[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 776 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                 S. 776

     To assist in creating substantive culture change in long-term 
   residential care by establishing a small house nursing home loan 
program to provide for the establishment, renovation, and construction 
                     of small house nursing homes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 1, 2009

 Mr. Casey (for himself, Mr. Wicker, and Mr. Martinez) introduced the 
 following bill; which was read twice and referred to the Committee on 
                  Banking, Housing, and Urban Affairs

_______________________________________________________________________

                                 A BILL


 
     To assist in creating substantive culture change in long-term 
   residential care by establishing a small house nursing home loan 
program to provide for the establishment, renovation, and construction 
                     of small house nursing homes.

    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 ``Promoting Small House Nursing Homes 
Act''.

SEC. 2. SMALL HOUSE NURSING HOME LOAN PROGRAM.

    (a) Establishment.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') shall establish a small 
house nursing home loan program (in this section referred to as the 
``program'') under which the Secretary makes grants to eligible lenders 
in order for such eligible lenders to make direct loans to eligible 
borrowers for the establishment, renovation, and construction of small 
house nursing homes that meet the requirements of this section.
    (b) Eligibility.--
            (1) Program grant eligibility.--To be eligible to obtain a 
        grant under the program, an eligible lender shall--
                    (A) be a nonprofit, non-Federal lender;
                    (B) have a track record of lending to small house 
                nursing homes, low income populations, or nursing homes 
                that serve low income populations; and
                    (C) submit to the Secretary an application in such 
                form as the Secretary may reasonably require.
            (2) Small house advisory panel.--
                    (A) In general.--Not later than 90 days after the 
                date of enactment of this Act, the Secretary shall 
                establish an advisory panel (in this section referred 
                to as the ``Small House Advisory Panel'') to--
                            (i) evaluate applications for direct loans 
                        under the program in conjunction with eligible 
                        lenders; and
                            (ii) carry out other responsibilities 
                        determined appropriate by the Secretary.
                    (B) Membership.--The Small House Advisory Panel 
                shall consist of not less than 5 and not more than 7 
                individuals who have expertise in the areas of person-
                centered long-term care culture change, long-term care 
                financing, consumers, and direct care workers.
            (3) Evaluation of eligible borrower applicants.--
                    (A) Establishment of evaluation tool and 
                criteria.--
                            (i) In general.--The Secretary, in 
                        collaboration with the Small House Advisory 
                        Panel, shall establish an evaluation tool and 
                        evaluation criteria with which to prioritize 
                        eligible borrowers who submit to an eligible 
                        lender an application for a direct loan under 
                        the program.
                            (ii) Evaluation tool.--The evaluation tool 
                        established under subparagraph (A) shall be 
                        based upon the model guideline priorities under 
                        subsection (c)(5).
                            (iii) Prioritization of eligible 
                        borrowers.--Eligible borrowers shall be 
                        prioritized under the program in accordance 
                        with the extent to which they meet such model 
                        guideline priorities.
                    (B) Evaluation of applications and 
                recommendations.--
                            (i) In general.--Applications for a direct 
                        loan under the program shall be evaluated by 
                        the Secretary, in collaboration with the Small 
                        House Advisory Panel.
                            (ii) Recommendations.--The Secretary shall 
                        establish procedural guidelines under which any 
                        recommendations of the Secretary for making 
                        direct loans shall be provided to eligible 
                        lenders.
            (4) Loan eligibility.--To be eligible for a direct loan 
        from an eligible lender under the program, an eligible borrower 
        shall be a private or public nonprofit entity or a for-profit 
        entity that--
                    (A) agrees to use the proceeds from such direct 
                loan to construct or renovate a small house nursing 
                home that--
                            (i) is designed to establish substantive 
                        culture change; and
                            (ii) meets the model small house nursing 
                        home requirements and guidelines under 
                        subsection (c);
                    (B) submits a detailed plan describing--
                            (i) the particular model or approach to 
                        person-centered care that the small house 
                        nursing home will implement; and
                            (ii) how the small house nursing home will 
                        meet such model small house nursing home 
                        requirements and guidelines;
                    (C) has been approved by a State or local entity 
                (in accordance with applicable State and local law) to 
                operate a skilled nursing facility (as defined in 
                section 1819(a) of the Social Security Act (42 U.S.C. 
                1395i-3(a)) or a nursing facility (as defined in 
                section 1919(a) of such Act (42 U.S.C. 1396r(a)));
                    (D) with respect to the facility, ensures that at 
                least 30 percent of the residents of the facility are 
                Medicaid-funded individuals under title XIX of the 
                Social Security Act (42 U.S.C. 1396 et seq.), as 
                determined in accordance with guidelines to be issued 
                by the Secretary that take into consideration the 
                number of days such residents spend in the facility, 
                and does not discharge residents based on their ability 
                to pay;
                    (E) complies with lending standards developed, in 
                consultation with the Secretary, by a task force of 
                experts in long-term care financing, affordable housing 
