II 

112TH CONGRESS 

1ST SESSION S. 1982 

To amend the Older Americans Act of 1965 to develop and test an expanded 

and advanced role for direct care workers who provide long-term services 

and supports to older individuals in efforts to coordinate care and improve the efficiency of service delivery. 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 13, 2011 

Mr. CASEY (for himself and Mr. FRANKEN) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To amend the Older Americans Act of 1965 to develop 

and test an expanded and advanced role for direct care 

workers who provide long-term services and supports to 

older individuals in efforts to coordinate care and improve the efficiency of service delivery. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Improving Care for 

5 Vulnerable Older Citizens through Workforce Advance6 ment Act of 2011’’. 


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1 SEC. 2. FINDINGS. 

2 Congress finds the following: 

3 (1) As of 2011, more than 35,000,000 Ameri4 cans are aged 65 or older. Sixty-two percent of them 

5 suffer from multiple chronic conditions which require 

6 person-centered, coordinated care that helps them to 

7 live in a home- or community-based setting. In 

8 2007, 42 percent of Americans 65 and older re9 ported needing assistance performing Instrumental 

10 Activities of Daily Living or Activities of Daily Liv11 ing. 

12 (2) Direct-care workers (referred to in this sec13 tion as ‘‘DCWs’’) provide an estimated 70 to 80 per14 cent of the paid hands-on long-term care and per15 sonal assistance received by elders and people with 

16 disabilities or other chronic conditions in the United 

17 States. These workers help their clients bathe, dress, 

18 and negotiate a host of other daily tasks. They are 

19 a lifeline for those they serve, as well as for families 

20 and friends struggling to provide quality care. 

21 (3) Eldercare and disability services positions 

22 account for nearly one-third of the 15,000,000 

23 health care jobs in the United States. The direct24 care workforce alone accounts for more than 

25 3,000,000 jobs, expected to grow to more than 

26 4,000,000 by 2018. 


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1 (4) The majority of DCWs are now employed in 

2 home and community-based settings, and not in in3 stitutional settings such as nursing care facilities or 

4 hospitals. By 2018, home and community-based 

5 DCWs are likely to outnumber facility workers by 

6 nearly 2 to 1. 

7 (5) A 2008 Institute of Medicine report, enti8 tled ‘‘Re-tooling for an Aging America: Building the 

9 Health Care Workforce’’, called for new models of 

10 care delivery and coordination, and dedicated a 

11 chapter to the central importance of the direct-care 

12 workforce in a ‘‘re-tooled’’ eldercare delivery system. 

13 (6) An Institute of Medicine report on the fu14 ture of nursing, released in October of 2010, rec15 ommended nurses should practice to the full extent 

16 of their education and training. The report also 

17 states that all health care professionals should work 

18 collaboratively in team-based models, and that the 

19 goal should be to encourage care models that use 

20 every member of the team to the full capacity of his 

21 or her training and skills. 

22 (7) The Patient Protection and Affordable Care 

23 Act (Public Law 111–148) emphasizes the need for 

24 improving care and lowering costs by better coordi25 nation of care and integration of services, particuVerDate Mar 15 2010 00:18 Dec 18, 2011 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1982.IS S1982

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1 larly for consumers with multiple chronic conditions. 

2 This will require developing new models of care for 

3 those receiving long-term services and supports. 

4 (8) A November 2010 focus group of DCWs ex5 amined the concept of an advanced role for this 

6 workforce. About half of the participants shared that 

7 they care for consumers who do not have any family 

8 or other unpaid caregivers present, which often re9 quires them to assume an additional role as an advo10 cate, with those consumers often turning to them as 

11 a source of trusted information and emotional sup12 port. All participants agreed that consumers and 

13 family members frequently ask them to undertake 

14 tasks that they would like to provide, but for which 

15 they have not received proper training. 

16 SEC. 3. DEMONSTRATION PROGRAM ON CARE COORDINA17 TION AND SERVICE DELIVERY. 

18 Part A of title IV of the Older Americans Act of 1965 

19 (42 U.S.C. 3032 et seq.) is amended by adding at the end 

20 the following: 

21 ‘‘SEC. 423. DEMONSTRATION PROGRAM ON CARE COORDI22 NATION AND SERVICE DELIVERY. 

