II 

111TH CONGRESS 

1ST SESSION S. 245 

To expand, train, and support all sectors of the health care workforce to 

care for the growing population of older individuals in the United States. 

IN THE SENATE OF THE UNITED STATES 

JANUARY 14, 2009 

Mr. KOHL (for himself, Mrs. LINCOLN, and Mr. CASEY) introduced the following bill; which was read twice and referred to the Committee on 

Health, Education, Labor, and Pensions 

A BILL 

To expand, train, and support all sectors of the health care 

workforce to care for the growing population of older 

individuals in the United States. 

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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Retooling the Health Care Workforce for an Aging 

6 America Act of 2009’’. 

7 (b) TABLE OF CONTENTS.—The table of contents of 

8 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 


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TITLE I—AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT 

Subtitle A—Health Professions Education Related to Geriatrics 

Sec. 101. Geriatric education centers. 

Sec. 102. Improving geriatric training for physicians, dentists, and behavior 

and mental health professionals. 

Sec. 103. Geriatric academic career awards. 

Sec. 104. Geriatric Career Incentive Awards. 

Sec. 105. National Center for Health Workforce Analysis. 

Subtitle B—Improved Nursing Services 

Sec. 121. Comprehensive geriatric education nursing grant program. 

TITLE II—AMENDMENTS TO THE WORKFORCE INVESTMENT ACT 

OF 1998 

Sec. 201. Core services. 

Sec. 202. Individual training accounts. 

Sec. 203. Collaboration between State boards and the veterans agencies of the 

States. 

Sec. 204. Collaboration between Department of Labor and Department of Veterans Affairs. 

Sec. 205. Training opportunities for direct care workers. 

TITLE III—AMENDMENTS TO THE OLDER AMERICANS ACT OF 

1965 

Sec. 301. Family caregiver training. 

Sec. 302. Redesignations in provisions for multigenerational and civic engagement activities. 

Sec. 303. National Resource Center on Volunteers, Students, and Seniors. 

TITLE IV—AMENDMENTS TO THE SOCIAL SECURITY ACT 

Sec. 401. Demonstration program for personal or home care aides, nurse aides, 

and home health aides in long-term care settings. 

Sec. 402. Medicare family caregiver information and referral. 

Sec. 403. Medicaid assessment of family caregiver support needs. 

TITLE V—STUDIES AND REPORTS 

Sec. 501. Studies and reports. 

1 SEC. 2. FINDINGS. 

2 Congress finds the following: 

3 (1) The United States will not be able to meet 

4 near-term demands for chronic, geriatric, and long5 term care without a workforce that is prepared for 

6 the job. 


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1 (2) Between 2005 and 2030, it is estimated 

2 that the number of adults aged 65 and older will al3 most double from 37,000,000 to over 70,000,000, 

4 increasing from 12 percent of the population of the 

5 United States to almost 20 percent of the popu6 lation. 

7 (3) Because the overall size of the population of 

8 older adults in the United States will increase rap9 idly, the number of older adults in the United States 

10 who are disabled will soar in the coming decades. 

11 Between 2000 and 2040 the number of older adults 

12 who are disabled will more than double, increasing 

13 from an estimated 10,000,000 to an estimated 

14 21,000,000. 

15 (4) A 2008 report by the Institute of Medicine 

16 of the National Academies, entitled, ‘‘Retooling for 

17 an Aging America’’ concludes that the health care 

18 workforce will lack the capacity, in both size and 

19 ability, to meet the needs of older patients in the fu20 ture unless action is taken immediately. 

21 (5) Inadequate training in geriatrics, geron22 tology, chronic care management, and long-term 

23 care is known to result in misdiagnoses, medication 

24 errors, and inadequate coordination of services and 


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1 treatments that result in poor care and is costly for 

2 the health care system as a whole. 

3 (6) Currently, only 1 percent of all physicians 

4 (approximately 7,000) in the United States are cer5 tified geriatricians, even as the population of older 

6 adults is on track to double by 2030. 

7 (7) Inadequate amounts of time devoted to geriatric training are reported by 1 8 ⁄4 of graduating medical students, and close to 1 9 ⁄2 of graduating medical 

10 students say they are unprepared to care for resi11 dents in nursing homes. 

12 (8) Less than 1 percent of all nurses are cer13 tified gerontological nurses. Absent any change, by 

14 the year 2020, the total supply of nurses in the 

15 United States is projected to fall 29 percent below 

16 requirements, resulting in a severe shortage of nurs17 ing expertise relative to the demand for care of 

18 medically complex, frail older adults. 

19 (9) Estimates suggest that there are currently 

20 only 700 practicing geropsychologists in the United 

21 States, falling far short of the current need for 

22 5,000 to 7,500 geropsychologists. 

23 (10) The Bureau of Labor Statistics of the De24 partment of Labor predicts that personal or home 

25 care aides and home health aides will represent the 


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1 second and third fastest-growing occupations be2 tween 2006 and 2016. Yet personal or home care 

3 aides are not subject to any Federal requirements 

4 related to training or education, and States have 

5 very different requirements for personal or home 

6 care aides. 

7 (11) Research shows that inadequate training is 

8 a major contributor to high turnover rates among 

9 direct care workers and more training is correlated 

10 with better staff recruitment and retention rates. 

11 (12) An estimated 44,000,000 family caregivers 

12 are being asked to provide increasingly complex 

13 medical services to frail and elderly loved ones wish14 ing to live at home. Multiple surveys have docu15 mented that basic training and access to other tar16 geted services are necessary for family caregivers to 

17 provide consistent quality care on an ongoing basis. 

18 TITLE I—AMENDMENTS TO THE 

19 PUBLIC HEALTH SERVICE ACT 

20 Subtitle A—Health Professions 

21 Education Related to Geriatrics 

22 SEC. 101. GERIATRIC EDUCATION CENTERS. 

23 Section 753 of the Public Health Service Act (42 

24 U.S.C. 294) is amended by adding at the end the fol25 lowing: 


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1 ‘‘(d) GRANTS TO EXPAND AND IMPROVE GERIATRIC

2 EDUCATION CENTERS.— 

3 ‘‘(1) IN GENERAL.—The Secretary shall award 

4 grants or contracts under this subsection to entities 

5 that operate a geriatric education center pursuant to 

6 subsection (a)(1). 

7 ‘‘(2) APPLICATION.—To be eligible for an 

8 award under paragraph (1), an entity described in 

9 such paragraph shall submit to the Secretary an ap10 plication at such time, in such manner, and con11 taining such information as the Secretary may re12 quire. 

13 ‘‘(3) USE OF FUNDS.—Amounts awarded under 

14 a grant or contract under paragraph (1) shall be 

15 used to— 

16 ‘‘(A) carry out the fellowship program de17 scribed in paragraph (4); and 

18 ‘‘(B) carry out 2 of the 3 activities de19 scribed in paragraph (5). 

20 ‘‘(4) FELLOWSHIP PROGRAM.— 

21 ‘‘(A) IN GENERAL.—Pursuant to para22 graph (3), a geriatric education center that re23 ceives an award under this subsection shall use 

24 such funds to offer short-term intensive courses 

25 (referred to in this subsection as a ‘fellowship’) 


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1 that focus on geriatrics, chronic care manage2 ment, and long-term care that provide supple3 mental training for faculty members in medical 

4 schools and other health professions schools 

5 with programs in psychology, pharmacy, nurs6 ing, social work, dentistry, public health, or 

7 other health disciplines, as approved by the Sec8 retary. Such a fellowship shall be open to cur9 rent faculty, and appropriately credentialed vol10 unteer faculty and practitioners, who do not 

11 have formal training in geriatrics, to upgrade 

12 their knowledge and clinical skills for the care 

13 of older adults and adults with functional limi14 tations and to enhance their interdisciplinary 

15 teaching skills. 

16 ‘‘(B) LOCATION.—A fellowship shall be of17 fered either at the geriatric education center 

18 that is sponsoring the course, in collaboration 

19 with other geriatric education centers, or at 

20 medical schools, schools of nursing, schools of 

21 pharmacy, schools of social work, graduate pro22 grams in psychology, or other health professions 

23 schools approved by the Secretary with which 

24 the geriatric education centers are affiliated. 


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1 ‘‘(C) CME CREDIT.—Participation in a fel2 lowship under this paragraph shall be accepted 

3 with respect to complying with continuing med4 ical education requirements. As a condition of 

5 such acceptance, the recipient shall agree to 

6 subsequently provide a minimum of 18 hours of 

7 voluntary instructional support through a geri8 atric education center that is providing clinical 

9 training to students or trainees in long-term 

10 care settings. 