                with services development, and nontraditional lending; 
                and
                    (F) agrees to share financial and operating data 
                with researchers and Federal agencies designated by the 
                Secretary.
            (5) Loan disqualification.--In no case may an entity which 
        has displayed a pattern of failing to comply with State and 
        Federal quality of care standards (as determined by the 
        Secretary) or an entity with a pattern of violating State and 
        Federal labor laws (as determined by the Secretary) be an 
        eligible borrower under the program.
    (c) Model Small House Nursing Home Requirements and Guidelines.--
            (1) In general.--
                    (A) Development.--Not later than 90 days after the 
                date of enactment of this Act, the Secretary shall 
                develop model small house nursing home guidelines that 
                meet the requirements of this subsection.
                    (B) Consistency with requirements applicable under 
                the social security act.--The guidelines established 
                under subparagraph (A) shall be consistent with, and in 
                addition to, any requirements applicable to an eligible 
                borrower under sections 1819 and 1919 of the Social 
                Security Act (42 U.S.C. 1395i-3; 1396r).
            (2) Practice research and implementation.--
                    (A) In general.--Under the guidelines under 
                paragraph (1), a small house nursing home that obtains 
                proceeds from a direct loan made under this section 
                shall be based on methods and practices that have been 
                tested through pilot programs and other research 
                carried out at not less than 1 implementation site in 
                the United States for at least a 2-year period.
                    (B) Improvements in quality of life.--Pilot 
                programs and research referred to in subparagraph (A) 
                shall be designed to establish a clearly articulated, 
                evidence-based approach to creating improvements in the 
                quality of life and care outcomes of residents of small 
                house nursing homes as well as providing for 
                improvements in the professional satisfaction and 
                career development of the staff of small house nursing 
                homes.
                    (C) Research requirement.--Research referred to in 
                subparagraph (A) shall be conducted by a researcher--
                            (i) who has expertise in long-term care; 
                        and
                            (ii) who has no financial or professional 
                        interests in the success of the methods or 
                        practices involved.
            (3) Requirements of small house nursing homes.--Under the 
        guidelines developed under paragraph (1), a small house nursing 
        home that obtains proceeds from a direct loan made under this 
        section shall--
                    (A) establish a self-directed model of care for 
                residents that incorporates collaborative 
                decisionmaking by residents and nursing assistants;
                    (B) provide for a universal worker approach to 
                resident care (including care available from a nursing 
                assistant, personal care, socialization services, meal 
                preparation services, and laundry housekeeping 
                services) that is organized to support and empower all 
                staff to respond to the needs and desires of residents;
                    (C) provide for consistent staff assignments;
                    (D) consist of a physical environment designed as a 
                home, rather than an institution--
                            (i) that contains residential style design 
                        elements and materials throughout the home that 
                        are similar to the residential style design 
                        elements and materials in the immediate 
                        surrounding community, including residential 
                        style design elements in areas that have mixed-
                        zoning purposes, and do not use commercial and 
                        institutional elements and products (such as a 
                        nurses' station, medication carts, hospital or 
                        office type florescent lighting, acoustical 
                        tile ceilings, institutional style railings and 
                        corner guards, and room numbering and labeling) 
                        unless mandated by authorities with appropriate 
                        jurisdiction over the small house nursing home;
                            (ii) which is designed to be a fully 
                        independent and disabled accessible house, 
                        apartment, or independent wing of an existing 
                        structure with not more than 25 residents in 
                        the house, apartment, or independent wing;
                            (iii) that contains a full private bathroom 
                        for each bedroom that, at a minimum, provides a 
                        toilet, sink, and accessible shower;
                            (iv) which has a life-safety rating that is 
                        sufficient to appropriately accommodate 
                        individuals who cannot self-evacuate; and
                            (v) in which the percentage of residents of 
                        the small house nursing home who are short stay 
                        rehabilitation residents does not exceed 20 
                        percent at any time unless the small house 
                        nursing home is entirely devoted to providing 
                        rehabilitation services, except that a long-
                        term resident returning to a small house 
                        nursing home after an acute episode and who is 
                        receiving rehabilitation services for which 
                        payment is made under the Medicare program 
                        under title XVIII of the Social Security Act 
                        shall not be counted toward such 20 percent 
                        limitation;
                    (E) provide for meals cooked in the small house 
                nursing home and not prepared in a central kitchen and 
                transported to the small house nursing home; and
                    (F) provide for the training of staff in accordance 
                with paragraph (4).
            (4) Training of staff.--
                    (A) In general.--Under the guidelines under 
                paragraph (1), a small house nursing home that obtains 
                proceeds from a direct loan made under this section 
                shall provide training for all staff involved in the 
                operations of the small house nursing home concerning 
