```

[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 3730 Introduced in Senate (IS)]

110th CONGRESS
  2d Session
                                S. 3730

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

                           December 10, 2008

   Mr. Kohl 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.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Retooling the 
Health Care Workforce for an Aging America Act of 2008''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
          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.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) The United States will not be able to meet near-term 
        demands for chronic, geriatric, and long-term care without a 
        workforce that is prepared for the job.
            (2) Between 2005 and 2030, it is estimated that the number 
        of adults aged 65 and older will almost double from 37,000,000 
        to over 70,000,000, increasing from 12 percent of the 
        population of the United States to almost 20 percent of the 
        population.
            (3) Because the overall size of the population of older 
        adults in the United States will increase rapidly, the number 
        of older adults in the United States who are disabled will soar 
        in the coming decades. Between 2000 and 2040 the number of 
        older adults who are disabled will more than double, increasing 
        from an estimated 10,000,000 to an estimated 21,000,000.
            (4) A 2008 report by the Institute of Medicine of the 
        National Academies, entitled, ``Retooling for an Aging 
        America'' concludes that the health care workforce will lack 
        the capacity, in both size and ability, to meet the needs of 
        older patients in the future unless action is taken 
        immediately.
            (5) Inadequate training in geriatrics, gerontology, chronic 
        care management, and long-term care is known to result in 
        misdiagnoses, medication errors, and inadequate coordination of 
        services and treatments that result in poor care and is costly 
        for the health care system as a whole.
            (6) Currently, only 1 percent of all physicians 
        (approximately 7,000) in the United States are certified 
        geriatricians, even as the population of older adults is on 
        track to double by 2030.
            (7) Inadequate amounts of time devoted to geriatric 
        training are reported by \1/4\ of graduating medical students, 
        and close to \1/2\ of graduating medical students say they are 
        unprepared to care for residents in nursing homes.
            (8) Less than 1 percent of all nurses are certified 
        gerontological nurses. Absent any change, by the year 2020, the 
        total supply of nurses in the United States is projected to 
        fall 29 percent below requirements, resulting in a severe 
        shortage of nursing expertise relative to the demand for care 
        of medically complex, frail older adults.
            (9) The Bureau of Labor Statistics of the Department of 
        Labor predicts that personal or home care aides and home health 
        aides will represent the second and third fastest-growing 
        occupations between 2006 and 2016. Yet personal or home care 
        aides are not subject to any Federal requirements related to 
        training or education, and States have very different 
        requirements for personal or home care aides.
            (10) Research shows that inadequate training is a major 
        contributor to high turnover rates among direct care workers 
        and more training is correlated with better staff recruitment 
        and retention rates.
            (11) An estimated 44,000,000 family caregivers are being 
        asked to provide increasingly complex medical services to frail 
        and elderly loved ones wishing to live at home. Multiple 
        surveys have documented that basic training and access to other 
        targeted services are necessary for family caregivers to 
        provide consistent quality care on an ongoing basis.

          TITLE I--AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT

     Subtitle A--Health Professions Education Related to Geriatrics

SEC. 101. GERIATRIC EDUCATION CENTERS.

    Section 753 of the Public Health Service Act (42 U.S.C. 294) is 
amended by adding at the end the following:
    ``(d) Grants To Expand and Improve Geriatric Education Centers.--
            ``(1) In general.--The Secretary shall award grants or 
        contracts under this subsection to entities that operate a 
        geriatric education center pursuant to subsection (a)(1).
            ``(2) Application.--To be eligible for an award under 
        paragraph (1), an entity described in such paragraph shall 
        submit to the Secretary an application at such time, in such 
        manner, and containing such information as the Secretary may 
        require.
            ``(3) Use of funds.--Amounts awarded under a grant or 
        contract under paragraph (1) shall be used to--
                    ``(A) carry out the fellowship program described in 
                paragraph (4); and
                    ``(B) carry out 2 of the 3 activities described in 
                paragraph (5).
            ``(4) Fellowship program.--
                    ``(A) In general.--Pursuant to paragraph (3), a 
                geriatric education center that receives an award under 
                this subsection shall use such funds to offer short-
                term intensive courses (referred to in this subsection 
                as a `fellowship') that focus on geriatrics, chronic 
                care management, and long-term care that provide 
                supplemental training for faculty members in medical 
                schools and other health professions schools with 
                programs in psychology, nursing, social work, 
                dentistry, public health, or other health disciplines, 
                as approved by the Secretary. Such a fellowship shall 
                be open to current faculty, and appropriately 
                credentialed volunteer faculty and practitioners, who 
                do not have formal training in geriatrics, to upgrade 
                their knowledge and clinical skills for the care of 
                older adults and adults with functional limitations and 
                to enhance their interdisciplinary teaching skills.
                    ``(B) Location.--A fellowship shall be offered 
                either at the geriatric education center that is 
                sponsoring the course, in collaboration with other 
                geriatric education centers, or at medical schools, 
                schools of nursing, schools of social work, or other 
                health professions schools approved by the Secretary 
                with which the geriatric education centers are 
                affiliated.
                    ``(C) CME credit.--Participation in a fellowship 
                under this paragraph shall be accepted with respect to 
                complying with continuing medical education 
                requirements. As a condition of such acceptance, the 
                recipient shall agree to subsequently provide a minimum 
                of 18 hours of voluntary instructional support through 
                a geriatric education center that is providing clinical 
                training to students or trainees in long-term care 
                settings.
            ``(5) Additional required activities described.--Pursuant 
        to paragraph (3), a geriatric education center that receives an 
        award under this subsection shall use such funds to carry out 2 
        of the 3 activities:
                    ``(A) Family caregiver training.--A geriatric 
                education center that receives an award under this 
                subsection shall offer at least 2 courses each year, at 
                no charge or nominal cost, to family caregivers that 
                are designed to provide practical training for 
                supporting frail elders and individuals with 
                disabilities. The Secretary shall require such Centers 
                to work with appropriate community partners and family 
                caregiver organizations to publicize the availability 
                of training courses in their service areas. All family 
                caregiver training programs shall include instruction 
                on the management of psychological and behavioral 
                aspects of dementia, and communication techniques for 
                working with individuals who have dementia.
                    ``(B) Direct care working training.--A geriatric 
                education center that receives an award under this 
                subsection shall offer at least 2 courses each year to 
                certified nurse aides, home health aides, personal or 
                home care aides and other types of direct care workers 
                on `best practices' for working with frail elders and 
                individuals with disabilities, including individuals 
                with dementia, urinary incontinence, and problems with 
                balance or mobility.
                    ``(C) Incorporation of best practices.--A geriatric 
                education center that receives an award under this 
                subsection shall develop and include material on 
                depression and other mental health disorders common 
                among older adults, and management of the psychological 
                and behavioral aspects of dementia and communication 
                techniques with individuals who have dementia in all 
                training courses, where appropriate.