11 ‘‘(5) ADDITIONAL REQUIRED ACTIVITIES DE12 SCRIBED.—Pursuant to paragraph (3), a geriatric 

13 education center that receives an award under this 

14 subsection shall use such funds to carry out 2 of the 

15 3 activities: 

16 ‘‘(A) FAMILY CAREGIVER TRAINING.—A 

17 geriatric education center that receives an 

18 award under this subsection shall offer at least 

19 2 courses each year, at no charge or nominal 

20 cost, to family caregivers that are designed to 

21 provide practical training for supporting frail 

22 elders and individuals with disabilities. The Sec23 retary shall require such Centers to work with 

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1 tions, to develop training program content and 

2 to publicize the availability of training courses 

3 in their service areas. All family caregiver train4 ing programs shall include instruction on the 

5 management of psychological and behavioral as6 pects of dementia, communication techniques 

7 for working with individuals who have demen8 tia, and the appropriate, safe, and effective use 

9 of medications for older adults. 

10 ‘‘(B) DIRECT CARE WORKING TRAINING.— 

11 A geriatric education center that receives an 

12 award under this subsection shall offer at least 

13 2 courses each year to certified nurse aides, 

14 home health aides, personal or home care aides 

15 and other types of direct care workers on ‘best 

16 practices’ for working with frail elders and indi17 viduals with disabilities, including individuals 

18 with dementia, urinary incontinence, and prob19 lems with balance or mobility, and raising 

20 awareness of medication issues for older adults. 

21 ‘‘(C) INCORPORATION OF BEST PRAC22 TICES.—A geriatric education center that re23 ceives an award under this subsection shall de24 velop and include material on depression and 

25 other mental disorders common among older 


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1 adults, medication safety issues for older adults, 

2 and management of the psychological and be3 havioral aspects of dementia and communica4 tion techniques with individuals who have de5 mentia in all training courses, where appro6 priate. 

7 ‘‘(6) TARGETS.—A geriatric education center 

8 that receives an award under this subsection shall 

9 meet targets approved by the Secretary for providing 

10 geriatric training to a certain number of faculty or 

11 practitioners during the term of the grant, as well 

12 as other parameters established by the Secretary, in13 cluding guidelines for the content of the fellowships. 

14 ‘‘(7) AMOUNT OF AWARD.—An award under 

15 this subsection shall be in an amount of $150,000. 

16 Not more than 24 geriatric education centers may 

17 receive an award under this subsection. 

18 ‘‘(8) MAINTENANCE OF EFFORT.—A geriatric 

19 education center that receives an award under this 

20 subsection shall provide assurances to the Secretary 

21 that funds provided to the geriatric education center 

22 under this subsection will be used only to supple23 ment, not to supplant, the amount of Federal, State, 

24 and local funds otherwise expended by the geriatric 

25 education center. 


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1 ‘‘(9) AUTHORIZATION OF APPROPRIATIONS.—In 

2 addition to any other funding available to carry out 

3 this section, there is authorized to be appropriated 

4 to carry out this subsection, $10,800,000 for the pe5 riod of fiscal year 2011 through 2013.’’. 

6 SEC. 102. IMPROVING GERIATRIC TRAINING FOR PHYSI7 CIANS, DENTISTS, AND BEHAVIOR AND MEN8 TAL HEALTH PROFESSIONALS. 

9 Section 753 of the Public Health Service Act (42 

10 U.S.C. 294), as amended by section 101, is amended by 

11 adding at the end the following: 

12 ‘‘(e) GERIATRIC TRAINING FOR PHYSICIANS, DEN13 TISTS, AND BEHAVIOR AND MENTAL HEALTH PROFES14 SIONALS.—An accredited school of medicine or osteopathic 

15 medicine, an accredited psychology program, a teaching 

16 hospital, or a graduate medical education program that 

17 receives an award under subsection (c) may use the funds 

18 under such award to carry out a program to train individ19 uals for either 1 year, 2 years, or both, who are seeking 

20 a certificate of added qualification or specialization in geri21 atrics for either 1 year, 2 years, or both. Such a program 

22 may be located in a medical school or academic health cen23 ter that offers programs in 2 of the 3 disciplines described 

24 in subsection (c)(5). Such program may fund the training 

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1 ical social workers as part of the behavior and mental 

2 health training programs.’’. 

3 SEC. 103. GERIATRIC ACADEMIC CAREER AWARDS. 

4 (a) EXPANSION OF ELIGIBILITY FOR GERIATRIC

5 ACADEMIC CAREER AWARDS; PAYMENT TO INSTITU6 TION.—Section 753(c) of the Public Health Service Act 

7 (42 U.S.C. 294(c)) is amended— 

8 (1) by striking paragraph (2) through para9 graph (3) and inserting the following: 

10 ‘‘(2) ELIGIBLE INDIVIDUALS.—To be eligible to 

11 receive an Award under paragraph (1), an individual 

12 shall— 

13 ‘‘(A) be board certified or board eligible in 

14 internal medicine, family practice, or psychiatry 

15 or have completed any required training in a 

16 discipline and employed in an accredited health 

17 professions school that is approved by the Sec18 retary, including dentistry, pharmacy, nursing, 

19 social work, and psychology; 

20 ‘‘(B) have completed an approved fellow21 ship program in geriatrics; and 

22 ‘‘(C) have a junior (non-tenured) faculty 

23 appointment at an accredited (as determined by 

24 the Secretary) school of medicine, osteopathic 

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1 tistry, pharmacy, or other allied health dis2 ciplines in an accredited health professions 

3 school that is approved by the Secretary. 

4 ‘‘(3) LIMITATIONS.—No Award under para5 graph (1) may be made to an eligible individual un6 less the individual— 

7 ‘‘(A) has submitted to the Secretary an ap8 plication, at such time, in such manner, and 

9 containing such information as the Secretary 

10 may require, and the Secretary has approved 

11 such application; 

12 ‘‘(B) provides, in such form and manner as 

13 the Secretary may require, assurances that the 

14 individual will meet the service requirement de15 scribed in paragraph (5); and 

16 ‘‘(C) provides, in such form and manner as 

17 the Secretary may require, assurances that the 

18 individual has a full-time faculty appointment 

19 in a health professions institution and docu20 mented commitment from such institution to 

21 spend 75 percent of the total time of such indi22 vidual on teaching and developing skills in 

23 interdisciplinary education in geriatrics. 

24 ‘‘(4) MAINTENANCE OF EFFORT.—An eligible 

25 individual that receives an Award under paragraph 


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1 (1) shall provide assurances to the Secretary that 

2 funds provided to the eligible individual under this 

3 subsection will be used only to supplement, not to 

4 supplant, the amount of Federal, State, and local 

5 funds otherwise expended by the eligible individual.’’; 

6 and 

7 (2) in paragraph (4)— 

8 (A) in subparagraph (A)— 

9 (i) by inserting ‘‘for individuals who 

10 are physicians’’ after ‘‘this section’’; and 

11 (ii) by inserting after the period at 

12 the end the following: ‘‘The Secretary shall 

13 determine the amount of an Award under 

14 this section for individuals who are not 

15 physicians.’’; and 

16 (B) by adding at the end the following: 

17 ‘‘(C) PAYMENT TO INSTITUTION.—The 

18 Secretary shall transfer funds awarded to an in19 dividual under this section to the institution 

20 where such individual will carry out the award, 

21 in order to facilitate financial management of 

22 the reward pursuant to guidelines of the Health 

23 Resources and Services Administration.’’. 

24 (b) AUTHORIZATION OF APPROPRIATIONS.—There 

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1 ments made by this section $6,000,000 for each of fiscal 

2 years 2011, 2012, and 2013. 

3 SEC. 104. GERIATRIC CAREER INCENTIVE AWARDS. 

4 Section 753 of the Public Health Service Act (42 

5 U.S.C. 294), as amended by section 102, is amended by 

6 adding at the end the following: 

7 ‘‘(f) GERIATRIC CAREER INCENTIVE AWARDS.— 

8 ‘‘(1) IN GENERAL.—The Secretary shall award 

9 grants or contracts under this section to individuals 

10 described in paragraph (2) to foster greater interest 

11 among a variety of health professionals in entering 

12 the field of geriatrics, long-term care, and chronic 

13 care management. 