23 ‘‘(a) ESTABLISHMENT OF DEMONSTRATION PRO24 GRAM.— 


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1 ‘‘(1) IN GENERAL.—The Assistant Secretary 

2 shall carry out a demonstration program in accord3 ance with this section. Under such program, the As4 sistant Secretary shall award grants to eligible enti5 ties to carry out demonstration projects that focus 

6 on care coordination and service delivery redesign 

7 for older individuals with chronic illness or at risk 

8 of institutional placement by— 

9 ‘‘(A) designing and testing new models of 

10 care coordination and service delivery that 

11 thoughtfully and effectively deploy advanced 

12 aides to improve efficiency and quality of care 

13 for frail older individuals; and 

14 ‘‘(B) giving direct-care workers opportuni15 ties for career advancement through additional 

16 training, an expanded role, and increased com17 pensation. 

18 ‘‘(2) DIRECT-CARE WORKER.—In this section, 

19 the term ‘direct-care worker’ has the meaning given 

20 that term in the 2010 Standard Occupational Classi21 fications of the Department of Labor for Home 

22 Health Aides [31–1011], Psychiatric Aides [31– 

23 1013], Nursing Assistants [31–1014], and Personal 

24 Care Aides [39–9021]. 


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1 ‘‘(b) DEMONSTRATION PROJECTS.—The demonstra2 tion program shall be composed of 6 demonstration 

3 projects, as follows: 

4 ‘‘(1) Two demonstration projects shall focus on 

5 using the abilities of direct-care workers to promote 

6 smooth transitions in care and help to prevent un7 necessary hospital readmissions. Under these 

8 projects, direct-care workers shall be incorporated as 

9 essential members of interdisciplinary care coordina10 tion teams. 

11 ‘‘(2) Two demonstration projects shall focus on 

12 maintaining the health and improving the health sta13 tus of those with multiple chronic conditions and 

14 long-term care needs. Under these projects, direct15 care workers shall assist in monitoring health status, 

16 ensuring compliance with prescribed care, and edu17 cating and coaching the older individual involved and 

18 any family caregivers. 

19 ‘‘(3) Two demonstration projects shall focus on 

20 training direct-care workers to take on deeper clin21 ical responsibilities related to specific diseases, in22 cluding Alzheimer’s and dementia, congestive heart 

23 failure, and diabetes. 

24 ‘‘(c) ELIGIBLE ENTITY.—In this section, the term 

25 ‘eligible entity’ means a consortium that consists of— 


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1 ‘‘(1) at least 1— 

2 ‘‘(A) long-term care and rehabilitation fa3 cility; or 

4 ‘‘(B) home personal care service provider; 

5 and 

6 ‘‘(2) at least 1— 

7 ‘‘(A) hospital or health system; 

8 ‘‘(B) labor organization or labor-manage9 ment partnership; 

10 ‘‘(C) community-based aging service pro11 vider; 

12 ‘‘(D) patient-centered medical home; 

13 ‘‘(E) federally qualified health center; 

14 ‘‘(F) managed care entity, including a 

15 managed health and long-term care program; 

16 ‘‘(G) entity that provides health services 

17 training; 

18 ‘‘(H) State-based public entity engaged in 

19 building new roles and related curricula for di20 rect-care workers; or 

21 ‘‘(I) any other entity that the Assistant 

22 Secretary deems eligible based on integrated 

23 care criteria. 

24 ‘‘(d) APPLICATION.—To be eligible to receive a grant 

25 under this section, an eligible entity shall submit to the 


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1 Assistant Secretary an application at such time, in such 

2 manner, and containing such information as the Secretary 

3 may require, which shall include— 

4 ‘‘(1) a description of the care coordination and 

5 service delivery models of the entity, detailed on a 

6 general, organizational, and staff level; 

7 ‘‘(2) a description of how the demonstration 

8 project carried out by the entity will improve care 

9 quality, including specific objectives and anticipated 

10 outcomes that will be used to measure success; and 

11 ‘‘(3) a description of how the coordinated care 

12 team approach with an enhanced role for the direct13 care worker under the demonstration project will in14 crease efficiency and cost effectiveness compared to 

15 past practice. 

