II 

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. 

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 2008’’. 

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. 


jbell on PROD1PC69 with BILLS
2 

•S 3730 IS

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. 


jbell on PROD1PC69 with BILLS
3 

•S 3730 IS

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 


jbell on PROD1PC69 with BILLS
4 

•S 3730 IS

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) The Bureau of Labor Statistics of the De20 partment of Labor predicts that personal or home 

21 care aides and home health aides will represent the 

22 second and third fastest-growing occupations be23 tween 2006 and 2016. Yet personal or home care 

24 aides are not subject to any Federal requirements 

25 related to training or education, and States have 


jbell on PROD1PC69 with BILLS
5 

•S 3730 IS

1 very different requirements for personal or home 

2 care aides. 

3 (10) Research shows that inadequate training is 

4 a major contributor to high turnover rates among 

5 direct care workers and more training is correlated 

6 with better staff recruitment and retention rates. 

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

8 are being asked to provide increasingly complex 

9 medical services to frail and elderly loved ones wish10 ing to live at home. Multiple surveys have docu11 mented that basic training and access to other tar12 geted services are necessary for family caregivers to 

13 provide consistent quality care on an ongoing basis. 

14 TITLE I—AMENDMENTS TO THE 

15 PUBLIC HEALTH SERVICE ACT 

16 Subtitle A—Health Professions 

17 Education Related to Geriatrics 

18 SEC. 101. GERIATRIC EDUCATION CENTERS. 

19 Section 753 of the Public Health Service Act (42 

20 U.S.C. 294) is amended by adding at the end the fol21 lowing: 

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

23 EDUCATION CENTERS.— 

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

25 grants or contracts under this subsection to entities 


jbell on PROD1PC69 with BILLS
6 

•S 3730 IS

1 that operate a geriatric education center pursuant to 

2 subsection (a)(1). 

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

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

5 such paragraph shall submit to the Secretary an ap6 plication at such time, in such manner, and con7 taining such information as the Secretary may re8 quire. 

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

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

11 used to— 

12 ‘‘(A) carry out the fellowship program de13 scribed in paragraph (4); and 

14 ‘‘(B) carry out 2 of the 3 activities de15 scribed in paragraph (5). 

16 ‘‘(4) FELLOWSHIP PROGRAM.— 

17 ‘‘(A) IN GENERAL.—Pursuant to para18 graph (3), a geriatric education center that re19 ceives an award under this subsection shall use 

20 such funds to offer short-term intensive courses 

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

22 that focus on geriatrics, chronic care manage23 ment, and long-term care that provide supple24 mental training for faculty members in medical 

25 schools and other health professions schools 


jbell on PROD1PC69 with BILLS
7 

•S 3730 IS

1 with programs in psychology, nursing, social 

2 work, dentistry, public health, or other health 

3 disciplines, as approved by the Secretary. Such 

4 a fellowship shall be open to current faculty, 

5 and appropriately credentialed volunteer faculty 

6 and practitioners, who do not have formal 

7 training in geriatrics, to upgrade their knowl8 edge and clinical skills for the care of older 

9 adults and adults with functional limitations 

10 and to enhance their interdisciplinary teaching 

11 skills. 

12 ‘‘(B) LOCATION.—A fellowship shall be of13 fered either at the geriatric education center 

14 that is sponsoring the course, in collaboration 

15 with other geriatric education centers, or at 

16 medical schools, schools of nursing, schools of 

17 social work, or other health professions schools 

18 approved by the Secretary with which the geri19 atric education centers are affiliated. 

20 ‘‘(C) CME CREDIT.—Participation in a fel21 lowship under this paragraph shall be accepted 

22 with respect to complying with continuing med23 ical education requirements. As a condition of 

24 such acceptance, the recipient shall agree to 

25 subsequently provide a minimum of 18 hours of 


jbell on PROD1PC69 with BILLS
8 

•S 3730 IS

1 voluntary instructional support through a geri2 atric education center that is providing clinical 

3 training to students or trainees in long-term 

4 care settings. 

5 ‘‘(5) ADDITIONAL REQUIRED ACTIVITIES DE6 SCRIBED.—Pursuant to paragraph (3), a geriatric 

7 education center that receives an award under this 

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

9 3 activities: 

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

11 geriatric education center that receives an 

12 award under this subsection shall offer at least 

13 2 courses each year, at no charge or nominal 

14 cost, to family caregivers that are designed to 

15 provide practical training for supporting frail 

16 elders and individuals with disabilities. The Sec17 retary shall require such Centers to work with 

18 appropriate community partners and family 

19 caregiver organizations to publicize the avail20 ability of training courses in their service areas. 

21 All family caregiver training programs shall in22 clude instruction on the management of psycho23 logical and behavioral aspects of dementia, and 

24 communication techniques for working with in25 dividuals who have dementia. 


jbell on PROD1PC69 with BILLS
9 

•S 3730 IS

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

2 A geriatric education center that receives an 

3 award under this subsection shall offer at least 

4 2 courses each year to certified nurse aides, 

5 home health aides, personal or home care aides 

6 and other types of direct care workers on ‘best 

7 practices’ for working with frail elders and indi8 viduals with disabilities, including individuals 

9 with dementia, urinary incontinence, and prob10 lems with balance or mobility. 

11 ‘‘(C) INCORPORATION OF BEST PRAC12 TICES.—A geriatric education center that re13 ceives an award under this subsection shall de14 velop and include material on depression and 

15 other mental health disorders common among 

16 older adults, and management of the psycho17 logical and behavioral aspects of dementia and 

18 communication techniques with individuals who 

19 have dementia in all training courses, where ap20 propriate. 

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

22 that receives an award under this subsection shall 

23 meet targets approved by the Secretary for providing 

24 geriatric training to a certain number of faculty or 

25 practitioners during the term of the grant, as well 


jbell on PROD1PC69 with BILLS
10 

•S 3730 IS

1 as other parameters established by the Secretary, in2 cluding guidelines for the content of the fellowships. 

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

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

5 Not more than 24 geriatric education centers may 

6 receive an award under this subsection. 

7 ‘‘(8) AUTHORIZATION OF APPROPRIATIONS.—In 

8 addition to any other funding available to carry out 

9 this section, there is authorized to be appropriated 

10 to carry out this subsection, $10,800,000 for the pe11 riod of fiscal year 2010 through 2012.’’. 

