1.This Act may be cited as
the Improving Care for Vulnerable
Older Citizens through Workforce Advancement Act of
2011
.
2.Congress finds the following:
(1)As of 2011, more
than 35,000,000 Americans are aged 65 or older. Sixty-two percent of them
suffer from multiple chronic conditions which require person-centered,
coordinated care that helps them to live in a home- or community-based setting.
In 2007, 42 percent of Americans 65 and older reported needing assistance
performing Instrumental Activities of Daily Living or Activities of Daily
Living.
(2)Direct-care
workers (referred to in this section as DCWs) provide an estimated
70 to 80 percent of the paid hands-on long-term care and personal assistance
received by elders and people with disabilities or other chronic conditions in
the United States. These workers help their clients bathe, dress, and negotiate
a host of other daily tasks. They are a lifeline for those they serve, as well
as for families and friends struggling to provide quality care.
(3)Eldercare and
disability services positions account for nearly one-third of the 15,000,000
health care jobs in the United States. The direct-care workforce alone accounts
for more than 3,000,000 jobs, expected to grow to more than 4,000,000 by
2018.
(4)The majority of
DCWs are now employed in home and community-based settings, and not in
institutional settings such as nursing care facilities or hospitals. By 2018,
home and community-based DCWs are likely to outnumber facility workers by
nearly 2 to 1.
(5)A 2008 Institute
of Medicine report, entitled Re-tooling for an Aging America: Building
the Health Care Workforce
, called for new models of care delivery and
coordination, and dedicated a chapter to the central importance of the
direct-care workforce in a re-tooled
eldercare delivery
system.
(6)An Institute of
Medicine report on the future of nursing, released in October of 2010,
recommended nurses should practice to the full extent of their education and
training. The report also states that all health care professionals should work
collaboratively in team-based models, and that the goal should be to encourage
care models that use every member of the team to the full capacity of his or
her training and skills.
(7)The Patient
Protection and Affordable Care Act (Public Law 111–148) emphasizes the need for
improving care and lowering costs by better coordination of care and
integration of services, particularly for consumers with multiple chronic
conditions. This will require developing new models of care for those receiving
long-term services and supports.
(8)A November 2010
focus group of DCWs examined the concept of an advanced role for this
workforce. About half of the participants shared that they care for consumers
who do not have any family or other unpaid caregivers present, which often
requires them to assume an additional role as an advocate, with those consumers
often turning to them as a source of trusted information and emotional support.
All participants agreed that consumers and family members frequently ask them
to undertake tasks that they would like to provide, but for which they have not
received proper training.
3.Demonstration
program on care coordination and service deliveryPart A of title IV of the Older Americans
Act of 1965 (42 U.S.C. 3032 et seq.) is amended by adding at the end the
following:
423.Demonstration
program on care coordination and service delivery
(a)Establishment
of demonstration program
(1)The Assistant Secretary shall carry out a demonstration
program in accordance with this section. Under such program, the Assistant
Secretary shall award grants to eligible entities to carry out demonstration
projects that focus on care coordination and service delivery redesign for
older individuals with chronic illness or at risk of institutional placement
by—
(A)designing and
testing new models of care coordination and service delivery that thoughtfully
and effectively deploy advanced aides to improve efficiency and quality of care
for frail older individuals; and
(B)giving
direct-care workers opportunities for career advancement through additional
training, an expanded role, and increased compensation.
(2)In this section, the term direct-care worker
has the meaning given that term in the 2010 Standard Occupational
Classifications of the Department of Labor for Home Health Aides [31–1011],
Psychiatric Aides [31–1013], Nursing Assistants [31–1014], and Personal Care
Aides [39–9021].
(b)The demonstration program shall be composed of 6
demonstration projects, as follows:
(1)Two demonstration
projects shall focus on using the abilities of direct-care workers to promote
smooth transitions in care and help to prevent unnecessary hospital
readmissions. Under these projects, direct-care workers shall be incorporated
as essential members of interdisciplinary care coordination teams.
(2)Two demonstration
projects shall focus on maintaining the health and improving the health status
of those with multiple chronic conditions and long-term care needs. Under these
projects, direct-care workers shall assist in monitoring health status,
ensuring compliance with prescribed care, and educating and coaching the older
individual involved and any family caregivers.