16 ‘‘(e) PLANNING AWARDS UNDER DEMONSTRATION

17 PROGRAM.— 

18 ‘‘(1) IN GENERAL.—Each eligible entity that re19 ceives a grant under this section shall receive a 

20 grant for planning activities related to the dem21 onstration project to be carried out by the entity, in22 cluding— 

23 ‘‘(A) designing the implementation of the 

24 project; 


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1 ‘‘(B) identifying competencies and devel2 oping curricula for the training of participating 

3 direct-care workers; 

4 ‘‘(C) developing training materials and 

5 processes for other members of the interdiscipli6 nary care team; 

7 ‘‘(D) articulating a plan for identifying 

8 and tracking cost savings gained from imple9 mentation of the project and for achieving long10 term financial sustainability; and 

11 ‘‘(E) articulating a plan for evaluating the 

12 project. 

13 ‘‘(2) AMOUNT AND TERM.— 

14 ‘‘(A) TOTAL AMOUNT.—The amount 

15 awarded under paragraph (1) for all grants 

16 shall not exceed $600,000. 

17 ‘‘(B) TERM.—Activities carried out under 

18 a grant awarded under paragraph (1) shall be 

19 completed not later than 1 year after the grant 

20 is awarded. 

21 ‘‘(f) IMPLEMENTATION AWARDS UNDER DEM22 ONSTRATION PROGRAM.— 

23 ‘‘(1) IN GENERAL.—Each eligible entity may re24 ceive a grant for implementation activities related to 

25 the demonstration project to be carried out by the 


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1 entity, if the Assistant Secretary determines the en2 tity— 

3 ‘‘(A) has successfully carried out the ac4 tivities under the grant awarded under sub5 section (e); 

6 ‘‘(B) offers a feasible plan for long-term fi7 nancial sustainability; 

8 ‘‘(C) has constructed a meaningful model 

9 of advancement for direct-care workers; and 

10 ‘‘(D) aims to provide training to a sizeable 

11 number of direct-care workers and to serve a 

12 sizeable number of older individuals. 

13 ‘‘(2) USE OF FUNDS.—The implementation ac14 tivities described under paragraph (1) shall in15 clude— 

16 ‘‘(A) training of all care team members in 

17 accordance with the design of the demonstra18 tion project; and 

19 ‘‘(B) evaluating the competency of all staff 

20 based on project design. 

21 ‘‘(3) EVALUATION AND REPORT.— 

22 ‘‘(A) EVALUATION.—Each recipient of a 

23 grant under paragraph (1), in consultation with 

24 an independent evaluation contractor, shall 

25 evaluate— 


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1 ‘‘(i) the impact of training and de2 ployment of direct-care workers in ad3 vanced roles, as described in this section, 

4 within each participating entity on out5 comes, such as direct-care worker job satis6 faction and turnover, beneficiary and fam7 ily caregiver satisfaction with services, rate 

8 of hospitalization of beneficiaries, and ad9 ditional measures determined by the Sec10 retary; 

11 ‘‘(ii) the impact of such training and 

12 deployment on the long-term services and 

13 supports delivery system and resources; 

14 ‘‘(iii) statement of the potential of the 

15 use of direct-care workers in advanced 

16 roles to lower cost and improve quality of 

17 care in the Medicaid program; and 

18 ‘‘(iv) long-term financial sustainability 

19 of the model used under the grant and the 

20 impact of such model on quality of care. 

21 ‘‘(B) REPORTS.—Not later than 180 days 

22 after completion of the demonstration program 

23 under this section, each recipient of a grant 

24 under paragraph (1) shall submit to the Sec25 retary a report on the implementation of activiVerDate Mar 15 2010 00:18 Dec 18, 2011 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1982.IS S1982

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1 ties conducted under the demonstration project, 

2 including— 

3 ‘‘(i) the outcomes, performance bench4 marks, lessons learned from the project; 

5 ‘‘(ii) a statement of cost savings 

6 gained from implementation of the project 

7 and how the cost savings have been rein8 vested to improve direct-care job quality 

9 and quality of care; and 

10 ‘‘(iii) results of the evaluation con11 ducted under subparagraph (A) with re12 spect to such activities, together with such 

13 recommendations for legislation or admin14 istrative action for expansion of the dem15 onstration program on a broader scale as 

16 the Secretary determines appropriate. 

17 ‘‘(4) AMOUNT AND TERM.— 

18 ‘‘(A) TOTAL AMOUNT.—The amount 

19 awarded under paragraph (1) for all grants 

20 shall not exceed $2,900,000. 

21 ‘‘(B) TERM.—Activities carried out under 

22 a grant awarded under paragraph (1) shall be 

23 completed not later than 2 years after the grant 

24 is awarded.’’. 

Æ 


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