12 SEC. 102. IMPROVING GERIATRIC TRAINING FOR PHYSI13 CIANS, DENTISTS, AND BEHAVIOR AND MEN14 TAL HEALTH PROFESSIONALS. 

15 Section 753 of the Public Health Service Act (42 

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

17 adding at the end the following: 

18 ‘‘(e) GERIATRIC TRAINING FOR PHYSICIANS, DEN19 TISTS, AND BEHAVIOR AND MENTAL HEALTH PROFES20 SIONALS.—An accredited school of medicine or osteopathic 

21 medicine, a teaching hospital, or a graduate medical edu22 cation program that receives an award under subsection 

23 (c) may use the funds under such award to carry out a 

24 program to train individuals for either 1 year, 2 years, 

25 or both, who are seeking a certificate of added qualificaVerDate Aug 31 2005 02:47 Dec 11, 2008 Jkt 079200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S3730.IS S3730

jbell on PROD1PC69 with BILLS
11 

•S 3730 IS

1 tion or specialization in geriatrics for either 1 year, 2 

2 years, or both. Such a program may be located in a med3 ical school that offers programs in 2 of the 3 disciplines 

4 described in subsection (c)(5). Such program may fund 

5 the training of doctorally-prepared clinical psychologists, 

6 psychiatric nurse practitioners, and clinical social workers 

7 as part of the behavior and mental health training pro8 grams.’’. 

9 SEC. 103. GERIATRIC ACADEMIC CAREER AWARDS. 

10 (a) EXPANSION OF ELIGIBILITY FOR GERIATRIC

11 ACADEMIC CAREER AWARDS; PAYMENT TO INSTITU12 TION.—Section 753(c) of the Public Health Service Act 

13 (42 U.S.C. 294(c)) is amended— 

14 (1) by striking paragraph (2) through para15 graph (3) and inserting the following: 

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

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

18 shall— 

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

20 internal medicine, family practice, or psychiatry 

21 or have completed any required training in a 

22 discipline and employed in an accredited health 

23 professions school that is approved by the Sec24 retary, including dentistry, pharmacy, nursing, 

25 social work, and psychology; 


jbell on PROD1PC69 with BILLS
12 

•S 3730 IS

1 ‘‘(B) have completed an approved fellow2 ship program in geriatrics; and 

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

4 appointment at an accredited (as determined by 

5 the Secretary) school of medicine, osteopathic 

6 medicine, nursing, social work, psychology, den7 tistry, pharmacy, or other allied health dis8 ciplines in an accredited health professions 

9 school that is approved by the Secretary. 

10 ‘‘(3) LIMITATIONS.—No Award under para11 graph (1) may be made to an eligible individual un12 less the individual— 

13 ‘‘(A) has submitted to the Secretary an ap14 plication, at such time, in such manner, and 

15 containing such information as the Secretary 

16 may require, and the Secretary has approved 

17 such application; 

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

19 the Secretary may require, assurances that the 

20 individual will meet the service requirement de21 scribed in paragraph (5); and 

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

23 the Secretary may require, assurances that the 

24 individual has a full-time faculty appointment 

25 in a health professions institution and docuVerDate Aug 31 2005 02:47 Dec 11, 2008 Jkt 079200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S3730.IS S3730

jbell on PROD1PC69 with BILLS
13 

•S 3730 IS

1 mented commitment from such institution to 

2 spend 75 percent of the total time of such indi3 vidual on teaching and developing skills in 

4 interdisciplinary education in geriatrics.’’; and 

5 (2) in paragraph (4)— 

6 (A) in subparagraph (A)— 

7 (i) by inserting ‘‘for individuals who 

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

9 (ii) by inserting after the period at 

10 the end the following: ‘‘The Secretary shall 

11 determine the amount of an Award under 

12 this section for individuals who are not 

13 physicians.’’; and 

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

15 ‘‘(C) PAYMENT TO INSTITUTION.—The 

16 Secretary shall transfer funds awarded to an in17 dividual under this section to the institution 

18 where such individual will carry out the award, 

19 in order to facilitate financial management of 

20 the reward pursuant to guidelines of the Health 

21 Resources and Services Administration.’’. 

22 (b) AUTHORIZATION OF APPROPRIATIONS.—There 

23 are authorized to be appropriated to carry out the amend24 ments made by this section $6,000,000 for each of fiscal 

25 years 2010, 2011, and 2012. 


jbell on PROD1PC69 with BILLS
14 

•S 3730 IS

1 SEC. 104. GERIATRIC CAREER INCENTIVE AWARDS. 

2 Section 753 of the Public Health Service Act (42 

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

4 adding at the end the following: 

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

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

7 grants or contracts under this section to individuals 

8 described in paragraph (2) to foster greater interest 

9 among a variety of health professionals in entering 

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

11 care management. 

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

13 received an award under paragraph (1), an indi14 vidual shall— 

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

16 as a clinical nurse specialist or nurse practi17 tioner), a clinical social worker, or clinical psy18 chologist who has a master’s degree or equiva19 lent graduate degree and is pursuing a doc20 torate or other advanced degree approved by 

21 the Secretary in geriatrics, long-term care, or 

22 chronic care management in an accredited 

23 health professions school that is approved by 

24 the Secretary; and 

25 ‘‘(B) submit to the Secretary an applica26 tion at such time, in such manner, and conVerDate Aug 31 2005 02:47 Dec 11, 2008 Jkt 079200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\S3730.IS S3730

jbell on PROD1PC69 with BILLS
15 

•S 3730 IS

1 taining such information as the Secretary may 

2 require. 

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

4 receiving an award under this subsection, an indi5 vidual shall agree that, following completion of the 

6 award period, the individual will teach or practice in 

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

8 care management for a minimum of 5 years under 

9 guidelines set by the Secretary. 

10 ‘‘(4) AUTHORIZATION OF APPROPRIATIONS.— 

11 There is authorized to be appropriated to carry out 

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

13 years 2010 through 2012.’’. 

14 SEC. 105. NATIONAL CENTER FOR HEALTH WORKFORCE 

15 ANALYSIS. 

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

17 (42 U.S.C. 294n et seq.) is amended by adding at the end 

18 the following: 

19 ‘‘Subpart 3—National Center for Health Workforce 

20 Analysis 

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

22 HEALTH WORKFORCE ANALYSIS. 

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

24 National Center for Health Workforce Analysis of the 

25 Health Resources and Services Administration as of the 


jbell on PROD1PC69 with BILLS
16 

•S 3730 IS

1 day before the date of enactment of the Retooling the 

2 Health Care Workforce for an Aging America Act of 2008, 

3 the head of such Center shall analyze— 

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

5 long-term care workforce demand and supply, and 

6 training and education needs specific to older adults 

7 and adults with functional limitations; and 

8 ‘‘(2) turnover and retention for professionals 

9 and paraprofessionals in these fields, including ad10 ministrators, medical directors and direct care staff 

11 of nursing homes, assisted living facilities and home 

12 and community-based settings, or any other setting 

13 or provider the Secretary determines appropriate. 

14 ‘‘SEC. 775. AUTHORIZATION OF APPROPRIATIONS. 

15 ‘‘There is authorized to be appropriated to the Na16 tional Center for Workforce Analysis to carry out this sub17 part $6,000,000 for the period of fiscal years 2010 

18 through 2012.’’. 

