C. 1395bbb(a)(3)(E)).
Nurse aide
The term nurse aide has the meaning given such term in section 1819(b)(5)(F) of the Social Security Act (42 U.S.C. 1395i–3(b)(5)(F)).
GAO study and report on NIH spending and grants
Study
The Comptroller General shall conduct a study on spending by the National Institutes of Health, including the number of grants made by the National Institutes of Health, on conditions and illnesses that disproportionately impact the physical and mental health of older individuals. Such study shall include an analysis of the number of older individuals who are included in clinical trials, including clinical trials assessing the prevalence and impact of medication-related problems for older adults, that are supported by the National Institutes of Health.
Report
Not later than 18 months after the date of enactment of this Act, the Comptroller General shall submit to Congress a report containing the results of the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.