            ``(6) Targets.--A geriatric education center that receives 
        an award under this subsection shall meet targets approved by 
        the Secretary for providing geriatric training to a certain 
        number of faculty or practitioners during the term of the 
        grant, as well as other parameters established by the 
        Secretary, including guidelines for the content of the 
        fellowships.
            ``(7) Amount of award.--An award under this subsection 
        shall be in an amount of $150,000. Not more than 24 geriatric 
        education centers may receive an award under this subsection.
            ``(8) Authorization of appropriations.--In addition to any 
        other funding available to carry out this section, there is 
        authorized to be appropriated to carry out this subsection, 
        $10,800,000 for the period of fiscal year 2010 through 2012.''.

SEC. 102. IMPROVING GERIATRIC TRAINING FOR PHYSICIANS, DENTISTS, AND 
              BEHAVIOR AND MENTAL HEALTH PROFESSIONALS.

    Section 753 of the Public Health Service Act (42 U.S.C. 294), as 
amended by section 101, is amended by adding at the end the following:
    ``(e) Geriatric Training for Physicians, Dentists, and Behavior and 
Mental Health Professionals.--An accredited school of medicine or 
osteopathic medicine, a teaching hospital, or a graduate medical 
education program that receives an award under subsection (c) may use 
the funds under such award to carry out a program to train individuals 
for either 1 year, 2 years, or both, who are seeking a certificate of 
added qualification or specialization in geriatrics for either 1 year, 
2 years, or both. Such a program may be located in a medical school 
that offers programs in 2 of the 3 disciplines described in subsection 
(c)(5). Such program may fund the training of doctorally-prepared 
clinical psychologists, psychiatric nurse practitioners, and clinical 
social workers as part of the behavior and mental health training 
programs.''.

SEC. 103. GERIATRIC ACADEMIC CAREER AWARDS.

    (a) Expansion of Eligibility for Geriatric Academic Career Awards; 
Payment to Institution.--Section 753(c) of the Public Health Service 
Act (42 U.S.C. 294(c)) is amended--
            (1) by striking paragraph (2) through paragraph (3) and 
        inserting the following:
            ``(2) Eligible individuals.--To be eligible to receive an 
        Award under paragraph (1), an individual shall--
                    ``(A) be board certified or board eligible in 
                internal medicine, family practice, or psychiatry or 
                have completed any required training in a discipline 
                and employed in an accredited health professions school 
                that is approved by the Secretary, including dentistry, 
                pharmacy, nursing, social work, and psychology;
                    ``(B) have completed an approved fellowship program 
                in geriatrics; and
                    ``(C) have a junior (non-tenured) faculty 
                appointment at an accredited (as determined by the 
                Secretary) school of medicine, osteopathic medicine, 
                nursing, social work, psychology, dentistry, pharmacy, 
                or other allied health disciplines in an accredited 
                health professions school that is approved by the 
                Secretary.
            ``(3) Limitations.--No Award under paragraph (1) may be 
        made to an eligible individual unless the individual--
                    ``(A) has submitted to the Secretary an 
                application, at such time, in such manner, and 
                containing such information as the Secretary may 
                require, and the Secretary has approved such 
                application;
                    ``(B) provides, in such form and manner as the 
                Secretary may require, assurances that the individual 
                will meet the service requirement described in 
                paragraph (5); and
                    ``(C) provides, in such form and manner as the 
                Secretary may require, assurances that the individual 
                has a full-time faculty appointment in a health 
                professions institution and documented commitment from 
                such institution to spend 75 percent of the total time 
                of such individual on teaching and developing skills in 
                interdisciplinary education in geriatrics.''; and
            (2) in paragraph (4)--
                    (A) in subparagraph (A)--
                            (i) by inserting ``for individuals who are 
                        physicians'' after ``this section''; and
                            (ii) by inserting after the period at the 
                        end the following: ``The Secretary shall 
                        determine the amount of an Award under this 
                        section for individuals who are not 
                        physicians.''; and
                    (B) by adding at the end the following:
                    ``(C) Payment to institution.--The Secretary shall 
                transfer funds awarded to an individual under this 
                section to the institution where such individual will 
                carry out the award, in order to facilitate financial 
                management of the reward pursuant to guidelines of the 
                Health Resources and Services Administration.''.
    (b) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out the amendments made by this section 
$6,000,000 for each of fiscal years 2010, 2011, and 2012.

SEC. 104. GERIATRIC CAREER INCENTIVE AWARDS.

    Section 753 of the Public Health Service Act (42 U.S.C. 294), as 
amended by section 102, is amended by adding at the end the following:
    ``(f) Geriatric Career Incentive Awards.--
            ``(1) In general.--The Secretary shall award grants or 
        contracts under this section to individuals described in 
        paragraph (2) to foster greater interest among a variety of 
        health professionals in entering the field of geriatrics, long-
        term care, and chronic care management.
            ``(2) Eligible individuals.--To be eligible to received an 
        award under paragraph (1), an individual shall--
                    ``(A) be an advanced practice nurse (such as a 
                clinical nurse specialist or nurse practitioner), a 
                clinical social worker, or clinical psychologist who 
                has a master's degree or equivalent graduate degree and 
                is pursuing a doctorate or other advanced degree 
                approved by the Secretary in geriatrics, long-term 
                care, or chronic care management in an accredited 
                health professions school that is approved by the 
                Secretary; and
                    ``(B) submit to the Secretary an application at 
                such time, in such manner, and containing such 
                information as the Secretary may require.
            ``(3) Condition of award.--As a condition of receiving an 
        award under this subsection, an individual shall agree that, 
        following completion of the award period, the individual will 
        teach or practice in the field of geriatrics, long-term care, 
        or chronic care management for a minimum of 5 years under 
        guidelines set by the Secretary.
            ``(4) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection, $10,000,000 
        for the period of fiscal years 2010 through 2012.''.

SEC. 105. NATIONAL CENTER FOR HEALTH WORKFORCE ANALYSIS.

    Part E of Title VII of the Public Health Service Act (42 U.S.C. 
294n et seq.) is amended by adding at the end the following:

       ``Subpart 3--National Center for Health Workforce Analysis

``SEC. 774. ACTIVITIES OF THE NATIONAL CENTER FOR HEALTH WORKFORCE 
              ANALYSIS.

    ``In addition to any activities being carried out at the National 
Center for Health Workforce Analysis of the Health Resources and 
Services Administration as of the day before the date of enactment of 
the Retooling the Health Care Workforce for an Aging America Act of 
2008, the head of such Center shall analyze--
            ``(1) current and projected needs for health and long-term 
        care workforce demand and supply, and training and education 
        needs specific to older adults and adults with functional 
        limitations; and
            ``(2) turnover and retention for professionals and 
        paraprofessionals in these fields, including administrators, 
        medical directors and direct care staff of nursing homes, 
        assisted living facilities and home and community-based 
        settings, or any other setting or provider the Secretary 
        determines appropriate.

