I 

117TH CONGRESS 

2D SESSION H. R. 6530 

To amend the Public Health Service Act to sustain senior congregate care 

operations in the wake of ongoing COVID–19 financial burdens, and 

for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 28, 2022 

Mrs. TRAHAN (for herself and Mr. FITZPATRICK) introduced the following bill; 

which was referred to the Committee on Energy and Commerce, and in 

addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such 

provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend the Public Health Service Act to sustain senior 

congregate care operations in the wake of ongoing 

COVID–19 financial burdens, and for other purposes. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Safeguarding Elderly 

5 Needs for Infrastructure and Occupational Resources Act 

6 of 2022’’ or the ‘‘SENIOR Act of 2022’’. 

7 SEC. 2. FINDINGS. 

8 The Congress finds as follows: 


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1 (1) Long-term care facilities and senior con2 gregate care homes provide direct and personalized 

3 care, where social distancing is not possible, 24 

4 hours a day, 7 days a week. 

5 (2) Assisted living, memory care, independent 

6 living, and other senior congregate care settings are 

7 the homes of America’s seniors and critical options 

8 on the long-term care continuum; these senior resi9 dences provide safety and security for our Nation’s 

10 most vulnerable population. 

11 (3) Sixty percent of a senior’s health is based 

12 on social determinants of health which include the 

13 need for adequate nutrition, housing, and social ac14 tivities; thus supporting caregivers and home- and 

15 community-based care models that prioritize the so16 cial determinants of senior health should be a pri17 ority of the Congress. 

18 (4) Investing in senior care and the caregiving 

19 workforce prevents hospitalization and skilled nurs20 ing expenses, preserving Medicare and Medicaid 

21 budgets. 

22 (5) Since March of 2020, senior care facilities 

23 have lost over 380,000 caregivers and are experi24 encing a workforce crisis as America’s population 

25 rapidly ages. 


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1 (6) By 2030, the entire Baby Boomer Genera2 tion will be 65 years of age or older. 

3 (7) By 2060, nearly 95 million Americans will 

4 be 65 years of age or older and the portion of the 

5 population over 85 years of age will have tripled to 

6 nearly 20 million persons. 

7 (8) Fifty-two percent of individuals require 

8 long-term care by age 65. Individuals over 65 years 

9 of age are 70 percent more likely to need long-term 

10 care, with half of those seniors requiring an even 

11 higher level of care. 

12 (9) The average duration of long-term care is 

13 nearly 4 years, and 14 percent of individuals need 

14 long-term care for 5 or more years. 

15 (10) Twenty-seven percent of seniors over 65 

16 years of age will spend at least $100,000 on long17 term care, and 15 percent will have costs for long18 term care surpassing $250,000. 

19 (11) The average cost for long-term care for a 

20 65-year old today is $138,000. 

21 (12) Long-term care infrastructure must ad22 dress the availability of cost-effective care and hous23 ing options to meet the growing needs of the Na24 tion’s aging population. 


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1 (13) On average, assisted living costs $4,300 

2 per month, which equals $5.91 per hour of available 

3 care (based on 24/7 care). Nursing homes cost 

4 $8,821 per month (or $13.13 per hour based on 24/ 

5 7 care). In-home care costs $4,576 per month (or 

6 $26 per hour based on 44 hours per week care). 

7 (14) An individual 85 years of age or older is 

8 630 percent more likely to die of COVID–19. 

9 (15) Sixty-three percent of residents of long10 term care facilities need assistance with bathing; 48 

11 percent need assistance with dressing; and 40 per12 cent need assistance with toileting. 

13 (16) More than 42 percent of residents of long14 term care facilities suffer from Alzheimer’s disease 

15 or some other form of dementia. 

16 (17) The people of the United States are a 

17 compassionate people who are committed to pro18 tecting the most vulnerable in our society, and we 

19 should not jeopardize the financial underpinnings of 

20 the long-term care communities our Nation’s senior 

21 citizens depend on day-in and day-out. 

22 SEC. 3. SENIOR CAREGIVER RELIEF ASSISTANCE. 

23 Part K of title III of the Public Health Service Act 

24 (42 U.S.C. 280c et seq.) is amended by adding at the end 

25 the following new subpart: 


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1 ‘‘Subpart IV—Senior Caregiver Relief Assistance 

2 ‘‘SEC. 399A–1. SENIOR CAREGIVER RELIEF ASSISTANCE. 

3 ‘‘(a) AUTHORITY.—The Secretary shall provide as4 sistance under this section to eligible entities to stabilize 

5 and preserve senior congregate care operations. 

