[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 2708 Introduced in Senate (IS)]







110th CONGRESS
  2d Session
                                S. 2708

 To amend the Public Health Service Act to attract and retain trained 
    health care professionals and direct care workers dedicated to 
  providing quality care to the growing population of older Americans.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 5, 2008

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

_______________________________________________________________________

                                 A BILL


 
 To amend the Public Health Service Act to attract and retain trained 
    health care professionals and direct care workers dedicated to 
  providing quality care to the growing population of older Americans.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Caring for an Aging America Act of 
2008''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) The projected growth in the number and proportion of 
        older adults is unprecedented in United States history.
            (2) By 2030, the population of the United States aged 65 
        and older will exceed 70,000,000, about twice the number of 
        such individuals in 2000.
            (3) In the December 2007 final report titled ``From 
        Isolation to Integration: Recommendations to Improve Quality in 
        Long-Term Care'' the National Commission for Quality Long-Term 
        Care reported that there is abundant evidence that the health 
        and long-term care workforce is not equipped in skills or in 
        numbers to respond adequately to the aging of the United States 
        population.
            (4) Inadequate training in geriatrics and gerontology often 
        results in misdiagnoses, medication errors, inappropriate 
        services, and a lack of care coordination, particularly in 
        transitions from one setting to another, that are harmful to 
        older patients and costly to our health and long-term care 
        system.
            (5) Twenty-five percent of medical students report 
        inadequate amounts of time devoted to geriatric training, 30 
        percent feel unprepared to care for older adults in acute care 
        settings, and 42 percent say they are unprepared to care for 
        frail older people in nursing homes.
            (6) Only 3 percent of psychologists view geriatrics as 
        their primary area of practice and only 28 percent of 
        psychologists have some graduate training in geriatrics or 
        gerontology.
            (7) Less than 1 percent of nurses are certified 
        gerontological nurses and only 3 percent of advance practice 
        nurses specialize in aging.
            (8) Only 5 percent of social workers are trained in aging 
        issues, yet 70 percent of licensed clinical social workers have 
        worked in some capacity with older adults and their families.
            (9) By 2050, the United States will need three times as 
        many direct care workers in home, community-based and facility-
        based long-term care settings as are employed now to meet the 
        needs of the baby boom generation.

SEC. 3. GERIATRIC AND GERONTOLOGY LOAN REPAYMENT PROGRAM.

    Part E of title VII of the Public Health Service Act (42 U.S.C. 295 
et seq.) is amended by adding at the end the following:

``Subpart 3--Strengthening Recruitment and Retention for Geriatric Care 
                                Practice

``SEC. 771. GERIATRIC AND GERONTOLOGY LOAN REPAYMENT PROGRAM.