``SEC. 775. AUTHORIZATION OF APPROPRIATIONS.

    ``There is authorized to be appropriated to the National Center for 
Workforce Analysis to carry out this subpart $6,000,000 for the period 
of fiscal years 2010 through 2012.''.

                 Subtitle B--Improved Nursing Services

SEC. 121. COMPREHENSIVE GERIATRIC EDUCATION NURSING GRANT PROGRAM.

    Section 855 of the Public Health Service Act (42 U.S.C. 298) is 
amended--
            (1) in subsection (b)--
                    (A) in paragraph (3), by striking ``or'';
                    (B) in paragraph (4), by striking the period and 
                inserting ``; or''; and
                    (C) by inserting after paragraph (4) the following:
            ``(5) establish Federal traineeships to individuals who are 
        preparing for advanced degrees in geriatric nursing, long-term 
        care, and gero-psychiatric nursing.''; and
            (2) in subsection (e), by inserting before the period the 
        following: ``, $12,000,000 for each of fiscal years 2010 
        through 2012 to provide assistance under this section to 
        support additional training for nurses who care for the elderly 
        and individuals with disabilities and for the development and 
        dissemination of curricula relating to geriatric nursing care, 
        the training of nursing faculty in geriatrics, and the 
        provision of continuing education for nurses practicing in 
        geriatrics, and $25,000,000 for each of fiscal years 2010 
        through 2012 to provide assistance under this section to 
        support the Federal traineeships established under subsection 
        (b)(5)''.

      TITLE II--AMENDMENTS TO THE WORKFORCE INVESTMENT ACT OF 1998

SEC. 201. CORE SERVICES.

    Section 134(d)(2)(E)(iii) of the Workforce Investment Act of 1998 
(29 U.S.C. 2864(d)(2)(E)(iii)) is amended to read as follows:
                            ``(iii) information relating to local 
                        occupations in demand, including health care 
                        and long-term care occupations, and the 
                        earnings and skill requirements for such local 
                        occupations;''.

SEC. 202. INDIVIDUAL TRAINING ACCOUNTS.

    Section 134(d)(4)(G)(iii) of the Workforce Investment Act of 1998 
(29 U.S.C. 2864(d)(4)(G)(iii)) is amended to read as follows:
                            ``(iii) Linkage to occupations in demand.--
                        Training services provided under this paragraph 
                        shall be directly linked to occupations, 
                        including health care and long-term care 
                        occupations, that are in demand in the local 
                        area, or in another area to which an adult or 
                        dislocated worker receiving such services is 
                        willing to relocate, except that a local board 
                        may approve training services for occupations 
                        determined by the local board to be in sectors 
                        of the economy that have a high potential for 
                        sustained demand or growth in the local area. 
                        In making determinations of demand or potential 
                        demand or growth under this clause, a local 
                        board shall consult local and State health 
                        agencies, employers, and other organizations 
                        that the local board determines to be 
                        appropriate.''.

SEC. 203. COLLABORATION BETWEEN STATE BOARDS AND THE VETERANS AGENCIES 
              OF THE STATES.

    Section 112(b) of the Workforce Investment Act of 1998 (29 U.S.C. 
2822(b)) is amended--
            (1) in paragraph (17), by striking ``and'' at the end;
            (2) in paragraph (18), by striking the period and inserting 
        ``; and''; and
            (3) by adding at the end the following new paragraph:
            ``(19) a description of how the State board will 
        collaborate with the veterans agency of the State, including 
        entering into a memorandum of understanding with the veterans 
        agency of the State specifying--
                    ``(A) the manner in which the State board and the 
                veterans agency of the State will provide information 
                on health care workforce employment and training 
                opportunities available to individuals, including 
                veterans who are receiving core services described in 
                section 134(d)(2) at a one-stop center and are 
                receiving assistance from the Veterans' Employment and 
                Training Service of the Department of Labor; and
                    ``(B) the manner in which the State board and the 
                veterans agency of the State will obtain and provide 
                information to one-stop operators in the State, for 
                distribution through one-stop centers, about training, 
                internship, and employment opportunities in geriatrics, 
                gerontology, and long-term care, including, as 
                available, opportunities at geriatric research, 
                education and clinical centers operated by the 
                Department of Veterans Affairs.''.

SEC. 204. COLLABORATION BETWEEN DEPARTMENT OF LABOR AND DEPARTMENT OF 
              VETERANS AFFAIRS.

    The Secretary of Labor, acting through the Assistant Secretary for 
Veterans' Employment and Training, and the Secretary of Veterans 
Affairs, shall develop memoranda of understanding outlining how 
veterans seeking employment information through the Local Veterans' 
Employment Representative Program and the Transition Assistance Program 
will be provided with information about training, internship, and 
employment opportunities in geriatrics, gerontology, and long-term 
care, including opportunities at geriatric research, education and 
clinical centers operated by the Department of Veterans Affairs.

SEC. 205. TRAINING OPPORTUNITIES FOR DIRECT CARE WORKERS.

    (a) In General.--Section 171 of the Workforce Investment Act of 
1998 (29 U.S.C. 2916) is amended by adding at the end the following new 
subsection:
    ``(f) Training Opportunities for Direct Care Workers.--
            ``(1) In general.--The Secretary shall award grants to 
        eligible entities to enable such entities to provide new 
        training opportunities for direct care workers (including 
        certified nursing assistants, home health aides, and personal 
        or home care aides) who are employed in long-term care settings 
        such as nursing homes (as defined in section 1908(e)(1) of the 
        Social Security Act (42 U.S.C. 1396g(e)(1)), assisted living 
        facilities, home care settings, and any other setting the 
        Secretary determines to be appropriate.
            ``(2) Eligibility.--To be eligible to receive a grant under 
        paragraph (1), an entity shall--
                    ``(A) be an institution of higher education (as 
                defined in section 102 of the Higher Education Act of 
                1965 (20 U.S.C. 1002)) that--
                            ``(i) is accredited by a nationally 
                        recognized accrediting agency or association 
                        listed under section 101(c) of the Higher 
                        Education Act of 1965 (20 U.S.C. 1001(c)); and
                            ``(ii) has established a public-private 
                        educational partnership with a nursing home, 
                        home health agency, or other long-term care 
                        provider; and
                    ``(B) submit to the Secretary an application at 
                such time, in such manner, and containing such 
                information as the Secretary may require.
            ``(3) Priority.--In making grants to eligible entities, the 
        Secretary shall give priority to entities that demonstrate that 
        the entities will coordinate activities with one-stop operators 
        and one-stop partners at local one-stop centers referred to in 
        section 134(c).