6 ‘‘(b) ELIGIBLE ENTITIES.— 

7 ‘‘(1) IN GENERAL.—The Secretary may provide 

8 assistance under this section only to an entity that— 

9 ‘‘(A) is an assisted living facility; 

10 ‘‘(B) demonstrates, by providing such doc11 umentation as the Secretary shall require, fi12 nancial need by having— 

13 ‘‘(i) incurred uncompensated losses 

14 because of the public health emergency de15 clared under section 319 with respect to 

16 COVID–19; and 

17 ‘‘(ii) consistently maintained ongoing 

18 operations during the period from March 

19 13, 2020, to December 31, 2020; and 

20 ‘‘(C) makes a good-faith certification to 

21 the Secretary— 

22 ‘‘(i) that the uncertainty of existing 

23 economic conditions makes the application 

24 for assistance under this section necessary 

25 to support ongoing operations of the enti26 ty; and 


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1 ‘‘(ii) that all amounts of such assist2 ance will be used to promote the health 

3 and well-being of the facility’s population 

4 of seniors, to retain workers, to maintain 

5 the facility, and for other eligible uses 

6 under the relevant provisions of this sec7 tion. 

8 ‘‘(2) BASIS OF DETERMINATIONS.—Any indi9 vidual determination of qualification of an entity as 

10 an eligible entity for purposes of this section shall be 

11 based on review of the entity’s existing versus recent 

12 historic financials, including— 

13 ‘‘(A) profit-loss statements; 

14 ‘‘(B) account receivables; 

15 ‘‘(C) Federal tax filings; and 

16 ‘‘(D) such other materials that the Sec17 retary deems relevant to meet the purposes of 

18 this section. 

19 ‘‘(c) APPLICATIONS.—The Secretary shall— 

20 ‘‘(1) provide for eligible entities to submit appli21 cations for assistance under this section; and 

22 ‘‘(2) require such applications— 

23 ‘‘(A) to set forth the proposed uses of such 

24 assistance; and 


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1 ‘‘(B) to contain such other assurances and 

2 information as the Secretary may require. 

3 ‘‘(d) FORMULA GRANTS FOR HEALTH CARE-RE4 LATED EXPENSES AND LOST REVENUE ATTRIBUTABLE

5 TO COVID–19.— 

6 ‘‘(1) IN GENERAL.—To the extent and in the 

7 amount of appropriations made in advance to carry 

8 out this section, the Secretary shall— 

9 ‘‘(A) make grants to eligible entities for 

10 health care-related expenses attributable to 

11 COVID–19 or to supplant lost revenue attrib12 utable to COVID–19; and 

13 ‘‘(B) distribute such amounts among eligi14 ble entities in an equitable and timely manner, 

15 but not later than December 31, 2022, based 

16 on the order in which approvable applications 

17 from such entities are received by the Sec18 retary. 

19 ‘‘(2) LIMITATION ON ADMINISTRATIVE EX20 PENSES.—As a condition on receipt of a grant under 

21 this section, an eligible entity shall agree to use not 

22 more than 5 percent of the amounts received 

23 through the grant for administrative expenses. 


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1 ‘‘(3) AMOUNT.—The amount of assistance dis2 tributed to an eligible entity pursuant to this sub3 section shall be— 

4 ‘‘(A) based on the number of beds in the 

5 facility to be assisted; and 

6 ‘‘(B) proportional to the uncompensated 

7 losses of the eligible entity referred to in sub8 section (b)(1)(B)(i). 

9 ‘‘(4) RULE OF CONSTRUCTION.—Nothing in 

10 this subsection shall be construed as preventing the 

11 Secretary from making assistance available to eligi12 ble entities at any time before the date specified in 

13 paragraph (1)(B). 

14 ‘‘(e) SENIOR CAREGIVER RELIEF GRANTS.— 

15 ‘‘(1) IN GENERAL.—To the extent and in the 

16 amount of appropriations made in advance to carry 

17 out this section, the Secretary shall make grants to 

18 eligible entities for use (subject to paragraph (2)) 

19 only for the following purposes: 

20 ‘‘(A) ENHANCED BROADBAND

21 CONNECTIVITY AND TELEHEALTH SUPPORT.— 

22 To ensure regular and reliable communications 

23 connections between seniors residing in the as24 sisted living facility of the entity and their phy25 sicians and medical support personnel. 


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1 ‘‘(B) CAREGIVER SUSTAINABILITY.—For 

2 costs of operating and maintaining the assisted 

3 living facility of the entity, including— 

4 ‘‘(i) for payments of principal or in5 terest on any mortgage obligation in con6 nection with the facility, but not including 

7 any prepayment of principal on such a 

8 mortgage obligation; 

9 ‘‘(ii) for payments of rent for a facil10 ity, including rent under a lease agree11 ment, but not including any prepayment of 

12 rent; 

13 ‘‘(iii) for costs of activities to prevent, 

14 prepare for, and mitigate the presence of 

15 COVID–19 on facility premises, including 

16 costs of purchasing and installing equip17 ment and supplies to disinfect the prem18 ises, support emergency management oper19 ations, and provide for associated staff-re20 lated expenses; 

21 ‘‘(iv) for maintenance expenses for the 

22 facility for the purposes of COVID–19 

23 mitigation and infection control, including 

24 construction to accommodate social 


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1 distancing and other preventive measures, 

2 such as plexiglass barriers; 

3 ‘‘(v) for costs of supplies for the facil4 ity, including protective equipment and 

5 cleaning materials; and 

6 ‘‘(vi) for any other expenses that the 

7 Secretary determines to be essential to 

8 maintaining the facility. 