19 Subtitle B—Improved Nursing 

20 Services 

21 SEC. 121. COMPREHENSIVE GERIATRIC EDUCATION NURS22 ING GRANT PROGRAM. 

23 Section 855 of the Public Health Service Act (42 

24 U.S.C. 298) is amended— 

25 (1) in subsection (b)— 


jbell on PROD1PC69 with BILLS
17 

•S 3730 IS

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

2 (B) in paragraph (4), by striking the pe3 riod and inserting ‘‘; or’’; and 

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

5 following: 

6 ‘‘(5) establish Federal traineeships to individ7 uals who are preparing for advanced degrees in geri8 atric nursing, long-term care, and gero-psychiatric 

9 nursing.’’; and 

10 (2) in subsection (e), by inserting before the pe11 riod the following: ‘‘, $12,000,000 for each of fiscal 

12 years 2010 through 2012 to provide assistance 

13 under this section to support additional training for 

14 nurses who care for the elderly and individuals with 

15 disabilities and for the development and dissemina16 tion of curricula relating to geriatric nursing care, 

17 the training of nursing faculty in geriatrics, and the 

18 provision of continuing education for nurses prac19 ticing in geriatrics, and $25,000,000 for each of fis20 cal years 2010 through 2012 to provide assistance 

21 under this section to support the Federal 

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


jbell on PROD1PC69 with BILLS
18 

•S 3730 IS

1 TITLE II—AMENDMENTS TO THE 

2 WORKFORCE INVESTMENT 

3 ACT OF 1998 

4 SEC. 201. CORE SERVICES. 

5 Section 134(d)(2)(E)(iii) of the Workforce Invest6 ment Act of 1998 (29 U.S.C. 2864(d)(2)(E)(iii)) is 

7 amended to read as follows: 

8 ‘‘(iii) information relating to local oc9 cupations in demand, including health care 

10 and long-term care occupations, and the 

11 earnings and skill requirements for such 

12 local occupations;’’. 

13 SEC. 202. INDIVIDUAL TRAINING ACCOUNTS. 

14 Section 134(d)(4)(G)(iii) of the Workforce Invest15 ment Act of 1998 (29 U.S.C. 2864(d)(4)(G)(iii)) is 

16 amended to read as follows: 

17 ‘‘(iii) LINKAGE TO OCCUPATIONS IN

18 DEMAND.—Training services provided 

19 under this paragraph shall be directly 

20 linked to occupations, including health care 

21 and long-term care occupations, that are in 

22 demand in the local area, or in another 

23 area to which an adult or dislocated work24 er receiving such services is willing to relo25 cate, except that a local board may apVerDate Aug 31 2005 02:47 Dec 11, 2008 Jkt 079200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\S3730.IS S3730

jbell on PROD1PC69 with BILLS
19 

•S 3730 IS

1 prove training services for occupations de2 termined by the local board to be in sectors 

3 of the economy that have a high potential 

4 for sustained demand or growth in the 

5 local area. In making determinations of de6 mand or potential demand or growth under 

7 this clause, a local board shall consult local 

8 and State health agencies, employers, and 

9 other organizations that the local board de10 termines to be appropriate.’’. 

11 SEC. 203. COLLABORATION BETWEEN STATE BOARDS AND 

12 THE VETERANS AGENCIES OF THE STATES. 

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

14 1998 (29 U.S.C. 2822(b)) is amended— 

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

16 end; 

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

18 and inserting ‘‘; and’’; and 

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

20 paragraph: 

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

22 collaborate with the veterans agency of the State, in23 cluding entering into a memorandum of under24 standing with the veterans agency of the State speci25 fying— 


jbell on PROD1PC69 with BILLS
20 

•S 3730 IS

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

2 and the veterans agency of the State will pro3 vide information on health care workforce em4 ployment and training opportunities available to 

5 individuals, including veterans who are receiving 

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

7 a one-stop center and are receiving assistance 

8 from the Veterans’ Employment and Training 

9 Service of the Department of Labor; and 

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

11 and the veterans agency of the State will obtain 

12 and provide information to one-stop operators 

13 in the State, for distribution through one-stop 

14 centers, about training, internship, and employ15 ment opportunities in geriatrics, gerontology, 

16 and long-term care, including, as available, op17 portunities at geriatric research, education and 

18 clinical centers operated by the Department of 

19 Veterans Affairs.’’. 

20 SEC. 204. COLLABORATION BETWEEN DEPARTMENT OF 

21 LABOR AND DEPARTMENT OF VETERANS AF22 FAIRS. 

23 The Secretary of Labor, acting through the Assistant 

24 Secretary for Veterans’ Employment and Training, and 

25 the Secretary of Veterans Affairs, shall develop memoVerDate Aug 31 2005 02:47 Dec 11, 2008 Jkt 079200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\S3730.IS S3730

jbell on PROD1PC69 with BILLS
21 

•S 3730 IS

1 randa of understanding outlining how veterans seeking 

2 employment information through the Local Veterans’ Em3 ployment Representative Program and the Transition As4 sistance Program will be provided with information about 

5 training, internship, and employment opportunities in ger6 iatrics, gerontology, and long-term care, including oppor7 tunities at geriatric research, education and clinical cen8 ters operated by the Department of Veterans Affairs. 

9 SEC. 205. TRAINING OPPORTUNITIES FOR DIRECT CARE 

10 WORKERS. 

11 (a) IN GENERAL.—Section 171 of the Workforce In12 vestment Act of 1998 (29 U.S.C. 2916) is amended by 

13 adding at the end the following new subsection: 

14 ‘‘(f) TRAINING OPPORTUNITIES FOR DIRECT CARE

15 WORKERS.— 

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

17 grants to eligible entities to enable such entities to 

18 provide new training opportunities for direct care 

19 workers (including certified nursing assistants, home 

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

21 are employed in long-term care settings such as 

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

23 the Social Security Act (42 U.S.C. 1396g(e)(1)), as24 sisted living facilities, home care settings, and any 


jbell on PROD1PC69 with BILLS
22 

•S 3730 IS

1 other setting the Secretary determines to be appro2 priate. 

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

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

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

6 (as defined in section 102 of the Higher Edu7 cation Act of 1965 (20 U.S.C. 1002)) that— 

8 ‘‘(i) is accredited by a nationally rec9 ognized accrediting agency or association 

10 listed under section 101(c) of the Higher 

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

12 1001(c)); and 

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

14 educational partnership with a nursing 

15 home, home health agency, or other long16 term care provider; and 

17 ‘‘(B) submit to the Secretary an applica18 tion at such time, in such manner, and con19 taining such information as the Secretary may 

20 require. 

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

22 entities, the Secretary shall give priority to entities 

23 that demonstrate that the entities will coordinate ac24 tivities with one-stop operators and one-stop partVerDate Aug 31 2005 02:47 Dec 11, 2008 Jkt 079200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\S3730.IS S3730

jbell on PROD1PC69 with BILLS
23 

•S 3730 IS

1 ners at local one-stop centers referred to in section 

2 134(c). 