    ``(a) Establishment.--The Secretary shall establish a Geriatric and 
Gerontology Loan Repayment Program within the Health Resources and 
Services Administration to ensure an adequate supply of physicians, 
physician assistants, nurse practitioners, clinical nurse specialists, 
psychologists, and social workers trained in geriatrics or gerontology 
and to reduce critical workforce shortages in geriatric care practice.
    ``(b) Contracts.--Under the program established under subsection 
(a), the Secretary shall enter into contracts with individuals 
described in subsection (d) under which the individuals agree to 
provide full-time clinical practice and service to older adults for a 
minimum of 2 years.
    ``(c) Payment for Years of Service.--In consideration of the 
Federal Government agreeing to pay, for each year of service under a 
contract under this section, not more than $35,000 of the principal and 
interest of the educational loans of the individual involved for each 
of the first 2 years of service, the individual shall carry out 
activities in accordance with subsection (d)(4). For subsequent years, 
loan repayments of up to $40,000 per year for a third or fourth year of 
service may be made available.
    ``(d) Eligible Individuals.--An individual described in this 
subsection is an individual--
            ``(1) who--
                    ``(A) is a physician, including an osteopathic 
                physician, who has completed specialty training in 
                geriatric medicine or geriatric psychiatry;
                    ``(B) is a nurse practitioner or clinical nurse 
                specialist who has completed specialty training in 
                geriatrics or gerontology;
                    ``(C) is a physician assistant who has completed 
                specialty training in geriatrics;
                    ``(D) is a social worker who has completed 
                specialty training in gerontology;
                    ``(E) is a psychologist who has completed specialty 
                training in gerontology; or
                    ``(F) otherwise--
                            ``(i) has a degree in medicine, osteopathic 
                        medicine, clinical or counseling psychology 
                        (doctoral degree program), social work 
                        (master's or doctoral degree program), or who 
                        is a certified nurse practitioner, certified 
                        clinical nurse specialist, or physician 
                        assistant; and
                            ``(ii) is enrolled in, or has successfully 
                        completed, an accredited program of specialty 
                        training in geriatric medicine, geriatric 
                        psychiatry, geropsychology, gerontological 
                        social work, gerontological nursing, or 
                        equivalent geriatric care practice (as 
                        determined by the Secretary);
            ``(2) who has obtained an educational loan for costs 
        associated with graduate training in medicine, psychology, or 
        social work, or costs associated with becoming a nurse 
        practitioner, clinical nurse specialist, or physician 
        assistant;
            ``(3) who is appropriately licensed, without restriction 
        (as determined by the Secretary), in the State in which the 
        individual practices; and
            ``(4) who agrees to provide clinical services to older 
        adults for a period of not less than 2 years in a setting 
        determined appropriate by the Secretary.
    ``(e) Applicability of Certain Provisions.--With respect to the 
National Health Service Corps Loan Repayment Program established in 
subpart III of part D of title III of this Act, the provisions of such 
subpart shall, except as inconsistent with this section, apply to the 
program established in this section in the same manner and to the same 
extent as such provisions apply to the National Health Service Corps 
Loan Repayment Program.
    ``(f) National Advisory Council on the Geriatric and Gerontology 
Loan Repayment Program.--
            ``(1) Establishment.--The Secretary shall establish a 
        National Advisory Council on the Geriatric and Gerontology Loan 
        Repayment Program (referred to in this section as the 
        `Council') that shall be composed of not to exceed 11 members 
        to be appointed by the Secretary.
            ``(2) Duties.--The Council shall consult with, advise, and 
        make recommendations to the Secretary with respect to the 
        Secretary's administration of the program established under 
        subsection (a).
            ``(3) Administrative provisions.--Members of the Council 
        shall be appointed for a term of 3 years and shall be 
        representative of the health professions, and professional 
        associations, that are eligible to enter into agreements under 
        this section.
    ``(g) Reports.--Not later than 2 years after the date of the 
enactment of this section, and annually thereafter, the Secretary shall 
prepare and submit to the appropriate committees of Congress a report 
that describes--
            ``(1) the program established under this section (including 
        the number and amount of loan repayments, the number and 
        practice locations of the loan repayment recipients, the 
        demographics of the individuals participating in the program, 
        the default rate and actions required upon default, and to the 
        extent that it can be determined, the reasons for such 
        defaults);
            ``(2) how the program interacts with other Federal loan 
        repayment programs for primary health care professionals; and
            ``(3) the overall costs and benefits of the program.
    ``(h) Definition.--In this section:
            ``(1) Geriatrics.--The term `geriatrics' means the branch 
        of medicine that deals with the problems and diseases of older 
        adults and aging.
            ``(2) Gerontology.--The term `gerontology' means the 
        multidisciplinary study of the aging process and individuals as 
        they grow from middle age through later life. Such term 
        encompasses the social, psychological, biological and economic 
        aspects of aging.
            ``(3) Specialty training.--The term `specialty training' 
        means coursework in geriatrics and gerontology and clinical 
        training, including internships or fellowships, in a geriatric 
        setting.
    ``(i) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $4,000,000 for fiscal year 
2009, $9,500,000 for fiscal year 2010, $16,000,000 for fiscal year 
2011, $24,000,000 for fiscal year 2012, and $30,500,000 for fiscal year 
2013.''.

SEC. 4. EXPANSION OF NURSING EDUCATION LOAN REPAYMENT PROGRAM.

    Section 846 of the Public Health Service Act (42 U.S.C. 297n) is 
amended--
            (1) by redesignating subsection (i) as subsection (j); and
            (2) by inserting after subsection (h), the following:
    ``(i) Geriatric Care Practice in Long-Term Care Settings.--
            ``(1) Loan repayments.--In providing for loan repayments 
        under this section, the Secretary shall ensure that eligible 
        individuals include registered nurses who complete specialty 
        training in geriatrics or gerontology and who elect to provide 
        nursing services to older adults in home and community-based or 
        facility-based long-term care settings, or any other program 
        determined appropriate by the Secretary.
            ``(2) Definition.--In this subsection, the term `specialty 
        training' means coursework in geriatrics and gerontology and 
        clinical training, including internships or fellowships, in a 
        geriatric setting.
            ``(3) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection, $1,500,000 for 
        fiscal year 2009, $3,000,000 for fiscal year 2010, $5,000,000 
        for fiscal year 2011, $7,000,000 for fiscal year 2012, and 
        $8,500,000 for fiscal year 2013.''.