            ``(4) Use of funds.--An eligible entity shall use amounts 
        awarded under a grant under paragraph (1) to provide assistance 
        to eligible individuals to offset the cost of tuition and 
        required fees for enrollment in academic programs provided by 
        such entity, including--
                    ``(A) the provision of stipends to such individuals 
                for a period of not to exceed 2 years;
                    ``(B) the lowering of fees assessed with respect to 
                eligible individuals who are enrolled in programs 
                leading to a licensed practical nursing degree, a 
                registered nursing degree, or any other advanced 
                nursing degree; and
                    ``(C) the lowering of fees assessed with respect to 
                eligible individuals who are enrolled in courses aimed 
                at improving direct care skills for the treatment of 
                specialized conditions that are common in the long-term 
                care sector, such as wound care, brain trauma, 
                immobility, incontinence, functional impairment, and 
                dementia.
            ``(5) Eligible individual.--
                    ``(A) Eligibility.--To be eligible for assistance 
                under paragraph (4), an individual shall be enrolled in 
                courses provided by a grantee under this subsection and 
                maintain satisfactory academic progress in such 
                courses.
                    ``(B) Condition of assistance.--As a condition of 
                receiving assistance under paragraph (4), an individual 
                shall agree that, following completion of the 
                assistance period, the individual will work in the 
                field of geriatrics, long-term care, or chronic care 
                management for a minimum of 2 years under guidelines 
                set by the Secretary.
            ``(6) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection, $10,000,000 
        for the period of fiscal years 2010 through 2012.''.
    (b) Conforming Amendments.--
            (1) Section 174(b)(1) of the Workforce Investment Act of 
        1998 (29 U.S.C. 2919(b)(1)) is amended by inserting ``and 
        except as provided in section 171(f),'' after ``paragraph 
        (2),''.
            (2) Section 174(b)(2)(B)(ii) of the Workforce Investment 
        Act (29 U.S.C. (b)(2)(B)(ii)) is amended to read as follows:
                            ``(ii) except as provided in section 
                        171(f), for each of the fiscal years 2000 
                        through 2003, reserve not less than 45 percent 
                        for carrying out section 171;''.

        TITLE III--AMENDMENTS TO THE OLDER AMERICANS ACT OF 1965

SEC. 301. FAMILY CAREGIVER TRAINING.

    (a) In General.--Part E of title III of the Older Americans Act of 
1965 (42 U.S.C. 3030s et seq.) is amended by adding at the end the 
following:

``SEC. 375. FAMILY CAREGIVER TRAINING.

    ``(a) Development of Materials.--
            ``(1) In general.--The Assistant Secretary shall, directly 
        or by contract, develop family caregiver training materials, 
        working with an advisory committee, comprised of experts on 
        matters related to family caregivers, including researchers, 
        representatives of nursing homes and State Long-Term Care 
        Ombudsman programs, representatives of community colleges and 
        vocational schools, and representatives of organizations for 
        family caregivers. The materials shall be suitable to provide 
        online training for family caregivers, and grandparents or 
        older individuals who are relative caregivers, in providing 
        personal care to care recipients.
            ``(2) Content.--The materials shall include written 
        materials and videos, designed to be easily downloaded, that 
        demonstrate techniques for key personal care activities. The 
        materials shall demonstrate ways of safely lifting and 
        transferring individuals with disabilities, means of preventing 
        falls, and other means of providing assistance with activities 
        of daily living, and instrumental activities of daily living 
        such as medication management. The materials shall provide 
        information on behavioral management and communication 
        techniques for care recipients that are individuals with 
        Alzheimer's disease or a related disorder with neurological and 
        organic brain dysfunction.
    ``(b) Distribution of Materials.--The Assistant Secretary shall 
make the training described in subsection (a)(1) available online, free 
of cost to users.
    ``(c) Definitions.--In this section:
            ``(1) Care recipient.--The term `care recipient'--
                    ``(A) used with respect to a family caregiver, 
                means an older individual or an individual with 
                Alzheimer's disease or a related disorder with 
                neurological and organic brain dysfunction; and
                    ``(B) used with respect to a grandparent or older 
                individual who is a relative caregiver, means an 
                individual with a disability.
            ``(2) Community college.--The term `community college' 
        means an institution of higher education (as defined in section 
        101(a) of the Higher Education Act of 1965 (20 U.S.C. 1001(a))) 
        that offers a 2-year program of study.
            ``(3) Individual with a disability.--The term `individual 
        with a disability' means an individual with a disability, 
        within the meaning of section 372(a)(1).
            ``(4) Vocational school.--The term `vocational school' 
        means an area career and technical education school, as defined 
        in section 3 of the Carl D. Perkins Career and Technical 
        Education Act of 2006 (20 U.S.C. 2302).''.
    (b) Authorization of Appropriations.--Section 303(e) of the Older 
Americans Act of 1965 (42 U.S.C. 3023(e)) is amended--
            (1) in paragraph (2), by inserting ``, other than section 
        375'' after ``part E''; and
            (2) by adding at the end the following:
    ``(4) There is authorized to be appropriated to carry out section 
375, $5,000,000 for the period of fiscal years 2010 through 2012.''.

SEC. 302. REDESIGNATIONS IN PROVISIONS FOR MULTIGENERATIONAL AND CIVIC 
              ENGAGEMENT ACTIVITIES.

    (a) Redesignations.--Section 417 of the Older Americans Act of 1965 
is amended--
            (1) in subsection (a)--
                    (A) in paragraph (1), by redesignating 
                subparagraphs (A) and (B) as clauses (i) and (ii), 
                respectively, and indenting accordingly;
                    (B) by redesignating paragraphs (1) and (2) as 
                subparagraphs (A) and (B), respectively, and indenting 
                accordingly; and
                    (C) by inserting all that precedes ``The Assistant 
                Secretary'' and inserting the following:
    ``(a) Demonstration, Support, and Research Projects.--
            ``(1) Grants and contracts.--'';
            (2) in subsection (b)--
                    (A) by redesignating paragraphs (1) and (2) as 
                subparagraphs (A) and (B), respectively, and indenting 
                accordingly; and
                    (B) by inserting all that precedes ``An eligible'' 
                and inserting the following:
            ``(2) Use of funds.--'';
            (3) in subsection (c)--
                    (A) by redesignating paragraphs (1) through (4) as 
                subparagraphs (A) through (D), respectively, and 
                indenting accordingly; and
                    (B) by striking all that precedes ``In awarding'' 
                and inserting the following:
            ``(3) Preference.--'';
            (4) in subsection (d), by striking all that precedes ``To 
        be'' and inserting the following:
            ``(4) Application.--'';
            (5) in subsection (e)--
                    (A) by redesignating paragraphs (1) and (2) as 
                subparagraphs (A) and (B), respectively, and indenting 
                accordingly; and
                    (B) by inserting all that precedes 
                ``Organizations'' and inserting the following:
            ``(5) Eligible organizations.--'';
            (6) in subsection (f)--
                    (A) in paragraph (1), by redesignating 
                subparagraphs (A), (B), and (C) as clauses (i), (ii), 
                and (iii), respectively, and indenting accordingly;
                    (B) by redesignating paragraphs (1) and (2) as 
                subparagraphs (A) and (B), respectively, and indenting 
                accordingly; and
                    (C) by inserting all that precedes subparagraph (A) 
                (as redesignated by subparagraph (B) of this paragraph) 
                and inserting the following:
            ``(6) Local evaluation and report.--'';
            (7) in subsection (g)--
                    (A) by redesignating paragraphs (1) through (8) as 
                subparagraphs (A) through (H), respectively, and 
                indenting accordingly; and
                    (B) by inserting all that precedes ``Not later'' 
                and inserting the following:
            ``(7) Report to congress.--''; and
            (8) in subsection (h)--
                    (A) in paragraph (2)--
                            (i) in subparagraph (B), by redesignating 
                        clauses (i) and (ii) as subclauses (I) and 
                        (II), respectively, and indenting accordingly; 
                        and
                            (ii) by redesignating subparagraphs (A) and 
                        (B) as clauses (i) and (ii), respectively, and 
                        indenting accordingly;
                    (B) by redesignating paragraphs (1) and (2) as 
                subparagraphs (A) and (B), respectively, and indenting 
                accordingly; and
                    (C) by inserting all that precedes ``As used'' and 
                inserting the following:
            ``(8) Definitions.--''.
