December 11, 2008 CONGRESSIONAL RECORD — SENATE S10947 

ADDITIONAL COSPONSORS 

S. 453

At the request of Mr. BAYH, his name 

was added as a cosponsor of S. 453, a 

bill to prohibit deceptive practices in 

Federal elections. 

S. 960

At the request of Mrs. CLINTON, the 

name of the Senator from Arkansas 

(Mr. PRYOR) was added as a cosponsor 

of S. 960, a bill to establish the United 

States Public Service Academy. 

S. 2173

At the request of Mr. HARKIN, the 

name of the Senator from Hawaii (Mr. 

AKAKA) was added as a cosponsor of S. 

2173, a bill to amend the Elementary 

and Secondary Education Act of 1965 to 

improve standards for physical education. 

S. 3364

At the request of Mrs. LINCOLN, the 

name of the Senator from Arkansas 

(Mr. PRYOR) was added as a cosponsor 

of S. 3364, a bill to increase the recruitment and retention of school counselors, school social workers, and 

school psychologists by low-income 

local educational agencies. 

S. 3517

At the request of Ms. SNOWE, the 

name of the Senator from Vermont 

(Mr. SANDERS) was added as a cosponsor of S. 3517, a bill to amend the Employee Retirement Income Security 

Act of 1974 and the Public Health Service Act to provide parity under group 

health plans and group health insurance coverage for the provision of benefits for prosthetic devices and components and benefits for other medical 

and surgical services. 

S. 3683

At the request of Mr. INHOFE, the 

name of the Senator from Alabama 

(Mr. SHELBY) was added as a cosponsor 

of S. 3683, a bill to amend the Emergency Economic Stabilization Act to 

require approval by the Congress for 

certain expenditures for the Troubled 

Asset Relief Program. 

S. 3697

At the request of Mr. INHOFE, the 

name of the Senator from Alabama 

(Mr. SHELBY) was added as a cosponsor 

of S. 3697, a bill to amend the Emergency Economic Stabilization Act to 

require approval by the Congress for 

certain expenditures for the Troubled 

Asset Relief Program. 

S. 3708

At the request of Mrs. CLINTON, the 

name of the Senator from Ohio (Mr. 

BROWN) was added as a cosponsor of S. 

3708, a bill to amend the Public Health 

Service Act with respect to health professions education, and for other purposes. 

S. 3728

At the request of Mr. SANDERS, the 

name of the Senator from Vermont 

(Mr. LEAHY) was added as a cosponsor 

of S. 3728, a bill to direct the Secretary 

of Transportation to waive non-Federal 

share requirements for certain transportation programs and activities 

through September 30, 2009. 

S. RES. 710

At the request of Mr. REED, his name 

was added as a cosponsor of S. Res. 710, 

a resolution designating the week of 

February 2 through February 6, 2009, as 

‘‘National Teen Dating Violence 

Awareness and Prevention Week’’. 

S. RES. 728

At the request of Mr. MCCAIN, the 

name of the Senator from Georgia (Mr. 

ISAKSON) was added as a cosponsor of S. 

Res. 728, a resolution designating January 2009 as ‘‘National Mentoring 

Month’’. 

f 

STATEMENTS ON INTRODUCED 

BILLS AND JOINT RESOLUTIONS 

Mr. CASEY: 

S. 3732. A bill to assist in creating 

substantive culture change in longterm residential care by establishing a 

small house nursing home loan program to provide for the establishment, 

renovation, and construction of small 

house nursing homes; to the Committee on Banking, Housing, and 

Urban Affairs. 

Mr. CASEY. Mr. President, I rise 

today to introduce the Promoting 

Small House Nursing Homes Act. This 

is a bill I expect will play a significant 

role in the way we care for our older 

citizens in this country. I also hope and 

expect this bill to make an important 

contribution to the framing and substance of the landmark health care reform we anticipate in the coming year. 

Moreover, because our current economic problems are interwoven with 

out-of-control health care costs, this 

bill will contribute to a revitalization 

of our economy and the creation of new 

jobs. Finally, it will establish solid criteria for long term residential care 

that will not only improve the quality 

of life of older citizens, but save money 

through cost-effective, comprehensive 

and coordinated long term and health 

care. 

This bill provides a dramatically different approach to long term residential care for older citizens than is offered by the traditional nursing home 

model. 

The Promoting Small House Nursing 

Home Act incorporates the principles 

of person-centered care as a cornerstone of all aspects of long term residential care. What do we mean by person-centered care? The philosophy is 

simple: Our older citizens deserve to 

live lives of dignity and respect 

through all stages of life. About 10 

years ago, the Philadelphia Inquirer reported, ‘‘Life can have quality and 

meaning even until the very last 

breath.’’ Our older citizens have a profound right to be decision-makers in 

their own care—to be at the center of 

their own care, with a partnership of 

family and providers. Our older citizens 

are critically important to the overall 

health and well-being of our society. I 

quote a well known expert in personcentered care, Dr. Bill Thomas, who 

says, ‘‘People of all ages will live better lives when we succeed in bringing 

elders back to the heart of our society.’’ 

My bill translates this profound philosophy into a specific policy prescription by doing the following: creating a 

low-interest loan fund for building new 

or renovating existing long term care 

facilities that follow articulated small 

house nursing home model guidelines; 

etablishing clear and specific program 

requirements and guidelines that build 

upon existing programs that have successfully implemented substantial culture change and person-centered care; 

creating a home-like and non-institutional model of care for long term care 

residential facilities that is based upon 

the principles of: collaborative decision-making; respect; and significantly 

improved quality of life for residents 

and staff alike. 

We currently have an estimated 38 

million Americans over the age of 65, 

and that number is expected to double 

within the next 20 years. In the midst 

of this, health care costs are rising exponentially, the quality of outcomes is 

not consistent, and older citizens are 

often abandoned to navigate a confusing and complex health care system. 

Older citizens also report extremely 

low levels of satisfaction with life in 

nursing homes. This $122 billion industry includes 16,000 nursing homes and 

significant concerns persist about maltreatment and neglect of our older citizens in 20 percent of these homes. As I 

know from my work in State government, most nursing homes provide 

quality care but that 20 percent is what 

we hear most about. However, a recent 

survey by the AARP found that fewer 

than 1 percent of individuals over 50 

with a disability want to move to a 

nursing home. There has to be a better 

way, and in fact there is. 

Person-centered care provides that 

better way. It is a straightforward concept and yet it has taken years of hard 

work to get concrete initiatives underway. We have a long way to go and 

much to learn. But in order to succeed, 

we must pass legislation like the bill I 

have introduced today. 

Traditional nursing facilities require 

residents’ lives to revolve around institutional schedules for waking, bathing 

and dressing. Traditional facilities far 

too often identify residents by their 

health conditions, vulnerabilities and 

room numbers rather than their unique 

strengths and gifts. Staff members are 

attracted to the field of direct care 

service because they want to help older 

citizens but they are just as ill-served 

by this institutionalized culture as are 

the residents. Workers are minimally 

trained, over-worked and carry patient 

loads that make it impossible to engage in any personal time with residents—in fact, such relationships are 

often discouraged. They have little or 

no say in decision-making, relegated— 

like the residents—to the fringes of a 

system that places the needs of the institution over those of the human 

beings in it.