SEC. 5. EXPANSION OF CAREER LADDER PROGRAMS.

    Section 831 of the Public Health Service Act (42 U.S.C. 296p) is 
amended--
            (1) in subsection (c)(1)(A)--
                    (A) by striking ``to promote career'' and inserting 
                the following: ``to--
                            ``(i) promote career''; and
                    (B) by adding at the end the following:
                            ``(ii) focus on specialty training in 
                        providing long-term care services for nursing 
                        personnel (including registered nurses, 
                        licensed practical nurses, licensed vocational 
                        nurses, certified nurse assistants, home health 
                        aides, personal care attendants, or any other 
                        related worker category designated by the 
                        Secretary) who provide services in home and 
                        community-based or facility-based long-term 
                        care settings; and''; and
            (2) in subsection (h), by adding at the end the following: 
        ``There is authorized to be appropriated for grants under 
        subsection (c)(1)(A)(ii), $4,000,000 for fiscal year 2009, 
        $4,000,000 for each of fiscal years 2010 through 2012, and 
        $3,500,000 for fiscal year 2013.''.

SEC. 6. HEALTH AND LONG-TERM CARE WORKFORCE ADVISORY PANEL FOR AN AGING 
              AMERICA.

    Subpart 3 of part E of title VII of the Public Health Service Act 
(as added by section 2) is further amended by adding at the end the 
following:

``SEC. 772. HEALTH AND LONG-TERM CARE WORKFORCE ADVISORY PANEL FOR AN 
              AGING AMERICA.

    ``(a) Establishment.--The Secretary, in consultation with the 
Secretary of Labor, shall establish a Health and Long-Term Care 
Workforce Advisory Panel (referred to in this section as the `Panel') 
to--
            ``(1) examine workforce issues related to health and long-
        term care for the aging population; and
            ``(2) provide advice to each such Secretary and to the 
        appropriate committees of Congress concerning workforce issues 
        related to health and long-term care for the aging population.
    ``(b) Membership.--The Panel shall be composed of not to exceed 20 
individuals to be appointed by the Secretary.
    ``(c) Duties.--The Panel shall--
            ``(1) analyze the existing geriatric health and long-term 
        care workforce data infrastructure;
            ``(2) make recommendations for new or additional uniform 
        data elements across regions and States that is necessary to 
        track supply, demand, and workforce shortages related to health 
        and long-term care for the aging population;
            ``(3) conduct a research project to identify incentives for 
        recruitment and retention of new populations of clinicians and 
        providers who agree to serve vulnerable older adults in 
        geriatric and long-term care settings and make recommendations 
        for one or more demonstrations, including the design, 
        implementation and evaluation of outcomes; and
            ``(4) carry out other activities determined appropriate by 
        the Secretary.
    ``(d) Focus of Research Project.--In carrying out the research 
project under subsection (c)(3), the Secretary in consultation with the 
Panel shall focus on individuals who are not otherwise eligible for 
loan repayment incentives under this title or title VIII, such as 
retired military clinicians or other retired health professionals, 
health care professionals seeking a mid-career change, and direct care 
workers in long-term care settings. To carry out such research project, 
the Secretary may award grants or contracts. Eligible entities shall 
include State or local government, health professions schools, academic 
health centers, and other appropriate public or private non-profit 
entities.
    ``(e) Administrative Provisions.--Members of the Panel shall be 
appointed for a term of not to exceed 3 years (as determined by the 
Secretary at the time of appointment), shall convene at least twice per 
year, and shall be representative of diverse public and private sector 
expertise and interests, including representation from the Department 
of Health and Human Services (including the Health Resources and 
Services Administration, the Agency for Healthcare Research and 
Quality, and the Administration on Aging), the Department of Labor 
(including the Bureau of Labor Statistics, the Employment and Training 
Administration, and the Employment Standards Administration), other 
Federal officials as the Secretary determines appropriate, academic 
institutions, consumer organizations, national aging advocates, health 
professional and paraprofessional associations, organized labor, 
nationally-recognized researchers in the area of geriatric care and 
long-term care workforce issues, health care and long-term care 
associations (including those representing home and community-based and 
facility-based settings), and private foundations that have sponsored 
initiatives to expand health professionals to care for the aging 
population.
    ``(f) Reports.--Not later than 2 years after the date of enactment 
of this section, and every 2 years thereafter, the Secretary, based on 
the advice and recommendations of the Panel, shall submit to the 
appropriate committees of Congress a report on the status of the health 
professions and long-term care workforce for the aging population.
    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $1,500,000 for fiscal year 
2009, and such sums as may be necessary for each of fiscal years 2010 
through 2013.''.
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