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

4 use amounts awarded under a grant under para5 graph (1) to provide assistance to eligible individuals 

6 to offset the cost of tuition and required fees for en7 rollment in academic programs provided by such en8 tity, including— 

9 ‘‘(A) the provision of stipends to such indi10 viduals for a period of not to exceed 2 years; 

11 ‘‘(B) the lowering of fees assessed with re12 spect to eligible individuals who are enrolled in 

13 programs leading to a licensed practical nursing 

14 degree, a registered nursing degree, or any 

15 other advanced nursing degree; and 

16 ‘‘(C) the lowering of fees assessed with re17 spect to eligible individuals who are enrolled in 

18 courses aimed at improving direct care skills for 

19 the treatment of specialized conditions that are 

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

21 wound care, brain trauma, immobility, inconti22 nence, functional impairment, and dementia. 

23 ‘‘(5) ELIGIBLE INDIVIDUAL.— 

24 ‘‘(A) ELIGIBILITY.—To be eligible for as25 sistance under paragraph (4), an individual 


jbell on PROD1PC69 with BILLS
24 

•S 3730 IS

1 shall be enrolled in courses provided by a grant2 ee under this subsection and maintain satisfac3 tory academic progress in such courses. 

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

5 condition of receiving assistance under para6 graph (4), an individual shall agree that, fol7 lowing completion of the assistance period, the 

8 individual will work in the field of geriatrics, 

9 long-term care, or chronic care management for 

10 a minimum of 2 years under guidelines set by 

11 the Secretary. 

12 ‘‘(6) 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 2010 through 2012.’’. 

16 (b) CONFORMING AMENDMENTS.— 

17 (1) Section 174(b)(1) of the Workforce Invest18 ment Act of 1998 (29 U.S.C. 2919(b)(1)) is amend19 ed by inserting ‘‘and except as provided in section 

20 171(f),’’ after ‘‘paragraph (2),’’. 

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

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

23 to read as follows: 

24 ‘‘(ii) except as provided in section 

25 171(f), for each of the fiscal years 2000 


jbell on PROD1PC69 with BILLS
25 

•S 3730 IS

1 through 2003, reserve not less than 45 

2 percent for carrying out section 171;’’. 

3 TITLE III—AMENDMENTS TO 

4 THE OLDER AMERICANS ACT 

5 OF 1965 

6 SEC. 301. FAMILY CAREGIVER TRAINING. 

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

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

9 amended by adding at the end the following: 

10 ‘‘SEC. 375. FAMILY CAREGIVER TRAINING. 

11 ‘‘(a) DEVELOPMENT OF MATERIALS.— 

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

13 shall, directly or by contract, develop family care14 giver training materials, working with an advisory 

15 committee, comprised of experts on matters related 

16 to family caregivers, including researchers, rep17 resentatives of nursing homes and State Long-Term 

18 Care Ombudsman programs, representatives of com19 munity colleges and vocational schools, and rep20 resentatives of organizations for family caregivers. 

21 The materials shall be suitable to provide online 

22 training for family caregivers, and grandparents or 

23 older individuals who are relative caregivers, in pro24 viding personal care to care recipients. 


jbell on PROD1PC69 with BILLS
26 

•S 3730 IS

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

2 written materials and videos, designed to be easily 

3 downloaded, that demonstrate techniques for key 

4 personal care activities. The materials shall dem5 onstrate ways of safely lifting and transferring indi6 viduals with disabilities, means of preventing falls, 

7 and other means of providing assistance with activi8 ties of daily living, and instrumental activities of 

9 daily living such as medication management. The 

10 materials shall provide information on behavioral 

11 management and communication techniques for care 

12 recipients that are individuals with Alzheimer’s dis13 ease or a related disorder with neurological and or14 ganic brain dysfunction. 

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

16 Secretary shall make the training described in subsection 

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

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

19 ‘‘(1) CARE RECIPIENT.—The term ‘care recipi20 ent’— 

21 ‘‘(A) used with respect to a family care22 giver, means an older individual or an indi23 vidual with Alzheimer’s disease or a related dis24 order with neurological and organic brain dys25 function; and 


jbell on PROD1PC69 with BILLS
27 

•S 3730 IS

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

2 older individual who is a relative caregiver, 

3 means an individual with a disability. 

4 ‘‘(2) COMMUNITY COLLEGE.—The term ‘com5 munity college’ means an institution of higher edu6 cation (as defined in section 101(a) of the Higher 

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

8 offers a 2-year program of study. 

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

10 term ‘individual with a disability’ means an indi11 vidual with a disability, within the meaning of sec12 tion 372(a)(1). 

13 ‘‘(4) VOCATIONAL SCHOOL.—The term ‘voca14 tional school’ means an area career and technical 

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

16 D. Perkins Career and Technical Education Act of 

17 2006 (20 U.S.C. 2302).’’. 

18 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

19 303(e) of the Older Americans Act of 1965 (42 U.S.C. 

20 3023(e)) is amended— 

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

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

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


jbell on PROD1PC69 with BILLS
28 

•S 3730 IS

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

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

3 2010 through 2012.’’. 

4 SEC. 302. REDESIGNATIONS IN PROVISIONS FOR 

5 MULTIGENERATIONAL AND CIVIC ENGAGE6 MENT ACTIVITIES. 

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

8 Americans Act of 1965 is amended— 

9 (1) in subsection (a)— 

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

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

12 (ii), respectively, and indenting accordingly; 

13 (B) by redesignating paragraphs (1) and 

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

15 and indenting accordingly; and 

16 (C) by inserting all that precedes ‘‘The As17 sistant Secretary’’ and inserting the following: 

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

19 PROJECTS.— 

20 ‘‘(1) GRANTS AND CONTRACTS.—’’; 

21 (2) in subsection (b)— 

22 (A) by redesignating paragraphs (1) and 

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

24 and indenting accordingly; and 


jbell on PROD1PC69 with BILLS
29 

•S 3730 IS

1 (B) by inserting all that precedes ‘‘An eli2 gible’’ and inserting the following: 

3 ‘‘(2) USE OF FUNDS.—’’; 

4 (3) in subsection (c)— 

5 (A) by redesignating paragraphs (1) 

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

7 respectively, and indenting accordingly; and 

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

9 awarding’’ and inserting the following: 

10 ‘‘(3) PREFERENCE.—’’; 

11 (4) in subsection (d), by striking all that pre12 cedes ‘‘To be’’ and inserting the following: 

13 ‘‘(4) APPLICATION.—’’; 

14 (5) in subsection (e)— 

15 (A) by redesignating paragraphs (1) and 

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

17 and indenting accordingly; and 

18 (B) by inserting all that precedes ‘‘Organi19 zations’’ and inserting the following: 

20 ‘‘(5) ELIGIBLE ORGANIZATIONS.—’’; 

21 (6) in subsection (f)— 

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

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

24 (ii), and (iii), respectively, and indenting ac25 cordingly; 


jbell on PROD1PC69 with BILLS
30 

•S 3730 IS

1 (B) by redesignating paragraphs (1) and 

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

3 and indenting accordingly; and 

4 (C) by inserting all that precedes subpara5 graph (A) (as redesignated by subparagraph 

6 (B) of this paragraph) and inserting the fol7 lowing: 

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

9 (7) in subsection (g)— 

10 (A) by redesignating paragraphs (1) 

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

12 respectively, and indenting accordingly; and 

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

14 later’’ and inserting the following: 

15 ‘‘(7) REPORT TO CONGRESS.—’’; and 

16 (8) in subsection (h)— 

17 (A) in paragraph (2)— 

18 (i) in subparagraph (B), by redesig19 nating clauses (i) and (ii) as subclauses (I) 

20 and (II), respectively, and indenting ac21 cordingly; and 

22 (ii) by redesignating subparagraphs 

23 (A) and (B) as clauses (i) and (ii), respec24 tively, and indenting accordingly; 


jbell on PROD1PC69 with BILLS
31 

•S 3730 IS

1 (B) by redesignating paragraphs (1) and 

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

3 and indenting accordingly; and 

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

5 used’’ and inserting the following: 

6 ‘‘(8) DEFINITIONS.—’’. 