14 ‘‘(2) ELIGIBLE INDIVIDUALS.—To be eligible to 

15 received an award under paragraph (1), an indi16 vidual shall— 

17 ‘‘(A) be an advanced practice nurse (such 

18 as a clinical nurse specialist or nurse practi19 tioner), a clinical social worker, a pharmacist, 

20 or student of psychology who is pursuing a doc21 torate or other advanced degree approved by 

22 the Secretary in geriatrics, long-term care, 

23 geropsychology, or chronic care management in 

24 an accredited health professions school that is 

25 approved by the Secretary; and 


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1 ‘‘(B) submit to the Secretary an applica2 tion at such time, in such manner, and con3 taining such information as the Secretary may 

4 require. 

5 ‘‘(3) CONDITION OF AWARD.—As a condition of 

6 receiving an award under this subsection, an indi7 vidual shall agree that, following completion of the 

8 award period, the individual will teach or practice in 

9 the field of geriatrics, long-term care, or chronic 

10 care management for a minimum of 5 years under 

11 guidelines set by the Secretary. 

12 ‘‘(4) AUTHORIZATION OF APPROPRIATIONS.— 

13 There is authorized to be appropriated to carry out 

14 this subsection, $10,000,000 for the period of fiscal 

15 years 2011 through 2013.’’. 

16 SEC. 105. NATIONAL CENTER FOR HEALTH WORKFORCE 

17 ANALYSIS. 

18 Part E of Title VII of the Public Health Service Act 

19 (42 U.S.C. 294n et seq.) is amended by adding at the end 

20 the following: 


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1 ‘‘Subpart 3—National Center for Health Workforce 

2 Analysis 

3 ‘‘SEC. 774. ACTIVITIES OF THE NATIONAL CENTER FOR 

4 HEALTH WORKFORCE ANALYSIS. 

5 ‘‘In addition to any activities being carried out at the 

6 National Center for Health Workforce Analysis of the 

7 Health Resources and Services Administration as of the 

8 day before the date of enactment of the Retooling the 

9 Health Care Workforce for an Aging America Act of 2009, 

10 the head of such Center shall analyze— 

11 ‘‘(1) current and projected needs for health and 

12 long-term care workforce demand and supply, and 

13 training and education needs specific to older adults 

14 and adults with functional limitations; 

15 ‘‘(2) turnover and retention for professionals 

16 and paraprofessionals in these fields, including ad17 ministrators, medical directors and direct care staff 

18 of nursing homes, assisted living facilities and home 

19 and community-based settings, or any other setting 

20 or provider the Secretary determines appropriate; 

21 and 

22 ‘‘(3) diversity of racial and ethnic minority 

23 groups represented by professionals and paraprofes24 sionals in these fields. 


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1 ‘‘SEC. 775. AUTHORIZATION OF APPROPRIATIONS. 

2 ‘‘There is authorized to be appropriated to the Na3 tional Center for Workforce Analysis to carry out this sub4 part $6,000,000 for the period of fiscal years 2011 

5 through 2013.’’. 

6 Subtitle B—Improved Nursing 

7 Services 

8 SEC. 121. COMPREHENSIVE GERIATRIC EDUCATION NURS9 ING GRANT PROGRAM. 

10 Section 855 of the Public Health Service Act (42 

11 U.S.C. 298) is amended— 

12 (1) in subsection (b)— 

13 (A) in paragraph (3), by striking ‘‘or’’; 

14 (B) in paragraph (4), by striking the pe15 riod and inserting ‘‘; or’’; and 

16 (C) by inserting after paragraph (4) the 

17 following: 

18 ‘‘(5) establish Federal traineeships to individ19 uals who are preparing for advanced degrees in geri20 atric nursing, long-term care, and gero-psychiatric 

21 nursing.’’; and 

22 (2) in subsection (e), by inserting before the pe23 riod the following: ‘‘, $12,000,000 for each of fiscal 

24 years 2011 through 2013 to provide assistance 

25 under this section to support additional training for 

26 nurses who care for the elderly and individuals with 


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1 disabilities and for the development and dissemina2 tion of curricula relating to geriatric nursing care, 

3 the training of nursing faculty in geriatrics, and the 

4 provision of continuing education for nurses prac5 ticing in geriatrics, and $25,000,000 for each of fis6 cal years 2011 through 2013 to provide assistance 

7 under this section to support the Federal 

8 traineeships established under subsection (b)(5)’’. 

9 TITLE II—AMENDMENTS TO THE 

10 WORKFORCE INVESTMENT 

11 ACT OF 1998 

12 SEC. 201. CORE SERVICES. 

13 Section 134(d)(2)(E)(iii) of the Workforce Invest14 ment Act of 1998 (29 U.S.C. 2864(d)(2)(E)(iii)) is 

15 amended to read as follows: 

16 ‘‘(iii) information relating to local oc17 cupations in demand, including health care 

18 and long-term care occupations, and the 

19 earnings and skill requirements for such 

20 local occupations;’’. 

21 SEC. 202. INDIVIDUAL TRAINING ACCOUNTS. 

22 Section 134(d)(4)(G)(iii) of the Workforce Invest23 ment Act of 1998 (29 U.S.C. 2864(d)(4)(G)(iii)) is 

24 amended to read as follows: 


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1 ‘‘(iii) LINKAGE TO OCCUPATIONS IN

2 DEMAND.—Training services provided 

3 under this paragraph shall be directly 

4 linked to occupations, including health care 

5 and long-term care occupations, that are in 

6 demand in the local area, or in another 

7 area to which an adult or dislocated work8 er receiving such services is willing to relo9 cate, except that a local board may ap10 prove training services for occupations de11 termined by the local board to be in sectors 

12 of the economy that have a high potential 

13 for sustained demand or growth in the 

14 local area. In making determinations of de15 mand or potential demand or growth under 

16 this clause, a local board shall consult local 

17 and State health agencies, employers, and 

18 other organizations that the local board de19 termines to be appropriate.’’. 

20 SEC. 203. COLLABORATION BETWEEN STATE BOARDS AND 

21 THE VETERANS AGENCIES OF THE STATES. 

22 Section 112(b) of the Workforce Investment Act of 

23 1998 (29 U.S.C. 2822(b)) is amended— 

24 (1) in paragraph (17), by striking ‘‘and’’ at the 

25 end; 


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1 (2) in paragraph (18), by striking the period 

2 and inserting ‘‘; and’’; and 

3 (3) by adding at the end the following new 

4 paragraph: 

5 ‘‘(19) a description of how the State board will 

6 collaborate with the veterans agency of the State, in7 cluding entering into a memorandum of under8 standing with the veterans agency of the State speci9 fying— 

10 ‘‘(A) the manner in which the State board 

11 and the veterans agency of the State will pro12 vide information on health care workforce em13 ployment and training opportunities available to 

14 individuals, including veterans who are receiving 

15 core services described in section 134(d)(2) at 

16 a one-stop center and are receiving assistance 

17 from the Veterans’ Employment and Training 

18 Service of the Department of Labor; and 

19 ‘‘(B) the manner in which the State board 

20 and the veterans agency of the State will obtain 

21 and provide information to one-stop operators 

22 in the State, for distribution through one-stop 

23 centers, about training, internship, and employ24 ment opportunities in geriatrics, gerontology, 

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1 portunities at geriatric research, education and 

2 clinical centers operated by the Department of 

3 Veterans Affairs.’’. 

4 SEC. 204. COLLABORATION BETWEEN DEPARTMENT OF 

5 LABOR AND DEPARTMENT OF VETERANS AF6 FAIRS. 

7 The Secretary of Labor, acting through the Assistant 

8 Secretary for Veterans’ Employment and Training, and 

9 the Secretary of Veterans Affairs, shall develop memo10 randa of understanding outlining how veterans seeking 

11 employment information through the Local Veterans’ Em12 ployment Representative Program and the Transition As13 sistance Program will be provided with information about 

14 training, internship, and employment opportunities in ger15 iatrics, gerontology, and long-term care, including oppor16 tunities at geriatric research, education and clinical cen17 ters operated by the Department of Veterans Affairs. 

18 SEC. 205. TRAINING OPPORTUNITIES FOR DIRECT CARE 

19 WORKERS. 

20 (a) IN GENERAL.—Section 171 of the Workforce In21 vestment Act of 1998 (29 U.S.C. 2916) is amended by 

22 adding at the end the following new subsection: 

23 ‘‘(f) TRAINING OPPORTUNITIES FOR DIRECT CARE

24 WORKERS.— 


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1 ‘‘(1) IN GENERAL.—The Secretary shall award 

2 grants to eligible entities to enable such entities to 

3 provide new training opportunities for direct care 

4 workers (including certified nursing assistants, home 

5 health aides, and personal or home care aides) who 

6 are employed in long-term care settings such as 

7 nursing homes (as defined in section 1908(e)(1) of 

8 the Social Security Act (42 U.S.C. 1396g(e)(1)), as9 sisted living facilities, home care settings, and any 

10 other setting the Secretary determines to be appro11 priate. 