                the philosophy, operations, and skills required to 
                implement and maintain self-directed care, self-managed 
                work teams, a noninstitutional approach to life and 
                care in long-term care, appropriate safety and 
                emergency skills, and other elements required for the 
                successful operation of and outcomes in the small house 
                nursing home.
                    (B) Collaboration.--
                            (i) In general.--Training under 
                        subparagraph (A) shall be interdisciplinary and 
                        collaborative.
                            (ii) Collective bargaining.--
                                    (I) In general.--In the case where 
                                staff involved in the operations of the 
                                small house nursing home are 
                                represented by a collective bargaining 
                                organization, the organization shall be 
                                provided an opportunity to fully 
                                participate in the development of a 
                                program for providing such training.
                                    (II) Prioritization.--In the case 
                                where there is an existing jointly 
                                funded employer-labor training 
                                partnership, or where a training 
                                program is funded through collective 
                                bargaining, the small house nursing 
                                home shall prioritize the utilization 
                                of or collaboration with those existing 
                                training programs in meeting the 
                                requirements of this paragraph.
                    (C) Amount.--Training under subparagraph (A) shall 
                be not less than 120 hours for each universal worker 
                employed by the small house nursing home and not less 
                than 60 hours for each leadership and clinical team 
                member employed by such small house nursing home. Such 
                training shall be in addition to any other State 
                training requirements and shall be completed for the 
                majority of the staff prior to the initial start-up of 
                the small house nursing home.
            (5) Model guideline priorities for loan applicants.--An 
        eligible borrower applying for a direct loan under this section 
        shall be given priority in evaluation of loan applications in 
        proportion to their compliance with 1 or more of the following 
        model guidelines:
                    (A) Residential model priorities.--Priority in 
                evaluation for loan eligibility shall be given to small 
                house nursing home models that--
                            (i) have private, single occupancy bedrooms 
                        that are shared only at the request of a 
                        resident to accommodate a spouse, partner, 
                        family member, or friend;
                            (ii) contain a living area where residents 
                        and staff may socialize, dine, and prepare food 
                        together that, at a minimum, provides a living 
                        room seating area, a dining area large enough 
                        for a single table serving all residents and 
                        not less than 2 staff members, and an open full 
                        kitchen;
                            (iii) contain ample natural light in each 
                        habitable space that is provided through 
                        exterior windows and other means, with window 
                        areas, exclusive of skylights and clearstories, 
                        being a minimum of 10 percent of the area of 
                        the room; and
                            (iv) have built-in safety features to allow 
                        all areas of the house to be accessible to the 
                        residents during the majority of the day and 
                        night.
                    (B) Direct care worker model priorities.--Priority 
                in evaluation for loan eligibility shall be given to 
                small house nursing home model operators that have a 
                legally binding collective bargaining agreement and a 
                signed labor-management partnership agreement covering 
                the planning and implementation of small house nursing 
                homes. Where employees are represented by a labor 
                organization, a signed labor management implementation 
                agreement will be required.
    (d) Loan Provisions.--
            (1) In general.--Except as otherwise provided in this 
        subsection, each direct loan made under this section shall be 
        subject to such terms, conditions, and covenants relating to 
        repayment of principal, payment of interest, and other matters 
        as may be established by the eligible lender.
            (2) Maximum loan amount.--The Secretary, in consultation 
        with the Small House Advisory Panel, shall determine the 
        maximum amount of any direct loan made under this section.
            (3) Rate of interest.--A direct loan made under this 
        section shall bear interest at an annual rate of not more than 
        3 percent, or as determined by the Secretary.
    (e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $50,000,000 for each of fiscal 
years 2010 through 2014. Amounts appropriated under this subsection 
shall be available until expended.
    (f) Termination.--The program shall terminate, and no loan may be 
made under this section, on or after the date that is 25 years after 
the date on which amounts are initially appropriated under subsection 
(e).

SEC. 3. REPORT.

    Not later than 5 years after the date of enactment of this Act, the 
Secretary of Health and Human Services shall submit to the appropriate 
committees of Congress a report on the small house nursing home loan 
program established under section 2(a). Such report shall include 
information on--
            (1) the use of direct loans made under the program to 
        establish, renovate, and construct small house nursing homes 
        that meet the requirements of section 2;
            (2) the quality of health care, quality of life, emotional 
        well-being, ability to perform functions of daily living, and 
        other outcomes found for residents of small house nursing 
        homes, as compared to such outcomes found for residents of 
        traditional nursing homes; and
            (3) staff wages, retention, and absenteeism rates, measures 
        of staff satisfaction, and workload and staffing levels for 
        small house nursing homes, as compared to traditional nursing 
        homes.
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