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

8 Older Americans Act of 1965 is amended— 

9 (1) by striking ‘‘this section’’ each place it ap10 pears and inserting ‘‘this subsection’’; 

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

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

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

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

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

16 (3), by striking ‘‘subsection (a)’’ each place it ap17 pears and inserting ‘‘paragraph (1)’’; and 

18 (5) in subsection (a) (as redesignated by sub19 section (a) of this section)— 

20 (A) in paragraph (2)(B), by striking ‘‘sub21 section (f)’’ and inserting ‘‘paragraph (6)’’; and 

22 (B) in paragraph (7)— 

23 (i) in the matter preceding subpara24 graph (A), by striking ‘‘subsection (f)(2)’’ 

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


jbell on PROD1PC69 with BILLS
32 

•S 3730 IS

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

2 ‘‘paragraph (1)’’ and inserting ‘‘subpara3 graph (A)’’. 

4 SEC. 303. NATIONAL RESOURCE CENTER ON VOLUNTEERS, 

5 STUDENTS, AND SENIORS. 

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

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

8 amended by adding at the end the following: 

9 ‘‘(b) NATIONAL RESOURCE CENTER ON VOLUN10 TEERS, STUDENTS, AND SENIORS.— 

11 ‘‘(1) IN GENERAL.— 

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

13 shall award a grant for the establishment and 

14 operation of a National Resource Center on 

15 Volunteers, Students, and Seniors (referred to 

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

17 shall promote partnerships between entities in 

18 the aging network, and institutions of higher 

19 education and secondary schools, in order to ex20 pand the capacity of individuals to serve in, and 

21 in order to attract new leaders for and profes22 sionals into, the aging network. 

23 ‘‘(B) PARTNERSHIPS.—Such partnerships 

24 may involve— 


jbell on PROD1PC69 with BILLS
33 

•S 3730 IS

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

2 aging, or other local government agencies, 

3 Aging and Disability Resource Centers, 

4 tribal organizations, nonprofit health or so5 cial service organizations, community clin6 ics, adult day care centers, senior housing 

7 providers, and other providers that provide 

8 direct services to older individuals and that 

9 are determined to be appropriate by the 

10 Assistant Secretary; and 

11 ‘‘(ii) local institutions of higher edu12 cation and secondary schools. 

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

14 made available through the grant to— 

15 ‘‘(A) identify and disseminate information 

16 (including information about best practices) 

17 concerning how entities described in paragraph 

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

19 that provides volunteers and students in nurs20 ing, social work, gerontology, psychology, dental 

21 hygiene, music and recreational therapy, nutri22 tion, and other disciplines identified by the As23 sistant Secretary with opportunities, approved 

24 by the Assistant Secretary, to gain experience 

25 working with older individuals, including older 


jbell on PROD1PC69 with BILLS
34 

•S 3730 IS

1 individuals with dementia or cognitive impair2 ment, receiving services under this Act; 

3 ‘‘(B) develop and implement a model dem4 onstration grant program to— 

5 ‘‘(i) promote new partnerships be6 tween the entities described in paragraph 

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

8 partnerships into established curricula of 

9 institutions of higher education and sec10 ondary schools; and 

11 ‘‘(ii) promote and sponsor internship 

12 programs, career development seminars, 

13 and continuing education and lifelong 

14 learning programs; and 

15 ‘‘(C) develop and implement a model ca16 reer ladder program that will disseminate infor17 mation on best practices designed to enable 

18 mid-level professionals to advance in the field of 

19 aging. 

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

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

22 section 9101 of the Elementary and Secondary Edu23 cation Act of 1965 (20 U.S.C. 8801). 

24 ‘‘(4) AUTHORIZATION OF APPROPRIATIONS.— 

25 There is authorized to be appropriated to carry out 


jbell on PROD1PC69 with BILLS
35 

•S 3730 IS

1 this subsection $3,000,000 for fiscal year 2010, 

2 $3,500,000 for fiscal year 2011, and $4,000,000 for 

3 fiscal year 2012.’’. 

4 TITLE IV—AMENDMENTS TO THE 

5 SOCIAL SECURITY ACT 

6 SEC. 401. DEMONSTRATION PROGRAM FOR PERSONAL OR 

7 HOME CARE AIDES, NURSE AIDES, AND HOME 

8 HEALTH AIDES IN LONG-TERM CARE SET9 TINGS. 

10 (a) ESTABLISHMENT.— 

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

12 a demonstration program (in this section referred to 

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

14 States to develop core training competencies for eli15 gible personal or home care aides and additional 

16 training content for nurse aides and home health 

17 aides to supplement training for nurse aides and 

18 home health aides that is required under Federal 

19 law or regulation, and to evaluate the effectiveness 

20 of such competencies and additional training con21 tent. Such program shall evaluate the efficacy of— 

22 (A) the core training competencies devel23 oped under subsection (b)(2)(A); 

24 (B) the additional training content devel25 oped under subsection (b)(2)(B); and 


jbell on PROD1PC69 with BILLS
36 

•S 3730 IS

1 (C) the method of implementation of such 

2 core training competencies and additional train3 ing content against a ‘‘control’’ group being 

4 trained under a participating State’s existing 

5 training protocols. 

6 (2) DURATION.—The program shall be con7 ducted for not less than 4 years. 

8 (b) ESTABLISHMENT OF EXPERT PANEL.— 

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

10 after the date of enactment of this Act, the Sec11 retary shall establish a panel of long-term care work12 force experts (in this section referred to as the ‘‘ex13 pert panel’’). 

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

15 the following duties: 

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

17 core training competencies for personal or home 

18 care aides, including such competencies with re19 spect to the following areas: 

20 (I) The role of the personal or home 

21 care aide (including differences between a 

22 personal or home care aide employed by an 

23 agency and a personal or home care aide 

24 employed directly by the health care con25 sumer or an independent provider). 


jbell on PROD1PC69 with BILLS
37 

•S 3730 IS

1 (II) Consumer rights, ethics, and con2 fidentiality (including the role of proxy de3 cision-makers in the case where a health 

4 care consumer has impaired decision-mak5 ing capacity). 