12 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 

13 grant under paragraph (1), an entity shall— 

14 ‘‘(A) be an institution of higher education 

15 (as defined in section 102 of the Higher Edu16 cation Act of 1965 (20 U.S.C. 1002)) that— 

17 ‘‘(i) is accredited by a nationally rec18 ognized accrediting agency or association 

19 listed under section 101(c) of the Higher 

20 Education Act of 1965 (20 U.S.C. 

21 1001(c)); and 

22 ‘‘(ii) has established a public-private 

23 educational partnership with a nursing 

24 home, home health agency, or other long25 term care provider; and 


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1 ‘‘(B) submit to the Secretary an applica2 tion at such time, in such manner, and con3 taining such information as the Secretary may 

4 require. 

5 ‘‘(3) PRIORITY.—In making grants to eligible 

6 entities, the Secretary shall give priority to entities 

7 that demonstrate that the entities will coordinate ac8 tivities with one-stop operators and one-stop part9 ners at local one-stop centers referred to in section 

10 134(c). 

11 ‘‘(4) USE OF FUNDS.—An eligible entity shall 

12 use amounts awarded under a grant under para13 graph (1) to provide assistance to eligible individuals 

14 to offset the cost of tuition and required fees for en15 rollment in academic programs provided by such en16 tity, including— 

17 ‘‘(A) the provision of stipends to such indi18 viduals for a period of not to exceed 2 years; 

19 ‘‘(B) the lowering of fees assessed with re20 spect to eligible individuals who are enrolled in 

21 programs leading to a licensed practical nursing 

22 degree, a registered nursing degree, or any 

23 other advanced nursing degree; and 

24 ‘‘(C) the lowering of fees assessed with re25 spect to eligible individuals who are enrolled in 


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1 courses aimed at improving direct care skills for 

2 the treatment of specialized conditions that are 

3 common in the long-term care sector, such as 

4 wound care, brain trauma, immobility, inconti5 nence, functional impairment, and dementia. 

6 ‘‘(5) ELIGIBLE INDIVIDUAL.— 

7 ‘‘(A) ELIGIBILITY.—To be eligible for as8 sistance under paragraph (4), an individual 

9 shall be enrolled in courses provided by a grant10 ee under this subsection and maintain satisfac11 tory academic progress in such courses. 

12 ‘‘(B) CONDITION OF ASSISTANCE.—As a 

13 condition of receiving assistance under para14 graph (4), an individual shall agree that, fol15 lowing completion of the assistance period, the 

16 individual will work in the field of geriatrics, 

17 long-term care, or chronic care management for 

18 a minimum of 2 years under guidelines set by 

19 the Secretary. 

20 ‘‘(6) AUTHORIZATION OF APPROPRIATIONS.— 

21 There is authorized to be appropriated to carry out 

22 this subsection, $10,000,000 for the period of fiscal 

23 years 2011 through 2013.’’. 

24 (b) CONFORMING AMENDMENTS.— 


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1 (1) Section 174(b)(1) of the Workforce Invest2 ment Act of 1998 (29 U.S.C. 2919(b)(1)) is amend3 ed by inserting ‘‘and except as provided in section 

4 171(f),’’ after ‘‘paragraph (2),’’. 

5 (2) Section 174(b)(2)(B)(ii) of the Workforce 

6 Investment Act (29 U.S.C. (b)(2)(B)(ii)) is amended 

7 to read as follows: 

8 ‘‘(ii) except as provided in section 

9 171(f), for each of the fiscal years 2000 

10 through 2003, reserve not less than 45 

11 percent for carrying out section 171;’’. 

12 TITLE III—AMENDMENTS TO 

13 THE OLDER AMERICANS ACT 

14 OF 1965 

15 SEC. 301. FAMILY CAREGIVER TRAINING. 

16 (a) IN GENERAL.—Part E of title III of the Older 

17 Americans Act of 1965 (42 U.S.C. 3030s et seq.) is 

18 amended by adding at the end the following: 

19 ‘‘SEC. 375. FAMILY CAREGIVER TRAINING. 

20 ‘‘(a) DEVELOPMENT OF MATERIALS.— 

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

22 shall, directly or by contract, develop family care23 giver training materials, working with an advisory 

24 committee, comprised of experts on matters related 

25 to family caregivers, including researchers, cliniVerDate Nov 24 2008 21:18 Jan 15, 2009 Jkt 079200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\S245.IS S245

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1 cians, representatives of nursing homes and State 

2 Long-Term Care Ombudsman programs, representa3 tives of community colleges and vocational schools, 

4 family caregivers, and representatives of organiza5 tions for family caregivers. The materials shall be 

6 suitable to provide online training for family care7 givers, and grandparents or older individuals who 

8 are relative caregivers, in providing personal care to 

9 care recipients. 

10 ‘‘(2) CONTENT.—The materials shall include 

11 written materials and videos, designed to be easily 

12 downloaded, that demonstrate techniques for key 

13 personal care activities. The materials shall dem14 onstrate ways of safely lifting and transferring indi15 viduals with disabilities, means of preventing falls, 

16 and other means of providing assistance with activi17 ties of daily living, and instrumental activities of 

18 daily living such as medication management. The 

19 materials shall provide information on behavioral 

20 management and communication techniques for care 

21 recipients that are individuals with Alzheimer’s dis22 ease or a related disorder with neurological and or23 ganic brain dysfunction. 


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1 ‘‘(b) DISTRIBUTION OF MATERIALS.—The Assistant 

2 Secretary shall make the training described in subsection 

3 (a)(1) available online, free of cost to users. 

4 ‘‘(c) DEFINITIONS.—In this section: 

5 ‘‘(1) CARE RECIPIENT.—The term ‘care recipi6 ent’— 

7 ‘‘(A) used with respect to a family care8 giver, means an older individual or an indi9 vidual with Alzheimer’s disease or a related dis10 order with neurological and organic brain dys11 function; and 

12 ‘‘(B) used with respect to a grandparent or 

13 older individual who is a relative caregiver, 

14 means an individual with a disability. 

15 ‘‘(2) COMMUNITY COLLEGE.—The term ‘com16 munity college’ means an institution of higher edu17 cation (as defined in section 101(a) of the Higher 

18 Education Act of 1965 (20 U.S.C. 1001(a))) that 

19 offers a 2-year program of study. 

20 ‘‘(3) INDIVIDUAL WITH A DISABILITY.—The 

21 term ‘individual with a disability’ means an indi22 vidual with a disability, within the meaning of sec23 tion 372(a)(1). 

24 ‘‘(4) VOCATIONAL SCHOOL.—The term ‘voca25 tional school’ means an area career and technical 


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1 education school, as defined in section 3 of the Carl 

2 D. Perkins Career and Technical Education Act of 

3 2006 (20 U.S.C. 2302).’’. 

4 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

5 303(e) of the Older Americans Act of 1965 (42 U.S.C. 

6 3023(e)) is amended— 

7 (1) in paragraph (2), by inserting ‘‘, other than 

8 section 375’’ after ‘‘part E’’; and 

9 (2) by adding at the end the following: 

10 ‘‘(4) There is authorized to be appropriated to carry 

11 out section 375, $5,000,000 for the period of fiscal years 

12 2011 through 2013.’’. 

