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).