6 (III) Communication, cultural com7 petence and sensitivity, problem solving, 

8 behavior management, and relationship 

9 skills. 

10 (IV) Personal care skills. 

11 (V) Health care support. 

12 (VI) Nutritional support. 

13 (VII) Infection control. 

14 (VIII) Safety and emergency training. 

15 (IX) Training specific to an individual 

16 consumer’s needs (including older individ17 uals, younger individuals with disabilities, 

18 individuals with developmental disabilities, 

19 individuals with dementia, and individuals 

20 with mental health needs). 

21 (X) Self-Care. 

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

23 training competencies developed under clause 

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

25 personal or home care aides. 


jbell on PROD1PC69 with BILLS
38 

•S 3730 IS

1 (B)(i) Subject to clause (ii), developing ad2 ditional training content for home health aides 

3 and nurse aides which is not required under 

4 Federal law as of the date of enactment of this 

5 Act, including such content with respect to the 

6 following areas: 

7 (I) Culturally competent practice. 

8 (II) Standardized direct care worker 

9 communication protocols (such as Situa10 tion, Background, Assessment, and Rec11 ommendation communication tools). 

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

13 (IV) Injury prevention. 

14 (V) Wound and decubitus care. 

15 (VI) Medication management. 

16 (VII) 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 (VIII) Prevention and reporting of 

24 abuse. 


jbell on PROD1PC69 with BILLS
39 

•S 3730 IS

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). 


jbell on PROD1PC69 with BILLS
40 

•S 3730 IS

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; 


jbell on PROD1PC69 with BILLS
41 

•S 3730 IS

1 (viii) State Medicaid waiver program 

2 officials; 

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

5 (x) researchers on direct care workers 

6 and the long-term care workforce. 

7 (B) INCLUSION OF REPRESENTATIVES OF

8 CERTAIN INDIVIDUALS.—Not less than 2 of the 

9 11 members appointed by the Secretary under 

10 subparagraph (A) shall represent the interests 

11 of individuals who rely on long-term care serv12 ices, including the interests of those individuals 

13 described in clause (vii) of such subparagraph. 

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

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

16 submit to the Secretary a report containing— 

17 (A) the core training competencies devel18 oped under paragraph (2)(A); 

19 (B) the additional training content devel20 oped under paragraph (2)(B); 

21 (C) any recommendations of the expert 

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

23 (D) recommendations for such legislation 

24 or administrative action as the expert panel de25 termines appropriate. 


jbell on PROD1PC69 with BILLS
42 

•S 3730 IS

1 (5) TERMINATION.—The expert panel shall ter2 minate 180 days after it submits the report under 

3 paragraph (4). 

4 (c) APPLICATION AND SELECTION CRITERIA.— 

5 (1) IN GENERAL.— 

6 (A) SOLICITATION.—Not later than 2 

7 years after the date of enactment of this Act, 

8 the Secretary shall issue a proposal soliciting 

9 States to voluntarily participate in the program. 

10 (B) AGREEMENTS.—The Secretary shall 

11 enter into agreements with not more than 4 

12 States to conduct the program in such States. 

13 (C) REQUIREMENTS FOR STATES.—An 

14 agreement entered into under subparagraph (B) 

15 shall require that a participating State— 

16 (i) use grant funds made available to 

17 the State under the program to recruit eli18 gible health and long-term care providers 

19 to— 

20 (I) participate in the program; 

21 and 

22 (II) implement the core training 

23 competencies developed under sub24 section (b)(2)(A) and the additional 


jbell on PROD1PC69 with BILLS
43 

•S 3730 IS

1 training content developed under sub2 section (b)(2)(B); and 

3 (ii) develop written materials and pro4 tocols for such core training competencies 

5 and such additional training content, in6 cluding the development of a certification 

7 test for personal or home care aides who 

8 have completed such training competencies 

9 and, if applicable, additional training con10 tent. 

11 (D) CONSULTATION AND COLLABORATION

12 WITH COMMUNITY AND VOCATIONAL COL13 LEGES.—The Secretary shall encourage partici14 pating States to consult with community and 

15 vocational colleges regarding the development of 

16 curricula to implement the program, which may 

17 include consideration of such colleges as part18 ners in such implementation. 

19 (2) APPLICATION AND ELIGIBILITY.—A State 

20 seeking to participate in the program shall— 

21 (A) submit an application to the Secretary 

22 containing such information and at such time 

23 as the Secretary may specify; 

24 (B) meet the selection criteria established 

25 under paragraph (3); and 


jbell on PROD1PC69 with BILLS
44 

•S 3730 IS

1 (C) meet such additional criteria as the 

2 Secretary may specify. 

3 (3) SELECTION CRITERIA.—In selecting States 

4 to participate in the program, the Secretary shall es5 tablish criteria to ensure— 

6 (A) geographic and demographic diversity; 

7 (B) that participating States offer medical 

8 assistance for personal care services under the 

9 State Medicaid plan; 

10 (C) that the existing training standards for 

11 personal or home care aides, home health aides, 

12 and nurse aides in each participating State— 

13 (i) are different from such standards 

14 in the other participating States; and 

15 (ii) are different from the core train16 ing competencies developed under sub17 section (b)(2)(A) and the additional train18 ing content developed under subsection 

19 (b)(2)(B); 

20 (D) that participating States do not reduce 

21 the number of hours of training required under 

22 applicable State law or regulation after being 

23 selected to participate in the program; and 


jbell on PROD1PC69 with BILLS
45 

•S 3730 IS

1 (E) that States recruit a minimum number 

2 of eligible health and long-term care providers 

3 to participate in the program. 

4 (4) TECHNICAL ASSISTANCE.—The Secretary 

5 shall provide technical assistance to States in devel6 oping written materials and protocols for such core 

7 training competencies and such additional training 

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

9 (d) EVALUATION AND REPORT.— 

10 (1) EVALUATION.—The Secretary shall develop 

11 an experimental or control group testing protocol in 

12 consultation with an independent evaluation con13 tractor selected by the Secretary. Such contractor 

14 shall evaluate— 

15 (A) the impact of core training com16 petencies developed under subsection (b)(2)(A), 

17 including curricula developed to implement such 

18 core training competencies, for personal or 

19 home care aides within each participating State 

20 on job satisfaction, mastery of job skills, bene21 ficiary and caregiver satisfaction with services, 

22 and additional measures determined by the Sec23 retary in consultation with the expert panel es24 tablished under subsection (b); 


jbell on PROD1PC69 with BILLS
46 

•S 3730 IS

1 (B) the impact of incorporating the addi2 tional training content developed under sub3 section (b)(2)(B) into existing training stand4 ards for home health aides and certified nurse 

5 aides within each participating State; 

6 (C) the impact of providing such core 

7 training competencies and additional training 

8 content on the existing training infrastructure 

9 and resources of States; 

10 (D) whether the minimum number of 

11 hours of initial training required for nurse aides 

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

13 1919(f)(2)(A)(i)(II) of the Social Security Act 

14 (42 U.S.C. 1395i–3(f)(2)(A)(i)(II); 

15 1396r(f)(2)(A)(i)(II)) should be increased; and 

16 (E) whether a minimum number of hours 

17 of initial training should be required for per18 sonal or home care aides and, if so, what min19 imum number of hours should be required. 