13 SEC. 302. REDESIGNATIONS IN PROVISIONS FOR 

14 MULTIGENERATIONAL AND CIVIC ENGAGE15 MENT ACTIVITIES. 

16 (a) REDESIGNATIONS.—Section 417 of the Older 

17 Americans Act of 1965 is amended— 

18 (1) in subsection (a)— 

19 (A) in paragraph (1), by redesignating 

20 subparagraphs (A) and (B) as clauses (i) and 

21 (ii), respectively, and indenting accordingly; 

22 (B) by redesignating paragraphs (1) and 

23 (2) as subparagraphs (A) and (B), respectively, 

24 and indenting accordingly; and 


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1 (C) by inserting all that precedes ‘‘The As2 sistant Secretary’’ and inserting the following: 

3 ‘‘(a) DEMONSTRATION, SUPPORT, AND RESEARCH

4 PROJECTS.— 

5 ‘‘(1) GRANTS AND CONTRACTS.—’’; 

6 (2) in subsection (b)— 

7 (A) by redesignating paragraphs (1) and 

8 (2) as subparagraphs (A) and (B), respectively, 

9 and indenting accordingly; and 

10 (B) by inserting all that precedes ‘‘An eli11 gible’’ and inserting the following: 

12 ‘‘(2) USE OF FUNDS.—’’; 

13 (3) in subsection (c)— 

14 (A) by redesignating paragraphs (1) 

15 through (4) as subparagraphs (A) through (D), 

16 respectively, and indenting accordingly; and 

17 (B) by striking all that precedes ‘‘In 

18 awarding’’ and inserting the following: 

19 ‘‘(3) PREFERENCE.—’’; 

20 (4) in subsection (d), by striking all that pre21 cedes ‘‘To be’’ and inserting the following: 

22 ‘‘(4) APPLICATION.—’’; 

23 (5) in subsection (e)— 


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1 (A) by redesignating paragraphs (1) and 

2 (2) as subparagraphs (A) and (B), respectively, 

3 and indenting accordingly; and 

4 (B) by inserting all that precedes ‘‘Organi5 zations’’ and inserting the following: 

6 ‘‘(5) ELIGIBLE ORGANIZATIONS.—’’; 

7 (6) in subsection (f)— 

8 (A) in paragraph (1), by redesignating 

9 subparagraphs (A), (B), and (C) as clauses (i), 

10 (ii), and (iii), respectively, and indenting ac11 cordingly; 

12 (B) by redesignating paragraphs (1) and 

13 (2) as subparagraphs (A) and (B), respectively, 

14 and indenting accordingly; and 

15 (C) by inserting all that precedes subpara16 graph (A) (as redesignated by subparagraph 

17 (B) of this paragraph) and inserting the fol18 lowing: 

19 ‘‘(6) LOCAL EVALUATION AND REPORT.—’’; 

20 (7) in subsection (g)— 

21 (A) by redesignating paragraphs (1) 

22 through (8) as subparagraphs (A) through (H), 

23 respectively, and indenting accordingly; and 

24 (B) by inserting all that precedes ‘‘Not 

25 later’’ and inserting the following: 


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1 ‘‘(7) REPORT TO CONGRESS.—’’; and 

2 (8) in subsection (h)— 

3 (A) in paragraph (2)— 

4 (i) in subparagraph (B), by redesig5 nating clauses (i) and (ii) as subclauses (I) 

6 and (II), respectively, and indenting ac7 cordingly; and 

8 (ii) by redesignating subparagraphs 

9 (A) and (B) as clauses (i) and (ii), respec10 tively, and indenting accordingly; 

11 (B) by redesignating paragraphs (1) and 

12 (2) as subparagraphs (A) and (B), respectively, 

13 and indenting accordingly; and 

14 (C) by inserting all that precedes ‘‘As 

15 used’’ and inserting the following: 

16 ‘‘(8) DEFINITIONS.—’’. 

17 (b) CONFORMING AMENDMENTS.—Section 417 of the 

18 Older Americans Act of 1965 is amended— 

19 (1) by striking ‘‘this section’’ each place it ap20 pears and inserting ‘‘this subsection’’; 

21 (2) by striking ‘‘subsection (a)(1)’’ each place it 

22 appears and inserting ‘‘paragraph (1)(A)’’; 

23 (3) by striking ‘‘subsection (a)(2)’’ each place it 

24 appears and inserting ‘‘paragraph (1)(B)’’; 


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1 (4) except as provided in paragraphs (2) and 

2 (3), by striking ‘‘subsection (a)’’ each place it ap3 pears and inserting ‘‘paragraph (1)’’; and 

4 (5) in subsection (a) (as redesignated by sub5 section (a) of this section)— 

6 (A) in paragraph (2)(B), by striking ‘‘sub7 section (f)’’ and inserting ‘‘paragraph (6)’’; and 

8 (B) in paragraph (7)— 

9 (i) in the matter preceding subpara10 graph (A), by striking ‘‘subsection (f)(2)’’ 

11 and inserting ‘‘paragraph (6)(B)’’; and 

12 (ii) in subparagraph (G), by striking 

13 ‘‘paragraph (1)’’ and inserting ‘‘subpara14 graph (A)’’. 

15 SEC. 303. NATIONAL RESOURCE CENTER ON VOLUNTEERS, 

16 STUDENTS, AND SENIORS. 

17 Section 417 of the Older Americans Act of 1965 (42 

18 U.S.C. 3032f), as amended by section 302, is further 

19 amended by adding at the end the following: 

20 ‘‘(b) NATIONAL RESOURCE CENTER ON VOLUN21 TEERS, STUDENTS, AND SENIORS.— 

22 ‘‘(1) IN GENERAL.— 

23 ‘‘(A) GRANT.—The Assistant Secretary 

24 shall award a grant for the establishment and 

25 operation of a National Resource Center on 


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1 Volunteers, Students, and Seniors (referred to 

2 in this subsection as the ‘Center’). The Center 

3 shall— 

4 ‘‘(i) promote partnerships between en5 tities in the aging network, and institu6 tions of higher education and secondary 

7 schools, in order to expand the capacity of 

8 individuals to serve in, and in order to at9 tract new leaders for and professionals 

10 into, the aging network; and 

11 ‘‘(ii) encourage projects that involve 

12 underserved communities, including rural 

13 communities and racial and ethnic minor14 ity communities. 

15 ‘‘(B) PARTNERSHIPS.—Such partnerships 

16 may involve— 

17 ‘‘(i) State agencies, area agencies on 

18 aging, or other local government agencies, 

19 Aging and Disability Resource Centers, 

20 tribal organizations, nonprofit health or so21 cial service organizations, community clin22 ics, adult day care centers, senior housing 

23 providers, and other providers that provide 

24 direct services to older individuals and that 


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1 are determined to be appropriate by the 

2 Assistant Secretary; and 

3 ‘‘(ii) local institutions of higher edu4 cation and secondary schools. 

5 ‘‘(2) CENTER.—The Center shall use the funds 

6 made available through the grant to— 

7 ‘‘(A) identify and disseminate information 

8 (including information about best practices) 

9 concerning how entities described in paragraph 

10 (1)(B) can establish partnerships in a manner 

11 that provides volunteers and students in nurs12 ing, social work, gerontology, psychology, dental 

13 hygiene, music and recreational therapy, nutri14 tion, and other disciplines identified by the As15 sistant Secretary with opportunities, approved 

16 by the Assistant Secretary, to gain experience 

17 working with older individuals, including older 

18 individuals with dementia or cognitive impair19 ment, receiving services under this Act; 

20 ‘‘(B) develop and implement a model dem21 onstration grant program to— 

22 ‘‘(i) promote new partnerships be23 tween the entities described in paragraph 

24 (1)(B) and incorporate activities of the 

25 partnerships into established curricula of 


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1 institutions of higher education and sec2 ondary schools; and 

3 ‘‘(ii) promote and sponsor internship 

4 programs, career development seminars, 

5 and continuing education and lifelong 

6 learning programs; and 

7 ‘‘(C) develop and implement a model ca8 reer ladder program that will disseminate infor9 mation on best practices designed to enable 

10 mid-level professionals to advance in the field of 

11 aging. 

12 ‘‘(3) DEFINITION.—In this subsection, the term 

13 ‘secondary school’ has the meaning given the term in 

14 section 9101 of the Elementary and Secondary Edu15 cation Act of 1965 (20 U.S.C. 8801). 

16 ‘‘(4) AUTHORIZATION OF APPROPRIATIONS.— 

17 There is authorized to be appropriated to carry out 

18 this subsection $3,000,000 for fiscal year 2011, 

19 $3,500,000 for fiscal year 2012, and $4,000,000 for 

20 fiscal year 2013.’’. 