    (b) Conforming Amendments.--Section 417 of the Older Americans Act 
of 1965 is amended--
            (1) by striking ``this section'' each place it appears and 
        inserting ``this subsection'';
            (2) by striking ``subsection (a)(1)'' each place it appears 
        and inserting ``paragraph (1)(A)'';
            (3) by striking ``subsection (a)(2)'' each place it appears 
        and inserting ``paragraph (1)(B)'';
            (4) except as provided in paragraphs (2) and (3), by 
        striking ``subsection (a)'' each place it appears and inserting 
        ``paragraph (1)''; and
            (5) in subsection (a) (as redesignated by subsection (a) of 
        this section)--
                    (A) in paragraph (2)(B), by striking ``subsection 
                (f)'' and inserting ``paragraph (6)''; and
                    (B) in paragraph (7)--
                            (i) in the matter preceding subparagraph 
                        (A), by striking ``subsection (f)(2)'' and 
                        inserting ``paragraph (6)(B)''; and
                            (ii) in subparagraph (G), by striking 
                        ``paragraph (1)'' and inserting ``subparagraph 
                        (A)''.

SEC. 303. NATIONAL RESOURCE CENTER ON VOLUNTEERS, STUDENTS, AND 
              SENIORS.

    Section 417 of the Older Americans Act of 1965 (42 U.S.C. 3032f), 
as amended by section 302, is further amended by adding at the end the 
following:
    ``(b) National Resource Center on Volunteers, Students, and 
Seniors.--
            ``(1) In general.--
                    ``(A) Grant.--The Assistant Secretary shall award a 
                grant for the establishment and operation of a National 
                Resource Center on Volunteers, Students, and Seniors 
                (referred to in this subsection as the `Center'). The 
                Center shall promote partnerships between entities in 
                the aging network, and institutions of higher education 
                and secondary schools, in order to expand the capacity 
                of individuals to serve in, and in order to attract new 
                leaders for and professionals into, the aging network.
                    ``(B) Partnerships.--Such partnerships may 
                involve--
                            ``(i) State agencies, area agencies on 
                        aging, or other local government agencies, 
                        Aging and Disability Resource Centers, tribal 
                        organizations, nonprofit health or social 
                        service organizations, community clinics, adult 
                        day care centers, senior housing providers, and 
                        other providers that provide direct services to 
                        older individuals and that are determined to be 
                        appropriate by the Assistant Secretary; and
                            ``(ii) local institutions of higher 
                        education and secondary schools.
            ``(2) Center.--The Center shall use the funds made 
        available through the grant to--
                    ``(A) identify and disseminate information 
                (including information about best practices) concerning 
                how entities described in paragraph (1)(B) can 
                establish partnerships in a manner that provides 
                volunteers and students in nursing, social work, 
                gerontology, psychology, dental hygiene, music and 
                recreational therapy, nutrition, and other disciplines 
                identified by the Assistant Secretary with 
                opportunities, approved by the Assistant Secretary, to 
                gain experience working with older individuals, 
                including older individuals with dementia or cognitive 
                impairment, receiving services under this Act;
                    ``(B) develop and implement a model demonstration 
                grant program to--
                            ``(i) promote new partnerships between the 
                        entities described in paragraph (1)(B) and 
                        incorporate activities of the partnerships into 
                        established curricula of institutions of higher 
                        education and secondary schools; and
                            ``(ii) promote and sponsor internship 
                        programs, career development seminars, and 
                        continuing education and lifelong learning 
                        programs; and
                    ``(C) develop and implement a model career ladder 
                program that will disseminate information on best 
                practices designed to enable mid-level professionals to 
                advance in the field of aging.
            ``(3) Definition.--In this subsection, the term `secondary 
        school' has the meaning given the term in section 9101 of the 
        Elementary and Secondary Education Act of 1965 (20 U.S.C. 
        8801).
            ``(4) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection $3,000,000 for 
        fiscal year 2010, $3,500,000 for fiscal year 2011, and 
        $4,000,000 for fiscal year 2012.''.

            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.

    (a) Establishment.--
            (1) In general.--The Secretary shall establish a 
        demonstration program (in this section referred to as the 
        ``program'') to make grants to participating States to develop 
        core training competencies for eligible personal or home care 
        aides and additional training content for nurse aides and home 
        health aides to supplement training for nurse aides and home 
        health aides that is required under Federal law or regulation, 
        and to evaluate the effectiveness of such competencies and 
        additional training content. Such program shall evaluate the 
        efficacy of--
                    (A) the core training competencies developed under 
                subsection (b)(2)(A);
                    (B) the additional training content developed under 
                subsection (b)(2)(B); and
                    (C) the method of implementation of such core 
                training competencies and additional training content 
                against a ``control'' group being trained under a 
                participating State's existing training protocols.
            (2) Duration.--The program shall be conducted for not less 
        than 4 years.
    (b) Establishment of Expert Panel.--
            (1) In general.--Not later than 120 days after the date of 
        enactment of this Act, the Secretary shall establish a panel of 
        long-term care workforce experts (in this section referred to 
        as the ``expert panel'').
            (2) Duties.--The expert panel shall carry out the following 
        duties:
                    (A)(i) Subject to clause (ii), developing core 
                training competencies for personal or home care aides, 
                including such competencies with respect to the 
                following areas:
                            (I) The role of the personal or home care 
                        aide (including differences between a personal 
                        or home care aide employed by an agency and a 
                        personal or home care aide employed directly by 
                        the health care consumer or an independent 
                        provider).