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

21 completion of the program, the Secretary shall sub22 mit to Congress a report containing the results of 

23 the evaluations conducted under paragraph (1), to24 gether with such recommendations for legislation or 


jbell on PROD1PC69 with BILLS
47 

•S 3730 IS

1 administrative action as the Secretary determines 

2 appropriate. 

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

4 otherwise appropriated, there are appropriated to the Sec5 retary to carry out the program under this section for the 

6 period of fiscal years 2010 through 2015, $14,000,000. 

7 (f) DEFINITIONS.—In this section: 

8 (1) ELIGIBLE HEALTH AND LONG-TERM CARE

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

10 care provider’’ means a personal or home care agen11 cy (including personal or home care public authori12 ties), a nursing home, a home health agency (as de13 fined in section 1861(o)) of the Social Security Act 

14 (42 U.S.C. 1395x(o)), or any other health care pro15 vider the Secretary determines appropriate which— 

16 (A) is licensed or authorized to provide 

17 services in a participating State; and 

18 (B) receives payment for services under 

19 title XVIII or XIX of the Social Security Act. 

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

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

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

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

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

25 the meaning given such term in section 


jbell on PROD1PC69 with BILLS
48 

•S 3730 IS

1 1819(b)(5)(F) of the Social Security Act (42 U.S.C. 

2 1395i–3(b)(5)(F)). 

3 (4) PERSONAL CARE SERVICES.—The term 

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

5 term for purposes of title XIX of the Social Security 

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

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

8 term ‘‘personal or home care aide’’ means an indi9 vidual who helps individuals who are elderly, dis10 abled, ill, or mentally disabled (including an indi11 vidual with Alzheimer’s disease or other dementia) 

12 to live in their own home or a residential care facil13 ity (such as a nursing home, assisted living facility, 

14 or any other facility the Secretary determines appro15 priate) by providing routine personal care services 

16 and other appropriate services to the individual. 

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

18 the Secretary of Health and Human Services. 

19 SEC. 402. MEDICARE FAMILY CAREGIVER INFORMATION 

20 AND REFERRAL. 

21 State health insurance assistance programs, the Ad22 ministrator of the Centers for Medicare & Medicaid Serv23 ices, and the Assistant Secretary of the Administration on 

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

25 by contract, develop practical, easy-to-understand inforVerDate Aug 31 2005 02:47 Dec 11, 2008 Jkt 079200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\S3730.IS S3730

jbell on PROD1PC69 with BILLS
49 

•S 3730 IS

1 mation and referral protocols for health care providers, so2 cial workers, and other appropriate individuals to provide 

3 to family caregivers of Medicare beneficiaries either on ad4 mission to or discharge from a hospital or a post-acute 

5 care setting (including a skilled nursing facility (as defined 

6 in section 1819(a) of the Social Security Act (42 U.S.C. 

7 1395i–3(a)), a comprehensive rehabilitation facility (as de8 fined in section 1861(cc)(2) of such Act (42 U.S.C. 

9 1395x(cc)(2)) or a rehabilitation agency, a provider of 

10 long-term care services, and a home health agency (as de11 fined in section 1861(o) of such Act (42 U.S.C. 1395x(o)). 

12 Information developed under the preceding sentence 

13 shall— 

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

15 community-based resources for seniors, individuals 

16 with disabilities and their caregivers, which shall be 

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

18 practicable); 

19 (2) be disseminated by health care providers, 

20 social workers, and other appropriate individuals as 

21 printed materials (including materials in Spanish 

22 and other languages (other than English) as appro23 priate); and 

24 (3) be made available on the Internet websites 

25 of State health insurance assistance programs, the 


jbell on PROD1PC69 with BILLS
50 

•S 3730 IS

1 Centers for Medicare & Medicaid Services, and the 

2 Administration on Aging. 

3 SEC. 403. MEDICAID ASSESSMENT OF FAMILY CAREGIVER 

4 SUPPORT NEEDS. 

5 (a) IN GENERAL.—Section 1915 of the Social Secu6 rity Act (42 U.S.C. 1396n) is amended— 

7 (1) in subsection (c)(2)— 

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

9 ‘‘and’’ at the end; 

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

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

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

13 subparagraph: 

14 ‘‘(F) under such waiver the State may pro15 vide for an assessment of family caregiver sup16 port needs (in accordance with subsection 

17 (k)).’’; 

18 (2) in subsection (d)(2)— 

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

20 ‘‘and’’ at the end; 

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

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

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

24 subparagraph: 


jbell on PROD1PC69 with BILLS
51 

•S 3730 IS

1 ‘‘(D) under such waiver the State may pro2 vide for an assessment of family caregiver sup3 port needs (in accordance with subsection 

4 (k)).’’; 

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

6 end the following new clause: 

7 ‘‘(vii) Where appropriate, an assess8 ment of family caregiver support needs (in 

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

10 (4) by adding at the end the following new sub11 section: 

12 ‘‘(k) ASSESSMENT OF FAMILY CAREGIVER SUPPORT

13 NEEDS.— 

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

15 who is determined to be eligible for home and com16 munity-based services under a waiver under sub17 section (c) or (d) or under section 1115, under a 

18 State plan amendment under subsection (i), under 

19 an MFP demonstration project established under 

20 section 6071 of the Deficit Reduction Act of 2005, 

21 or as part of self-directed personal assistance serv22 ices provided pursuant to a written plan of care in 

23 accordance with the requirements of subsection (j), 

24 and who is dependent upon the assistance of a fam25 ily caregiver, the State may provide for an assessVerDate Aug 31 2005 02:47 Dec 11, 2008 Jkt 079200 PO 00000 Frm 00051 Fmt 6652 Sfmt 6201 E:\BILLS\S3730.IS S3730

jbell on PROD1PC69 with BILLS
52 

•S 3730 IS

1 ment of the family caregiver support needs of the in2 dividual. Such assessment shall, to the extent fea3 sible, be conducted at the same time as, or closely 

4 coordinated with, the determination of the eligibility 

5 of the individual for such services. 

6 ‘‘(2) QUESTIONNAIRE.— 

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

8 include asking the family caregiver of the indi9 vidual questions in order to determine whether 

10 they would benefit from targeted support serv11 ices (such as those services described in para12 graph (3)). 

13 ‘‘(B) COMPLETION ON A VOLUNTARY

14 BASIS.—The answering of questions under sub15 paragraph (A) by a family caregiver shall be on 

16 a voluntary basis. 

17 ‘‘(3) TARGETED SUPPORT SERVICES DE18 SCRIBED.—The following targeted support services 

19 are described in this paragraph: 

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

21 services (including short-term help for the indi22 vidual that gives the family caregiver a break 

23 from providing such care). 