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1 TITLE IV—AMENDMENTS TO THE 

2 SOCIAL SECURITY ACT 

3 SEC. 401. DEMONSTRATION PROGRAM FOR PERSONAL OR 

4 HOME CARE AIDES, NURSE AIDES, AND HOME 

5 HEALTH AIDES IN LONG-TERM CARE SET6 TINGS. 

7 (a) ESTABLISHMENT.— 

8 (1) IN GENERAL.—The Secretary shall establish 

9 a demonstration program (in this section referred to 

10 as the ‘‘program’’) to make grants to participating 

11 States to develop core training competencies for eli12 gible personal or home care aides and additional 

13 training content for nurse aides and home health 

14 aides to supplement training for nurse aides and 

15 home health aides that is required under Federal 

16 law or regulation, and to evaluate the effectiveness 

17 of such competencies and additional training con18 tent. Such program shall evaluate the efficacy of— 

19 (A) the core training competencies devel20 oped under subsection (b)(2)(A); 

21 (B) the additional training content devel22 oped under subsection (b)(2)(B); and 

23 (C) the method of implementation of such 

24 core training competencies and additional train25 ing content against a ‘‘control’’ group being 


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1 trained under a participating State’s existing 

2 training protocols. 

3 (2) DURATION.—The program shall be con4 ducted for not less than 4 years. 

5 (b) ESTABLISHMENT OF EXPERT PANEL.— 

6 (1) IN GENERAL.—Not later than 120 days 

7 after the date of enactment of this Act, the Sec8 retary shall establish a panel of long-term care work9 force experts (in this section referred to as the ‘‘ex10 pert panel’’). 

11 (2) DUTIES.—The expert panel shall carry out 

12 the following duties: 

13 (A)(i) Subject to clause (ii), developing 

14 core training competencies for personal or home 

15 care aides, including such competencies with re16 spect to the following areas: 

17 (I) The role of the personal or home 

18 care aide (including differences between a 

19 personal or home care aide employed by an 

20 agency and a personal or home care aide 

21 employed directly by the health care con22 sumer or an independent provider). 

23 (II) Consumer rights, ethics, and con24 fidentiality (including the role of proxy de25 cision-makers in the case where a health 


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1 care consumer has impaired decision-mak2 ing capacity). 

3 (III) Communication, cultural and lin4 guistic competence and sensitivity, problem 

5 solving, behavior management, and rela6 tionship skills. 

7 (IV) Personal care skills. 

8 (V) Health care support. 

9 (VI) Nutritional support. 

10 (VII) Infection control. 

11 (VIII) Safety and emergency training. 

12 (IX) Training specific to an individual 

13 consumer’s needs (including older individ14 uals, younger individuals with disabilities, 

15 individuals with developmental disabilities, 

16 individuals with dementia, and individuals 

17 with mental and behavioral health needs). 

18 (X) Self-Care. 

19 (ii) For purposes of the program, the core 

20 training competencies developed under clause 

21 (i) shall only apply with respect to newly hired 

22 personal or home care aides. 

23 (B)(i) Subject to clause (ii), developing ad24 ditional training content for home health aides 

25 and nurse aides which is not required under 


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1 Federal law as of the date of enactment of this 

2 Act, including such content with respect to the 

3 following areas: 

4 (I) Culturally and linguistically com5 petent practice. 

6 (II) Standardized direct care worker 

7 communication protocols (such as Situa8 tion, Background, Assessment, and Rec9 ommendation communication tools). 

10 (III) Palliative and end-of-life care. 

11 (IV) Injury prevention. 

12 (V) Wound and decubitus care. 

13 (VI) Medication management, adher14 ence, and safe disposal. 

15 (VII) Mental and behavioral health. 

16 (VIII) Additional aspects of dementia 

17 care training (such as understanding de18 mentia and Alzheimer’s disease, dealing 

19 with challenging behavior, developing com20 munication skills, working with family 

21 caregivers, and ensuring physical health 

22 and safety). 

23 (IX) Prevention and reporting of 

24 abuse and caregiver burnout. 


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1 (ii) For purposes of the program, the addi2 tional training content developed under clause 

3 (i) shall only apply with respect to newly hired 

4 home health aides and nurse aides. 

5 (C)(i) Subject to clause (ii), making rec6 ommendations regarding how training shall be 

7 provided under the program, including rec8 ommendations with respect to the following: 

9 (I) The length of the training. 

10 (II) The appropriate trainer to stu11 dent ratio. 

12 (III) The amount of instruction time 

13 spent in the classroom as compared to on14 site in the home or a facility. 

15 (IV) Trainer qualifications. 

16 (V) Content for a ‘‘hands-on’’ and 

17 written certification exam. 

18 (VI) Continuing education require19 ments. 

20 (VII) Ways to integrate the core 

21 training competencies developed for per22 sonal and home care aides under subpara23 graph (A) with the additional training con24 tent developed for home health aides and 

25 nurse aides under subparagraph (B). 


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1 (ii) The recommendations under clause (i) 

2 shall ensure that the number of hours of train3 ing provided under the program are not less 

4 than the number of hours of training required 

5 under any applicable State or Federal law or 

6 regulation. 

7 (3) MEMBERSHIP.— 

8 (A) IN GENERAL.—Subject to subpara9 graph (B), the expert panel shall be composed 

10 of 11 members appointed by the Secretary from 

11 among leading experts in the long-term care 

12 field, including representatives of— 

13 (i) personal or home care agencies; 

14 (ii) home health care agencies; 

15 (iii) nursing homes and residential 

16 care facilities; 

17 (iv) the disability community (includ18 ing the mental retardation and develop19 mental disability communities); 

20 (v) the nursing community; 

21 (vi) national advocacy organizations 

22 and unions that represent direct care 

23 workers; 

24 (vii) older individuals and family care25 givers; 


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1 (viii) State Medicaid waiver program 

2 officials; 

3 (ix) curriculum developers with exper4 tise in adult learning; 

5 (x) researchers on direct care workers 

6 and the long-term care workforce; and 

7 (xi) geriatric pharmacists. 

8 (B) INCLUSION OF REPRESENTATIVES OF

9 CERTAIN INDIVIDUALS.—Not less than 2 of the 

10 11 members appointed by the Secretary under 

11 subparagraph (A) shall represent the interests 

12 of individuals who rely on long-term care serv13 ices, including the interests of those individuals 

14 described in clause (vii) of such subparagraph. 

15 (4) REPORT.—Not later than 1 year after the 

16 date of enactment of this Act, the expert panel shall 

17 submit to the Secretary a report containing— 

18 (A) the core training competencies devel19 oped under paragraph (2)(A); 

20 (B) the additional training content devel21 oped under paragraph (2)(B); 

22 (C) any recommendations of the expert 

23 panel under paragraph (2)(C); and 


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1 (D) recommendations for such legislation 

2 or administrative action as the expert panel de3 termines appropriate. 

4 (5) TERMINATION.—The expert panel shall ter5 minate 180 days after it submits the report under 

6 paragraph (4). 

7 (c) APPLICATION AND SELECTION CRITERIA.— 

8 (1) IN GENERAL.— 

9 (A) SOLICITATION.—Not later than 2 

10 years after the date of enactment of this Act, 

11 the Secretary shall issue a proposal soliciting 

12 States to voluntarily participate in the program. 

13 (B) AGREEMENTS.—The Secretary shall 

14 enter into agreements with not more than 4 

15 States to conduct the program in such States. 

16 (C) REQUIREMENTS FOR STATES.—An 

17 agreement entered into under subparagraph (B) 

18 shall require that a participating State— 

19 (i) use grant funds made available to 

20 the State under the program to recruit eli21 gible health and long-term care providers 

22 to— 

23 (I) participate in the program; 

24 and 


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1 (II) implement the core training 

2 competencies developed under sub3 section (b)(2)(A) and the additional 

4 training content developed under sub5 section (b)(2)(B); and 

6 (ii) develop written materials and pro7 tocols for such core training competencies 

8 and such additional training content, in9 cluding the development of a certification 

10 test for personal or home care aides who 

11 have completed such training competencies 

12 and, if applicable, additional training con13 tent. 

14 (D) CONSULTATION AND COLLABORATION

15 WITH COMMUNITY AND VOCATIONAL COL16 LEGES.—The Secretary shall encourage partici17 pating States to consult with community and 

18 vocational colleges regarding the development of 

19 curricula to implement the program, which may 

20 include consideration of such colleges as part21 ners in such implementation. 

