[Congressional Record Volume 143, Number 34 (Monday, March 17, 1997)]
[Senate]
[Pages S2358-S2373]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DORGAN (for himself, Mr. Grassley, Mr. Rockefeller, Mr. 
        Baucus, Mr. Roberts, Mr. Harkin, Mr. Faircloth, Mr. Hutchinson, 
        Mr. Inouye and Mr. Conrad):
  S. 452. A bill to amend titles XVIII and XIX of the Social Security 
Act to permit a waiver of the prohibition of offering nurse aide 
training and competency evaluation programs in certain nursing 
facilities; to the Committee on Finance.


                  THE NURSE AIDE TRAINING ACT OF 1997

 Mr. DORGAN. Mr. President, today, I am introducing legislation 
that will preserve quality care in rural nursing homes by ensuring that 
they can continue to conduct nurse aide training programs in their 
facilities.

[[Page S2373]]

  This bill enjoys bipartisan support, and I am joined in introducing 
this bill by Senators Grassley, Rockefeller, Baucus, Roberts, Harkin, 
Faircloth, Hutchinson, Inouye, and Conrad. The bill, which also has the 
support of the Clinton administration, will prevent the termination of 
nurse aide training programs where the reason for the termination is 
unrelated to the quality of the program and where no training 
alternative exists within a reasonable distance.
  I have long believed that the Federal Government has an important 
role to play in ensuring against the kinds of abuses that sometimes 
occurred prior to enactment of Federal nursing home standards. I do not 
believe that those abuses were the norm in nursing homes. Nursing homes 
in my State of North Dakota have a strong record of providing quality 
care, and I believe that this was the case in most nursing homes.
  But it is clear that some nursing homes did not meet that high 
standard, and many States were slow to respond. To address that 
critical problem, I supported and continue to support minimum Federal 
quality standards. Our first priority in nursing home legislation must 
be the quality of care provided to residents, and we should not pass 
any laws that would compromise that goal.
  However, I believe that some of our efforts to regulate nursing homes 
have not resulted in greater quality of care for residents. In some 
cases, by imposing unnecessary burdens and severe penalties that are 
not focused on quality, some laws and regulations can actually hinder 
the delivery of quality care. The legislation I am offering today will 
address one such instance.

  In rural areas all over the country, nursing facilities offer 
potential caretakers an opportunity to learn the basic nursing and 
personal care skills needed to become a certified nurse aide. In 
return, those who participate in a nurse aide training program help 
nursing facilities meet their staffing needs and allow the nursing 
staff to focus more on administering quality nursing care.
  Nurse aide training programs are especially important in rural areas 
like my State of North Dakota, where potential nurse aides might have 
to travel hundreds of miles for training if it is not available at the 
nursing facility in their community. These nurse aide training programs 
comply with strict guidelines related to the amount of training 
necessary and determination of competency for certification.
  Despite these safeguards, current law allows programs to be 
terminated for up to 2 years if a facility has been cited for a 
deficiency or assessed a civil money penalty for reasons completely 
unrelated to the quality of the nurse aide training program. In North 
Dakota, this could result in real hardship not just for the nursing 
facility and potential nurse aides, but for the nursing home residents 
who rely on nurse aides for their day-to-day care.
  Under my bill, rural areas would be exempt from termination of nurse 
aide training programs in these specific instances only if: First, no 
other program is offered within a reasonable distance of the facility; 
second, the State assures that an adequate environment exists for 
operating the program; and third, the State provides notice of the 
determination and assurances to the State long-term care ombudsman.
  The President has included this proposal in the last two budgets he 
has presented to Congress. In addition, Congress included this proposal 
in the Balanced Budget Act passed in December 1995.
  I hope my colleagues will join me in supporting this bill.
  I ask unanimous consent that the full text of the bill be printed in 
the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 452

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

     SECTION 1. PERMITTING WAIVER OF PROHIBITION OF OFFERING NURSE 
                   AIDE TRAINING AND COMPETENCY EVALUATION 
                   PROGRAMS IN CERTAIN FACILITIES.

       (a) Waiver.--Sections 1819(f)(2) and section 1919(f)(2) of 
     the Social Security Act (42 U.S.C. 1395i-3(f)(2), 
     1396r(f)(2)) are each amended--
       (1) in subparagraph (B)(iii), by inserting ``subject to 
     subparagraph (C),'' after ``(iii)''; and
       (2) by adding at the end, the following:
       ``(C) Waiver authorized.--Clause (iii) of subparagraph (B) 
     shall not apply to a program offered in (but not by) a 
     nursing facility in a State if the State--
       ``(i) determines that there is no other such program 
     offered within a reasonable distance of the facility;
       ``(ii) assures, through an oversight effort, that an 
     adequate environment exists for operating the program in the 
     facility; and
       ``(iii) provides notice of such determination and 
     assurances to the State long-term care ombudsman.''.
       (b) Effective Date.--The amendments made by subsection (a) 
     apply to programs offered on or after the date of enactment 
     of this Act.

  Mr. GRASSLEY. Mr. President, today I join Senator Byron Dorgan of 
North Dakota in introducing legislation aimed at reversing the lack of 
qualified nurse aides in rural America by encouraging local training 
programs to continue their work. Our goal is to improve the level of 
care in nursing homes. Increasing the availability of qualified staff 
in rural nursing homes will help older Americans live better lives.
  Many rural nursing homes rely on their own training programs to 
certify nurse aides. Current Federal law allows these training programs 
to be terminated due to problems unrelated to the quality of the 
training program. In rural areas, terminating a nurse aide training 
program can result in a lack of qualified staff at a rural facility. 
Therefore, terminating a nurse training program can actually make 
conditions worse, not better.
  This bill ensures that nurse aide training programs will be judged on 
their own merits, not on outside factors. This is commonsense 
legislation. Judging people on their actions and programs on their 
results is the American way. Judging training programs on outside 
factors doesn't penalize the substandard nursing homes, it penalizes 
older Americans.
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