                            (II) Consumer rights, ethics, and 
                        confidentiality (including the role of proxy 
                        decision-makers in the case where a health care 
                        consumer has impaired decision-making 
                        capacity).
                            (III) Communication, cultural competence 
                        and sensitivity, problem solving, behavior 
                        management, and relationship skills.
                            (IV) Personal care skills.
                            (V) Health care support.
                            (VI) Nutritional support.
                            (VII) Infection control.
                            (VIII) Safety and emergency training.
                            (IX) Training specific to an individual 
                        consumer's needs (including older individuals, 
                        younger individuals with disabilities, 
                        individuals with developmental disabilities, 
                        individuals with dementia, and individuals with 
                        mental health needs).
                            (X) Self-Care.
                    (ii) For purposes of the program, the core training 
                competencies developed under clause (i) shall only 
                apply with respect to newly hired personal or home care 
                aides.
                    (B)(i) Subject to clause (ii), developing 
                additional training content for home health aides and 
                nurse aides which is not required under Federal law as 
                of the date of enactment of this Act, including such 
                content with respect to the following areas:
                            (I) Culturally competent practice.
                            (II) Standardized direct care worker 
                        communication protocols (such as Situation, 
                        Background, Assessment, and Recommendation 
                        communication tools).
                            (III) Palliative and end-of-life care.
                            (IV) Injury prevention.
                            (V) Wound and decubitus care.
                            (VI) Medication management.
                            (VII) Additional aspects of dementia care 
                        training (such as understanding dementia and 
                        Alzheimer's disease, dealing with challenging 
                        behavior, developing communication skills, 
                        working with family caregivers, and ensuring 
                        physical health and safety).
                            (VIII) Prevention and reporting of abuse.
                    (ii) For purposes of the program, the additional 
                training content developed under clause (i) shall only 
                apply with respect to newly hired home health aides and 
                nurse aides.
                    (C)(i) Subject to clause (ii), making 
                recommendations regarding how training shall be 
                provided under the program, including recommendations 
                with respect to the following:
                            (I) The length of the training.
                            (II) The appropriate trainer to student 
                        ratio.
                            (III) The amount of instruction time spent 
                        in the classroom as compared to on-site in the 
                        home or a facility.
                            (IV) Trainer qualifications.
                            (V) Content for a ``hands-on'' and written 
                        certification exam.
                            (VI) Continuing education requirements.
                            (VII) Ways to integrate the core training 
                        competencies developed for personal and home 
                        care aides under subparagraph (A) with the 
                        additional training content developed for home 
                        health aides and nurse aides under subparagraph 
                        (B).
                    (ii) The recommendations under clause (i) shall 
                ensure that the number of hours of training provided 
                under the program are not less than the number of hours 
                of training required under any applicable State or 
                Federal law or regulation.
            (3) Membership.--
                    (A) In general.--Subject to subparagraph (B), the 
                expert panel shall be composed of 11 members appointed 
                by the Secretary from among leading experts in the 
                long-term care field, including representatives of--
                            (i) personal or home care agencies;
                            (ii) home health care agencies;
                            (iii) nursing homes and residential care 
                        facilities;
                            (iv) the disability community (including 
                        the mental retardation and developmental 
                        disability communities);
                            (v) the nursing community;
                            (vi) national advocacy organizations and 
                        unions that represent direct care workers;
                            (vii) older individuals and family 
                        caregivers;
                            (viii) State Medicaid waiver program 
                        officials;
                            (ix) curriculum developers with expertise 
                        in adult learning; and
                            (x) researchers on direct care workers and 
                        the long-term care workforce.
                    (B) Inclusion of representatives of certain 
                individuals.--Not less than 2 of the 11 members 
                appointed by the Secretary under subparagraph (A) shall 
                represent the interests of individuals who rely on 
                long-term care services, including the interests of 
                those individuals described in clause (vii) of such 
                subparagraph.
            (4) Report.--Not later than 1 year after the date of 
        enactment of this Act, the expert panel shall submit to the 
        Secretary a report containing--
                    (A) the core training competencies developed under 
                paragraph (2)(A);
                    (B) the additional training content developed under 
                paragraph (2)(B);
                    (C) any recommendations of the expert panel under 
                paragraph (2)(C); and
                    (D) recommendations for such legislation or 
                administrative action as the expert panel determines 
                appropriate.
            (5) Termination.--The expert panel shall terminate 180 days 
        after it submits the report under paragraph (4).
    (c) Application and Selection Criteria.--
            (1) In general.--
                    (A) Solicitation.--Not later than 2 years after the 
                date of enactment of this Act, the Secretary shall 
                issue a proposal soliciting States to voluntarily 
                participate in the program.
                    (B) Agreements.--The Secretary shall enter into 
                agreements with not more than 4 States to conduct the 
                program in such States.
                    (C) Requirements for states.--An agreement entered 
                into under subparagraph (B) shall require that a 
                participating State--
                            (i) use grant funds made available to the 
                        State under the program to recruit eligible 
                        health and long-term care providers to--
                                    (I) participate in the program; and
                                    (II) implement the core training 
                                competencies developed under subsection 
                                (b)(2)(A) and the additional training 
                                content developed under subsection 
                                (b)(2)(B); and
                            (ii) develop written materials and 
                        protocols for such core training competencies 
                        and such additional training content, including 
                        the development of a certification test for 
                        personal or home care aides who have completed 
                        such training competencies and, if applicable, 
                        additional training content.
                    (D) Consultation and collaboration with community 
                and vocational colleges.--The Secretary shall encourage 
                participating States to consult with community and 
                vocational colleges regarding the development of 
                curricula to implement the program, which may include 
                consideration of such colleges as partners in such 
                implementation.
            (2) Application and eligibility.--A State seeking to 
        participate in the program shall--
                    (A) submit an application to the Secretary 
                containing such information and at such time as the 
                Secretary may specify;
                    (B) meet the selection criteria established under 
                paragraph (3); and
                    (C) meet such additional criteria as the Secretary 
                may specify.
            (3) Selection criteria.--In selecting States to participate 
        in the program, the Secretary shall establish criteria to 
        ensure--
                    (A) geographic and demographic diversity;
                    (B) that participating States offer medical 
                assistance for personal care services under the State 
                Medicaid plan;
                    (C) that the existing training standards for 
                personal or home care aides, home health aides, and 
                nurse aides in each participating State--
                            (i) are different from such standards in 
                        the other participating States; and
                            (ii) are different from the core training 
                        competencies developed under subsection 
                        (b)(2)(A) and the additional training content 
                        developed under subsection (b)(2)(B);
                    (D) that participating States do not reduce the 
                number of hours of training required under applicable 
                State law or regulation after being selected to 
                participate in the program; and
                    (E) that States recruit a minimum number of 
                eligible health and long-term care providers to 
                participate in the program.