22 (2) APPLICATION AND ELIGIBILITY.—A State 

23 seeking to participate in the program shall— 


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1 (A) submit an application to the Secretary 

2 containing such information and at such time 

3 as the Secretary may specify; 

4 (B) meet the selection criteria established 

5 under paragraph (3); and 

6 (C) meet such additional criteria as the 

7 Secretary may specify. 

8 (3) SELECTION CRITERIA.—In selecting States 

9 to participate in the program, the Secretary shall es10 tablish criteria to ensure— 

11 (A) geographic and demographic diversity; 

12 (B) that participating States offer medical 

13 assistance for personal care services under the 

14 State Medicaid plan; 

15 (C) that the existing training standards for 

16 personal or home care aides, home health aides, 

17 and nurse aides in each participating State— 

18 (i) are different from such standards 

19 in the other participating States; and 

20 (ii) are different from the core train21 ing competencies developed under sub22 section (b)(2)(A) and the additional train23 ing content developed under subsection 

24 (b)(2)(B); 


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1 (D) that participating States do not reduce 

2 the number of hours of training required under 

3 applicable State law or regulation after being 

4 selected to participate in the program; and 

5 (E) that States recruit a minimum number 

6 of eligible health and long-term care providers 

7 to participate in the program. 

8 (4) TECHNICAL ASSISTANCE.—The Secretary 

9 shall provide technical assistance to States in devel10 oping written materials and protocols for such core 

11 training competencies and such additional training 

12 content under paragraph (1)(C)(ii). 

13 (d) EVALUATION AND REPORT.— 

14 (1) EVALUATION.—The Secretary shall develop 

15 an experimental or control group testing protocol in 

16 consultation with an independent evaluation con17 tractor selected by the Secretary. Such contractor 

18 shall evaluate— 

19 (A) the impact of core training com20 petencies developed under subsection (b)(2)(A), 

21 including curricula developed to implement such 

22 core training competencies, for personal or 

23 home care aides within each participating State 

24 on job satisfaction, mastery of job skills, bene25 ficiary and family caregiver satisfaction with 


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1 services, and additional measures determined by 

2 the Secretary in consultation with the expert 

3 panel established under subsection (b); 

4 (B) the impact of incorporating the addi5 tional training content developed under sub6 section (b)(2)(B) into existing training stand7 ards for home health aides and certified nurse 

8 aides within each participating State; 

9 (C) the impact of providing such core 

10 training competencies and additional training 

11 content on the existing training infrastructure 

12 and resources of States; 

13 (D) whether the minimum number of 

14 hours of initial training required for nurse aides 

15 under sections 1819(f)(2)(A)(i)(II) and 

16 1919(f)(2)(A)(i)(II) of the Social Security Act 

17 (42 U.S.C. 1395i–3(f)(2)(A)(i)(II); 

18 1396r(f)(2)(A)(i)(II)) should be increased; and 

19 (E) whether a minimum number of hours 

20 of initial training should be required for per21 sonal or home care aides and, if so, what min22 imum number of hours should be required. 

23 (2) REPORT.—Not later than 1 year after the 

24 completion of the program, the Secretary shall sub25 mit to Congress a report containing the results of 


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1 the evaluations conducted under paragraph (1), to2 gether with such recommendations for legislation or 

3 administrative action as the Secretary determines 

4 appropriate. 

5 (e) FUNDING.—Out of any funds in the Treasury not 

6 otherwise appropriated, there are appropriated to the Sec7 retary to carry out the program under this section for the 

8 period of fiscal years 2011 through 2016, $14,000,000. 

9 (f) DEFINITIONS.—In this section: 

10 (1) ELIGIBLE HEALTH AND LONG-TERM CARE

11 PROVIDER.—The term ‘‘eligible health and long-term 

12 care provider’’ means a personal or home care agen13 cy (including personal or home care public authori14 ties), a nursing home, a home health agency (as de15 fined in section 1861(o)) of the Social Security Act 

16 (42 U.S.C. 1395x(o)), or any other health care pro17 vider the Secretary determines appropriate which— 

18 (A) is licensed or authorized to provide 

19 services in a participating State; and 

20 (B) receives payment for services under 

21 title XVIII or XIX of the Social Security Act. 

22 (2) HOME HEALTH AIDE.—The term ‘‘home 

23 health aide’’ has the meaning given such term in 

24 section 1891(a)(3)(E) of the Social Security Act (42 

25 U.S.C. 1395bbb(a)(3)(E)). 


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1 (3) NURSE AIDE.—The term ‘‘nurse aide’’ has 

2 the meaning given such term in section 

3 1819(b)(5)(F) of the Social Security Act (42 U.S.C. 

4 1395i–3(b)(5)(F)). 

5 (4) PERSONAL CARE SERVICES.—The term 

6 ‘‘personal care services’’ has the meaning given such 

7 term for purposes of title XIX of the Social Security 

8 Act (42 U.S.C. 1396 et seq.). 

9 (5) PERSONAL OR HOME CARE AIDE.—The 

10 term ‘‘personal or home care aide’’ means an indi11 vidual who helps individuals who are elderly, dis12 abled, ill, or mentally disabled (including an indi13 vidual with Alzheimer’s disease or other dementia) 

14 to live in their own home or a residential care facil15 ity (such as a nursing home, assisted living facility, 

16 or any other facility the Secretary determines appro17 priate) by providing routine personal care services 

18 and other appropriate services to the individual. 

19 (6) SECRETARY.—The term ‘‘Secretary’’ means 

20 the Secretary of Health and Human Services. 

21 SEC. 402. MEDICARE FAMILY CAREGIVER INFORMATION 

22 AND REFERRAL. 

23 State health insurance assistance programs, the Ad24 ministrator of the Centers for Medicare & Medicaid Serv25 ices, and the Assistant Secretary of the Administration on 


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1 Aging shall, in collaboration with each other, directly or 

2 by contract, develop practical, easy-to-understand infor3 mation and referral protocols for health care providers, so4 cial workers, and other appropriate individuals to provide 

5 to family caregivers of Medicare beneficiaries either on ad6 mission to or discharge from a hospital (including a dis7 charge from a hospital emergency room or a hospital out8 patient department which has furnished a surgical service) 

9 or a post-acute care setting (including a skilled nursing 

10 facility (as defined in section 1819(a) of the Social Secu11 rity Act (42 U.S.C. 1395i–3(a)), a comprehensive rehabili12 tation facility (as defined in section 1861(cc)(2) of such 

13 Act (42 U.S.C. 1395x(cc)(2)) or a rehabilitation agency, 

14 a provider of long-term care services, and a home health 

15 agency (as defined in section 1861(o) of such Act (42 

16 U.S.C. 1395x(o)). Information developed under the pre17 ceding sentence shall— 

18 (1) include information on national, State, and 

19 community-based resources for seniors, individuals 

20 with disabilities and their caregivers, which shall be 

21 updated on a semi-annual basis (or as frequently as 

22 practicable); 

23 (2) be disseminated by health care providers, 

24 social workers, and other appropriate individuals as 

25 printed materials (including materials in Spanish 


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1 and other languages (other than English) as appro2 priate); and 

3 (3) be made available on the Internet websites 

4 of State health insurance assistance programs, the 

5 Centers for Medicare & Medicaid Services, and the 

6 Administration on Aging. 

7 SEC. 403. MEDICAID ASSESSMENT OF FAMILY CAREGIVER 

8 SUPPORT NEEDS. 

9 (a) IN GENERAL.—Section 1915 of the Social Secu10 rity Act (42 U.S.C. 1396n) is amended— 

11 (1) in subsection (c)(2)— 

12 (A) in subparagraph (D), by striking 

13 ‘‘and’’ at the end; 

14 (B) in subparagraph (E), by striking the 

15 period at the end and inserting ‘‘; and’’; and 

16 (C) by adding at the end the following new 

17 subparagraph: 

18 ‘‘(F) under such waiver the State may pro19 vide for an assessment of family caregiver sup20 port needs (in accordance with subsection 

21 (k)).’’; 

22 (2) in subsection (d)(2)— 

23 (A) in subparagraph (B), by striking 

24 ‘‘and’’ at the end; 


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1 (B) in subparagraph (C), by striking the 

2 period at the end and inserting ‘‘; and’’; and 

3 (C) by adding at the end the following new 

4 subparagraph: 

5 ‘‘(D) under such waiver the State may pro6 vide for an assessment of family caregiver sup7 port needs (in accordance with subsection 

8 (k)).’’; 

9 (3) in subsection (i)(1)(F), by adding at the 

10 end the following new clause: 

11 ‘‘(vii) Where appropriate, an assess12 ment of family caregiver support needs (in 

13 accordance with subsection (k)).’’; and 

14 (4) by adding at the end the following new sub15 section: 

16 ‘‘(k) ASSESSMENT OF FAMILY CAREGIVER SUPPORT

17 NEEDS.— 

18 ‘‘(1) IN GENERAL.—In the case of an individual 

19 who is determined to be eligible for home and com20 munity-based services under a waiver under sub21 section (c) or (d) or under section 1115, under a 

22 State plan amendment under subsection (i), under 

23 an MFP demonstration project established under 

24 section 6071 of the Deficit Reduction Act of 2005, 

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1 ices provided pursuant to a written plan of care in 

2 accordance with the requirements of subsection (j), 

3 and who is dependent upon the assistance of a fam4 ily caregiver, the State may provide for an assess5 ment of the family caregiver support needs of the in6 dividual. Such assessment shall, to the extent fea7 sible, be conducted at the same time as, or closely 

8 coordinated with, the determination of the eligibility 

9 of the individual for such services. 