(3)Two demonstration
projects shall focus on training direct-care workers to take on deeper clinical
responsibilities related to specific diseases, including Alzheimer’s and
dementia, congestive heart failure, and diabetes.
(c)In this section, the term eligible entity
means a consortium that consists of—
(1)at least
1—
(A)long-term care
and rehabilitation facility; or
(B)home personal
care service provider; and
(2)at least
1—
(A)hospital or
health system;
(B)labor
organization or labor-management partnership;
(C)community-based
aging service provider;
(D)patient-centered
medical home;
(E)federally
qualified health center;
(F)managed care
entity, including a managed health and long-term care program;
(G)entity that
provides health services training;
(H)State-based
public entity engaged in building new roles and related curricula for
direct-care workers; or
(I)any other entity
that the Assistant Secretary deems eligible based on integrated care
criteria.
(d)To
be eligible to receive a grant under this section, an eligible entity shall
submit to the Assistant Secretary an application at such time, in such manner,
and containing such information as the Secretary may require, which shall
include—
(1)a description of
the care coordination and service delivery models of the entity, detailed on a
general, organizational, and staff level;
(2)a description of
how the demonstration project carried out by the entity will improve care
quality, including specific objectives and anticipated outcomes that will be
used to measure success; and
(3)a description of
how the coordinated care team approach with an enhanced role for the
direct-care worker under the demonstration project will increase efficiency and
cost effectiveness compared to past practice.
(e)Planning awards
under demonstration program
(1)Each eligible entity that receives a grant under this
section shall receive a grant for planning activities related to the
demonstration project to be carried out by the entity, including—
(A)designing the
implementation of the project;
(B)identifying
competencies and developing curricula for the training of participating
direct-care workers;
(C)developing
training materials and processes for other members of the interdisciplinary
care team;
(D)articulating a
plan for identifying and tracking cost savings gained from implementation of
the project and for achieving long-term financial sustainability; and
(E)articulating a
plan for evaluating the project.
(2)
(A)The amount awarded under paragraph (1) for all grants
shall not exceed $600,000.
(B)Activities
carried out under a grant awarded under paragraph (1) shall be completed not
later than 1 year after the grant is awarded.
(f)Implementation
awards under demonstration program
(1)Each eligible entity may receive a grant for
implementation activities related to the demonstration project to be carried
out by the entity, if the Assistant Secretary determines the entity—
(A)has successfully
carried out the activities under the grant awarded under subsection (e);
(B)offers a feasible
plan for long-term financial sustainability;
(C)has constructed a
meaningful model of advancement for direct-care workers; and
(D)aims to provide
training to a sizeable number of direct-care workers and to serve a sizeable
number of older individuals.
(2)The implementation activities described under paragraph (1)
shall include—
(A)training of all
care team members in accordance with the design of the demonstration project;
and
(B)evaluating the
competency of all staff based on project design.
(3)
(A)Each
recipient of a grant under paragraph (1), in consultation with an independent
evaluation contractor, shall evaluate—
(i)the impact of
training and deployment of direct-care workers in advanced roles, as described
in this section, within each participating entity on outcomes, such as
direct-care worker job satisfaction and turnover, beneficiary and family
caregiver satisfaction with services, rate of hospitalization of beneficiaries,
and additional measures determined by the Secretary;
(ii)the impact of
such training and deployment on the long-term services and supports delivery
system and resources;
(iii)statement of
the potential of the use of direct-care workers in advanced roles to lower cost
and improve quality of care in the Medicaid program; and
(iv)long-term
financial sustainability of the model used under the grant and the impact of
such model on quality of care.
(B)Not
later than 180 days after completion of the demonstration program under this
section, each recipient of a grant under paragraph (1) shall submit to the
Secretary a report on the implementation of activities conducted under the
demonstration project, including—
(i)the outcomes,
performance benchmarks, lessons learned from the project;
(ii)a statement of
cost savings gained from implementation of the project and how the cost savings
have been reinvested to improve direct-care job quality and quality of care;
and
(iii)results of the
evaluation conducted under subparagraph (A) with respect to such activities,
together with such recommendations for legislation or administrative action for
expansion of the demonstration program on a broader scale as the Secretary
determines appropriate.
(4)
(A)The amount awarded under paragraph (1) for all grants
shall not exceed $2,900,000.
(B)Activities
carried out under a grant awarded under paragraph (1) shall be completed not
later than 2 years after the grant is
awarded.
.