24 ‘‘(B) Individual counseling (including ad25 vice and consultation sessions to bolster emoVerDate Aug 31 2005 02:47 Dec 11, 2008 Jkt 079200 PO 00000 Frm 00052 Fmt 6652 Sfmt 6201 E:\BILLS\S3730.IS S3730

jbell on PROD1PC69 with BILLS
53 

•S 3730 IS

1 tional support for the family caregiver to make 

2 well-informed decisions about how to cope with 

3 the strain of supporting the individual). 

4 ‘‘(C) Support groups, including groups 

5 which provide help for family caregivers to— 

6 ‘‘(i) locate a support group either lo7 cally or online to share experiences and re8 duce isolation; 

9 ‘‘(ii) make well-informed decisions 

10 about caring for the individual; and 

11 ‘‘(iii) reduce isolation. 

12 ‘‘(D) Information and assistance (including 

13 brochures and online resources for researching 

14 a disease or disability or learning and managing 

15 a regular caregiving role, new technologies that 

16 can assist family caregivers, and practical as17 sistance for locating services). 

18 ‘‘(E) Chore services (such as house clean19 ing). 

20 ‘‘(F) Personal care (including outside 

21 help). 

22 ‘‘(G) Education and training (including 

23 workshops and other resources available with 

24 information about stress management, self-care 

25 to maintain good health, understanding and 


jbell on PROD1PC69 with BILLS
54 

•S 3730 IS

1 communicating with individuals with dementia, 

2 medication management, normal aging proc3 esses, change in disease and disability, the role 

4 of assistive technologies, and other relevant top5 ics). 

6 ‘‘(H) Legal and financial planning and 

7 consultation (including advice and counseling 

8 regarding long-term care planning, estate plan9 ning, powers of attorney, community property 

10 laws, tax advice, employment leave advice, ad11 vance directives, and end-of-life care). 

12 ‘‘(I) Transportation (including transpor13 tation to medical appointments). 

14 ‘‘(J) Other targeted support services the 

15 Secretary or the State determines appropriate. 

16 ‘‘(4) REFERRALS.—In the case where a ques17 tionnaire completed by a family caregiver under 

18 paragraph (2) indicates that the family caregiver 

19 would benefit from 1 or more of the targeted sup20 port services described in paragraph (3), the State 

21 shall provide referrals to the family caregiver for 

22 local, State, and private-sector family caregiver pro23 grams and other resources that provide such tar24 geted support services.’’. 


jbell on PROD1PC69 with BILLS
55 

•S 3730 IS

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

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

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

4 the date of enactment of this Act. 

5 TITLE V—STUDIES AND 

6 REPORTS 

7 SEC. 501. STUDIES AND REPORTS. 

8 (a) IOM STUDY AND REPORT ON MENTAL HEALTH

9 WORKFORCE NEEDS.— 

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

11 date of enactment of this Act, the Secretary of 

12 Health and Human Services shall enter into a con13 tract with the Institute of Medicine of the National 

14 Academies (in this section referred to as the ‘‘Insti15 tute’’) under which the Institute shall conduct a 

16 study on the specific policy, workforce, economic, 

17 and implementation issues relevant to the mental 

18 health workforce that need to be addressed to meet 

19 the current needs of older individuals and the future 

20 needs of the aging boomer generation. 

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

22 the effective date of the contract under paragraph 

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

24 submit a report to the Secretary of Health and 

25 Human Services and the appropriate committees of 


jbell on PROD1PC69 with BILLS
56 

•S 3730 IS

1 jurisdiction of Congress containing the results of the 

2 study conducted under paragraph (1), together with 

3 recommendations for such legislation and adminis4 trative action as the Institute determines appro5 priate. 

6 (3) AUTHORIZATION.—There is authorized to 

7 be appropriated to carry out this subsection, 

8 $1,200,000 for the period of fiscal years 2010 

9 through 2011. 

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

11 THE AGING NETWORK.— 

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

13 United States (in this section referred to as the 

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

15 aging network, focusing on State agencies and area 

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

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

18 determine the current capacity of such network and 

19 to identify challenges in providing services to older 

20 adults, including older adults who are low-income 

21 and older adults with functional disabilities, during 

22 the 10-year period beginning on the date of enact23 ment of this Act. 

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

25 the date of enactment of this Act, the Comptroller 


jbell on PROD1PC69 with BILLS
57 

•S 3730 IS

1 General shall submit to Congress a report containing 

2 the results of the study conducted under paragraph 

3 (1), together with recommendations— 

4 (A) on the workforce supply and capitol re5 sources needed by the aging network in order to 

6 meet the demand for services by older adults 

7 during such 10-year period; and 

8 (B) for such legislation and administrative 

9 action as the Comptroller General determines 

10 appropriate. 

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

12 WORKFORCE IN LONG-TERM CARE SETTINGS.— 

13 (1) STUDY.—The Comptroller General shall 

14 conduct a study on the use of practices to reduce 

15 turnover and improve retention and tenure of nurse 

16 aides and home health aides in nursing homes, as17 sisted living facilities, and home health agencies (as 

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

19 (42 U.S.C. 1395x(o)). Such study shall include an 

20 analysis of the reasons for the success of such prac21 tices and how such practices could be replicated in 

22 other facilities. 

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

24 the date of enactment of this Act, the Comptroller 

25 General shall submit to Congress a report containing 


jbell on PROD1PC69 with BILLS
58 

•S 3730 IS

1 the results of the study conducted under paragraph 

2 (1), together with recommendations for such legisla3 tion and administrative action as the Comptroller 

4 General determines appropriate. 

5 (3) DEFINITIONS.—In this subsection: 

6 (A) HOME HEALTH AIDE.—The term 

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

8 term in section 1891(a)(3)(E) of the Social Se9 curity Act (42 U.S.C. 1395bbb(a)(3)(E)). 

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

11 has the meaning given such term in section 

12 1819(b)(5)(F) of the Social Security Act (42 

13 U.S.C. 1395i–3(b)(5)(F)). 

14 (d) GAO STUDY AND REPORT ON NIH SPENDING

15 AND GRANTS.— 

16 (1) STUDY.—The Comptroller General shall 

17 conduct a study on spending by the National Insti18 tutes of Health, including the number of grants 

19 made by the National Institutes of Health, on condi20 tions and illnesses that disproportionately impact the 

21 health of older individuals. Such study shall include 

22 an analysis of the number of older individuals which 

23 are included in clinical trials supported by the Na24 tional Institutes of Health. 


jbell on PROD1PC69 with BILLS
59 

•S 3730 IS

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

2 the date of enactment of this Act, the Comptroller 

3 General shall submit to Congress a report containing 

4 the results of the study conducted under paragraph 

5 (1), together with recommendations for such legisla6 tion and administrative action as the Comptroller 

7 General determines appropriate. 

Æ 


jbell on PROD1PC69 with BILLS