            (4) Technical assistance.--The Secretary shall provide 
        technical assistance to States in developing written materials 
        and protocols for such core training competencies and such 
        additional training content under paragraph (1)(C)(ii).
    (d) Evaluation and Report.--
            (1) Evaluation.--The Secretary shall develop an 
        experimental or control group testing protocol in consultation 
        with an independent evaluation contractor selected by the 
        Secretary. Such contractor shall evaluate--
                    (A) the impact of core training competencies 
                developed under subsection (b)(2)(A), including 
                curricula developed to implement such core training 
                competencies, for personal or home care aides within 
                each participating State on job satisfaction, mastery 
                of job skills, beneficiary and caregiver satisfaction 
                with services, and additional measures determined by 
                the Secretary in consultation with the expert panel 
                established under subsection (b);
                    (B) the impact of incorporating the additional 
                training content developed under subsection (b)(2)(B) 
                into existing training standards for home health aides 
                and certified nurse aides within each participating 
                State;
                    (C) the impact of providing such core training 
                competencies and additional training content on the 
                existing training infrastructure and resources of 
                States;
                    (D) whether the minimum number of hours of initial 
                training required for nurse aides under sections 
                1819(f)(2)(A)(i)(II) and 1919(f)(2)(A)(i)(II) of the 
                Social Security Act (42 U.S.C. 1395i-3(f)(2)(A)(i)(II); 
                1396r(f)(2)(A)(i)(II)) should be increased; and
                    (E) whether a minimum number of hours of initial 
                training should be required for personal or home care 
                aides and, if so, what minimum number of hours should 
                be required.
            (2) Report.--Not later than 1 year after the completion of 
        the program, the Secretary shall submit to Congress a report 
        containing the results of the evaluations conducted under 
        paragraph (1), together with such recommendations for 
        legislation or administrative action as the Secretary 
        determines appropriate.
    (e) Funding.--Out of any funds in the Treasury not otherwise 
appropriated, there are appropriated to the Secretary to carry out the 
program under this section for the period of fiscal years 2010 through 
2015, $14,000,000.
    (f) Definitions.--In this section:
            (1) Eligible health and long-term care provider.--The term 
        ``eligible health and long-term care provider'' means a 
        personal or home care agency (including personal or home care 
        public authorities), a nursing home, a home health agency (as 
        defined in section 1861(o)) of the Social Security Act (42 
        U.S.C. 1395x(o)), or any other health care provider the 
        Secretary determines appropriate which--
                    (A) is licensed or authorized to provide services 
                in a participating State; and
                    (B) receives payment for services under title XVIII 
                or XIX of the Social Security Act.
            (2) Home health aide.--The term ``home health aide'' has 
        the meaning given such term in section 1891(a)(3)(E) of the 
        Social Security Act (42 U.S.C. 1395bbb(a)(3)(E)).
            (3) Nurse aide.--The term ``nurse aide'' has the meaning 
        given such term in section 1819(b)(5)(F) of the Social Security 
        Act (42 U.S.C. 1395i-3(b)(5)(F)).
            (4) Personal care services.--The term ``personal care 
        services'' has the meaning given such term for purposes of 
        title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).
            (5) Personal or home care aide.--The term ``personal or 
        home care aide'' means an individual who helps individuals who 
        are elderly, disabled, ill, or mentally disabled (including an 
        individual with Alzheimer's disease or other dementia) to live 
        in their own home or a residential care facility (such as a 
        nursing home, assisted living facility, or any other facility 
        the Secretary determines appropriate) by providing routine 
        personal care services and other appropriate services to the 
        individual.
            (6) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.

SEC. 402. MEDICARE FAMILY CAREGIVER INFORMATION AND REFERRAL.

    State health insurance assistance programs, the Administrator of 
the Centers for Medicare & Medicaid Services, and the Assistant 
Secretary of the Administration on Aging shall, in collaboration with 
each other, directly or by contract, develop practical, easy-to-
understand information and referral protocols for health care 
providers, social workers, and other appropriate individuals to provide 
to family caregivers of Medicare beneficiaries either on admission to 
or discharge from a hospital or a post-acute care setting (including a 
skilled nursing facility (as defined in section 1819(a) of the Social 
Security Act (42 U.S.C. 1395i-3(a)), a comprehensive rehabilitation 
facility (as defined in section 1861(cc)(2) of such Act (42 U.S.C. 
1395x(cc)(2)) or a rehabilitation agency, a provider of long-term care 
services, and a home health agency (as defined in section 1861(o) of 
such Act (42 U.S.C. 1395x(o)). Information developed under the 
preceding sentence shall--
            (1) include information on national, State, and community-
        based resources for seniors, individuals with disabilities and 
        their caregivers, which shall be updated on a semi-annual basis 
        (or as frequently as practicable);
            (2) be disseminated by health care providers, social 
        workers, and other appropriate individuals as printed materials 
        (including materials in Spanish and other languages (other than 
        English) as appropriate); and
            (3) be made available on the Internet websites of State 
        health insurance assistance programs, the Centers for Medicare 
        & Medicaid Services, and the Administration on Aging.

SEC. 403. MEDICAID ASSESSMENT OF FAMILY CAREGIVER SUPPORT NEEDS.

    (a) In General.--Section 1915 of the Social Security Act (42 U.S.C. 
1396n) is amended--
            (1) in subsection (c)(2)--
                    (A) in subparagraph (D), by striking ``and'' at the 
                end;
                    (B) in subparagraph (E), by striking the period at 
                the end and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(F) under such waiver the State may provide for 
                an assessment of family caregiver support needs (in 
                accordance with subsection (k)).'';
            (2) in subsection (d)(2)--
                    (A) in subparagraph (B), by striking ``and'' at the 
                end;
                    (B) in subparagraph (C), by striking the period at 
                the end and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(D) under such waiver the State may provide for 
                an assessment of family caregiver support needs (in 
                accordance with subsection (k)).'';
            (3) in subsection (i)(1)(F), by adding at the end the 
        following new clause:
                            ``(vii) Where appropriate, an assessment of 
                        family caregiver support needs (in accordance 
                        with subsection (k)).''; and
            (4) by adding at the end the following new subsection:
    ``(k) Assessment of Family Caregiver Support Needs.--
            ``(1) In general.--In the case of an individual who is 
        determined to be eligible for home and community-based services 
        under a waiver under subsection (c) or (d) or under section 
        1115, under a State plan amendment under subsection (i), under 
        an MFP demonstration project established under section 6071 of 
        the Deficit Reduction Act of 2005, or as part of self-directed 
        personal assistance services provided pursuant to a written 
        plan of care in accordance with the requirements of subsection 
        (j), and who is dependent upon the assistance of a family 
        caregiver, the State may provide for an assessment of the 
        family caregiver support needs of the individual. Such 
        assessment shall, to the extent feasible, be conducted at the 
        same time as, or closely coordinated with, the determination of 
        the eligibility of the individual for such services.