10 ‘‘(2) QUESTIONNAIRE.— 

11 ‘‘(A) IN GENERAL.—Such assessment shall 

12 include asking the family caregiver of the indi13 vidual questions in order to determine whether 

14 they would benefit from targeted support serv15 ices (such as those services described in para16 graph (3)). 

17 ‘‘(B) COMPLETION ON A VOLUNTARY

18 BASIS.—The answering of questions under sub19 paragraph (A) by a family caregiver shall be on 

20 a voluntary basis. 

21 ‘‘(3) TARGETED SUPPORT SERVICES DE22 SCRIBED.—The following targeted support services 

23 are described in this paragraph: 

24 ‘‘(A) Respite care and emergency back-up 

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1 vidual that gives the family caregiver a break 

2 from providing such care). 

3 ‘‘(B) Individual counseling (including ad4 vice and consultation sessions to bolster emo5 tional support for the family caregiver to make 

6 well-informed decisions about how to cope with 

7 the strain of supporting the individual). 

8 ‘‘(C) Support groups, including groups 

9 which provide help for family caregivers to— 

10 ‘‘(i) locate a support group either lo11 cally or online to share experiences and re12 duce isolation; 

13 ‘‘(ii) make well-informed decisions 

14 about caring for the individual; and 

15 ‘‘(iii) reduce isolation. 

16 ‘‘(D) Information and assistance (including 

17 brochures and online resources for researching 

18 a disease or disability or learning and managing 

19 a regular caregiving role, new technologies that 

20 can assist family caregivers, and practical as21 sistance for locating services). 

22 ‘‘(E) Chore services (such as house clean23 ing). 

24 ‘‘(F) Personal care (including outside 

25 help). 


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1 ‘‘(G) Education and training (including 

2 workshops and other resources available with 

3 information about stress management, self-care 

4 to maintain good physical and mental health, 

5 understanding and communicating with individ6 uals with dementia, medication management, 

7 normal aging processes, change in disease and 

8 disability, the role of assistive technologies, and 

9 other relevant topics). 

10 ‘‘(H) Legal and financial planning and 

11 consultation (including advice and counseling 

12 regarding long-term care planning, estate plan13 ning, powers of attorney, community property 

14 laws, tax advice, employment leave advice, ad15 vance directives, and end-of-life care). 

16 ‘‘(I) Transportation (including transpor17 tation to medical appointments). 

18 ‘‘(J) Other targeted support services the 

19 Secretary or the State determines appropriate. 

20 ‘‘(4) REFERRALS.—In the case where a ques21 tionnaire completed by a family caregiver under 

22 paragraph (2) indicates that the family caregiver 

23 would benefit from 1 or more of the targeted sup24 port services described in paragraph (3), the State 

25 shall provide referrals to the family caregiver for 


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1 local, State, and private-sector family caregiver pro2 grams and other resources that provide such tar3 geted support services.’’. 

4 (b) EFFECTIVE DATE.—The amendments made by 

5 subsection (a) shall apply to medical assistance for home 

6 and community-based services that is provided on or after 

7 the date of enactment of this Act. 

8 TITLE V—STUDIES AND 

9 REPORTS 

10 SEC. 501. STUDIES AND REPORTS. 

11 (a) IOM STUDY AND REPORT ON MENTAL HEALTH

12 WORKFORCE NEEDS.— 

13 (1) STUDY.—Not later than 90 days after the 

14 date of enactment of this Act, the Secretary of 

15 Health and Human Services shall enter into a con16 tract with the Institute of Medicine of the National 

17 Academies (in this section referred to as the ‘‘Insti18 tute’’) under which the Institute shall conduct a 

19 study on the specific policy, workforce, economic, 

20 and implementation issues relevant to the mental 

21 health workforce that need to be addressed to meet 

22 the current needs of older individuals and the future 

23 needs of the aging boomer generation. 

24 (2) REPORT.—Not later than 24 months after 

25 the effective date of the contract under paragraph 


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1 (1), the Institute, as part of such contract, shall 

2 submit a report to the Secretary of Health and 

3 Human Services and the appropriate committees of 

4 jurisdiction of Congress containing the results of the 

5 study conducted under paragraph (1), together with 

6 recommendations for such legislation and adminis7 trative action as the Institute determines appro8 priate. 

9 (3) AUTHORIZATION.—There is authorized to 

10 be appropriated to carry out this subsection, 

11 $1,200,000 for the period of fiscal years 2011 

12 through 2012. 

13 (b) GAO STUDY AND REPORT ON THE NEEDS OF

14 THE AGING NETWORK.— 

15 (1) STUDY.—The Comptroller General of the 

16 United States (in this section referred to as the 

17 ‘‘Comptroller General’’) shall conduct a study on the 

18 aging network, focusing on State agencies and area 

19 agencies on aging (as defined in section 102 of the 

20 Older Americans Act of 1965 (42 U.S.C. 3002)) to 

21 determine the current capacity of such network and 

22 to identify challenges in providing services to older 

23 adults, including older adults who are low-income 

24 and older adults with functional disabilities, during 


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1 the 10-year period beginning on the date of enact2 ment of this Act. 

3 (2) REPORT.—Not later than 18 months after 

4 the date of enactment of this Act, the Comptroller 

5 General shall submit to Congress a report containing 

6 the results of the study conducted under paragraph 

7 (1), together with recommendations— 

8 (A) on the workforce supply and capitol re9 sources needed by the aging network in order to 

10 meet the demand for services by older adults 

11 during such 10-year period; and 

12 (B) for such legislation and administrative 

13 action as the Comptroller General determines 

14 appropriate. 

15 (c) GAO STUDY AND REPORT ON THE DIRECT CASE

16 WORKFORCE IN LONG-TERM CARE SETTINGS.— 

17 (1) STUDY.—The Comptroller General shall 

18 conduct a study on the use of practices to reduce 

19 turnover and improve retention and tenure of nurse 

20 aides and home health aides in nursing homes, as21 sisted living facilities, and home health agencies (as 

22 defined in section 1861(o) of the Social Security Act 

23 (42 U.S.C. 1395x(o)). Such study shall include an 

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1 tices and how such practices could be replicated in 

2 other facilities. 

3 (2) REPORT.—Not later than 18 months after 

4 the date of enactment of this Act, the Comptroller 

5 General shall submit to Congress a report containing 

6 the results of the study conducted under paragraph 

7 (1), together with recommendations for such legisla8 tion and administrative action as the Comptroller 

9 General determines appropriate. 

10 (3) DEFINITIONS.—In this subsection: 

11 (A) HOME HEALTH AIDE.—The term 

12 ‘‘home health aide’’ has the meaning given such 

13 term in section 1891(a)(3)(E) of the Social Se14 curity Act (42 U.S.C. 1395bbb(a)(3)(E)). 

15 (B) NURSE AIDE.—The term ‘‘nurse aide’’ 

16 has the meaning given such term in section 

17 1819(b)(5)(F) of the Social Security Act (42 

18 U.S.C. 1395i–3(b)(5)(F)). 

19 (d) GAO STUDY AND REPORT ON NIH SPENDING

20 AND GRANTS.— 

21 (1) STUDY.—The Comptroller General shall 

22 conduct a study on spending by the National Insti23 tutes of Health, including the number of grants 

24 made by the National Institutes of Health, on condi25 tions and illnesses that disproportionately impact the 


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1 physical and mental health of older individuals. Such 

2 study shall include an analysis of the number of 

3 older individuals who are included in clinical trials, 

4 including clinical trials assessing the prevalence and 

5 impact of medication-related problems for older 

6 adults, that are supported by the National Institutes 

7 of Health. 

8 (2) REPORT.—Not later than 18 months after 

9 the date of enactment of this Act, the Comptroller 

10 General shall submit to Congress a report containing 

11 the results of the study conducted under paragraph 

12 (1), together with recommendations for such legisla13 tion and administrative action as the Comptroller 

14 General determines appropriate. 

Æ 


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