            ``(2) Questionnaire.--
                    ``(A) In general.--Such assessment shall include 
                asking the family caregiver of the individual questions 
                in order to determine whether they would benefit from 
                targeted support services (such as those services 
                described in paragraph (3)).
                    ``(B) Completion on a voluntary basis.--The 
                answering of questions under subparagraph (A) by a 
                family caregiver shall be on a voluntary basis.
            ``(3) Targeted support services described.--The following 
        targeted support services are described in this paragraph:
                    ``(A) Respite care and emergency back-up services 
                (including short-term help for the individual that 
                gives the family caregiver a break from providing such 
                care).
                    ``(B) Individual counseling (including advice and 
                consultation sessions to bolster emotional support for 
                the family caregiver to make well-informed decisions 
                about how to cope with the strain of supporting the 
                individual).
                    ``(C) Support groups, including groups which 
                provide help for family caregivers to--
                            ``(i) locate a support group either locally 
                        or online to share experiences and reduce 
                        isolation;
                            ``(ii) make well-informed decisions about 
                        caring for the individual; and
                            ``(iii) reduce isolation.
                    ``(D) Information and assistance (including 
                brochures and online resources for researching a 
                disease or disability or learning and managing a 
                regular caregiving role, new technologies that can 
                assist family caregivers, and practical assistance for 
                locating services).
                    ``(E) Chore services (such as house cleaning).
                    ``(F) Personal care (including outside help).
                    ``(G) Education and training (including workshops 
                and other resources available with information about 
                stress management, self-care to maintain good health, 
                understanding and communicating with individuals with 
                dementia, medication management, normal aging 
                processes, change in disease and disability, the role 
                of assistive technologies, and other relevant topics).
                    ``(H) Legal and financial planning and consultation 
                (including advice and counseling regarding long-term 
                care planning, estate planning, powers of attorney, 
                community property laws, tax advice, employment leave 
                advice, advance directives, and end-of-life care).
                    ``(I) Transportation (including transportation to 
                medical appointments).
                    ``(J) Other targeted support services the Secretary 
                or the State determines appropriate.
            ``(4) Referrals.--In the case where a questionnaire 
        completed by a family caregiver under paragraph (2) indicates 
        that the family caregiver would benefit from 1 or more of the 
        targeted support services described in paragraph (3), the State 
        shall provide referrals to the family caregiver for local, 
        State, and private-sector family caregiver programs and other 
        resources that provide such targeted support services.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to medical assistance for home and community-based services that 
is provided on or after the date of enactment of this Act.

                      TITLE V--STUDIES AND REPORTS

SEC. 501. STUDIES AND REPORTS.

    (a) IOM Study and Report on Mental Health Workforce Needs.--
            (1) Study.--Not later than 90 days after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services shall enter into a contract with the Institute of 
        Medicine of the National Academies (in this section referred to 
        as the ``Institute'') under which the Institute shall conduct a 
        study on the specific policy, workforce, economic, and 
        implementation issues relevant to the mental health workforce 
        that need to be addressed to meet the current needs of older 
        individuals and the future needs of the aging boomer 
        generation.
            (2) Report.--Not later than 24 months after the effective 
        date of the contract under paragraph (1), the Institute, as 
        part of such contract, shall submit a report to the Secretary 
        of Health and Human Services and the appropriate committees of 
        jurisdiction of Congress containing the results of the study 
        conducted under paragraph (1), together with recommendations 
        for such legislation and administrative action as the Institute 
        determines appropriate.
            (3) Authorization.--There is authorized to be appropriated 
        to carry out this subsection, $1,200,000 for the period of 
        fiscal years 2010 through 2011.
    (b) GAO Study and Report on the Needs of the Aging Network.--
            (1) Study.--The Comptroller General of the United States 
        (in this section referred to as the ``Comptroller General'') 
        shall conduct a study on the aging network, focusing on State 
        agencies and area agencies on aging (as defined in section 102 
        of the Older Americans Act of 1965 (42 U.S.C. 3002)) to 
        determine the current capacity of such network and to identify 
        challenges in providing services to older adults, including 
        older adults who are low-income and older adults with 
        functional disabilities, during the 10-year period beginning on 
        the date of enactment of this Act.
            (2) Report.--Not later than 18 months after the date of 
        enactment of this Act, the Comptroller General shall submit to 
        Congress a report containing the results of the study conducted 
        under paragraph (1), together with recommendations--
                    (A) on the workforce supply and capitol resources 
                needed by the aging network in order to meet the demand 
                for services by older adults during such 10-year 
                period; and
                    (B) for such legislation and administrative action 
                as the Comptroller General determines appropriate.
    (c) GAO Study and Report on the Direct Case Workforce in Long-Term 
Care Settings.--
            (1) Study.--The Comptroller General shall conduct a study 
        on the use of practices to reduce turnover and improve 
        retention and tenure of nurse aides and home health aides in 
        nursing homes, assisted living facilities, and home health 
        agencies (as defined in section 1861(o) of the Social Security 
        Act (42 U.S.C. 1395x(o)). Such study shall include an analysis 
        of the reasons for the success of such practices and how such 
        practices could be replicated in other facilities.
            (2) Report.--Not later than 18 months after the date of 
        enactment of this Act, the Comptroller General shall submit to 
        Congress a report containing the results of the study conducted 
        under paragraph (1), together with recommendations for such 
        legislation and administrative action as the Comptroller 
        General determines appropriate.
            (3) Definitions.--In this subsection:
                    (A) Home health aide.--The term ``home health 
                aide'' has the meaning given such term in section 
                1891(a)(3)(E) of the Social Security Act (42 U.S.C. 
                1395bbb(a)(3)(E)).
                    (B) Nurse aide.--The term ``nurse aide'' has the 
                meaning given such term in section 1819(b)(5)(F) of the 
                Social Security Act (42 U.S.C. 1395i-3(b)(5)(F)).
    (d) GAO Study and Report on NIH Spending and Grants.--
            (1) Study.--The Comptroller General shall conduct a study 
        on spending by the National Institutes of Health, including the 
        number of grants made by the National Institutes of Health, on 
        conditions and illnesses that disproportionately impact the 
        health of older individuals. Such study shall include an 
        analysis of the number of older individuals which are included 
        in clinical trials supported by the National Institutes of 
        Health.
            (2) Report.--Not later than 18 months after the date of 
        enactment of this Act, the Comptroller General shall submit to 
        Congress a report containing the results of the study conducted 
        under paragraph (1), together with recommendations for such 
        legislation and administrative action as the Comptroller 
        General determines appropriate.
                                 <all>
```