9 ‘‘(2) OTHER ACTIVITIES.—Nothing in this sub10 section may be construed to prevent the Secretary 

11 from approving applications providing for use of 

12 funds for other costs, purposes, and activities not 

13 specifically identified in paragraph (1) that the Sec14 retary deems appropriate and consistent with the 

15 purposes of this section. 

16 ‘‘(f) REPORTING.—Each recipient of a grant under 

17 subsection (d) or (e) shall submit reports and maintain 

18 documentation by such deadlines, in such form, and con19 taining such content as the Secretary determines nec20 essary to ensure compliance with the conditions of the 

21 grant. 

22 ‘‘(g) TAX TREATMENT.— 

23 ‘‘(1) EXCLUSION FROM GROSS INCOME.—For 

24 purposes of the Internal Revenue Code of 1986, 

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1 retary under a grant under subsection (d) or (e) 

2 shall not be included in the gross income of such eli3 gible entity. 

4 ‘‘(2) EFFECT OF EXCLUSION.—An eligible enti5 ty shall not have a tax deduction denied, a tax at6 tribute reduced, or any basis increased by reason of 

7 the exclusion from gross income pursuant to para8 graph (1). 

9 ‘‘(h) GAO REPORT TO CONGRESS.—Not later than 

10 2 years after the date of enactment of this Act, the Comp11 troller General of the United States shall submit to the 

12 Congress a report assessing the efficacy of assistance 

13 made available under this section and the activities sup14 ported with such assistance. 

15 ‘‘(i) DEFINITIONS.—In this section: 

16 ‘‘(1) The term ‘assisted living facility’ means a 

17 licensed, registered, certified, listed, or State-regu18 lated residence, managed residential community, 

19 building, or part of a building that provides, or con20 tracts to provide, housing with supportive services on 

21 a continuing basis to individuals who— 

22 ‘‘(A) are elderly or have a mental health, 

23 developmental, or physical disability; and 

24 ‘‘(B) are unrelated by blood or marriage to 

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1 nity, building, or part of a building if the owner 

2 or operator is an individual. 

3 ‘‘(2) The term ‘eligible entity’ means an entity 

4 that is eligible under subsection (b) to be provided 

5 assistance under this section. 

6 ‘‘(3) The term ‘health care-related expenses at7 tributable to COVID–19’ means health care-related 

8 expenses to prevent, prepare for, and respond to 

9 COVID–19, including the building or construction of 

10 a temporary structure, the leasing of a property, the 

11 purchase of medical supplies and equipment (includ12 ing personal protective equipment and testing sup13 plies), providing for an expanded workforce (includ14 ing by training staff, maintaining staff, and hiring 

15 additional staff), the operation of an emergency op16 eration center, retrofitting a facility, providing for 

17 surge capacity, and other expenses determined ap18 propriate by the Secretary. 

19 ‘‘(4) The term ‘lost revenue attributable to 

20 COVID–19’ means the cost of services that were re21 ceived, building modifications made, and tangible 

22 property ordered for mitigation and prevention of 

23 COVID–19, including the difference between such 

24 provider’s budgeted and actual revenue if such budg25 et was established and approved before March 27, 


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1 2020, for the purposes of preventing, preparing for, 

2 and responding to COVID–19. 

3 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—To 

4 carry out this section, there is authorized to be appro5 priated $10,000,000,000 for fiscal year 2022, to remain 

6 available until expended.’’. 

7 SEC. 4. SENIOR CAREGIVING WORKFORCE DEVELOPMENT 

8 SUSTAINMENT GRANTS. 

9 Part K of title III of the Public Health Service Act 

10 (42 U.S.C. 280c et seq.) is amended by inserting after 

11 section 399A–1, as added by section 3 of this Act, the 

12 following: 

13 ‘‘SEC. 399A–2. SENIOR CAREGIVING WORKFORCE DEVELOP14 MENT SUSTAINMENT GRANTS. 

15 ‘‘(a) IN GENERAL.—The Secretary may award grants 

16 to eligible entities to establish or expand a senior caregiver 

17 workforce training and recruitment program on the cam18 pus of the respective eligible entity. 

19 ‘‘(b) AMOUNT; DURATION.—A grant under this sec20 tion shall be for— 

21 ‘‘(1) an amount of not more than $1,000,000; 

22 and 

23 ‘‘(2) a term of not more than 4 years. 


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1 ‘‘(c) USE OF FUNDS.—Amounts provided to an eligi2 ble entity through a grant under this section shall be used 

3 to cover the costs of— 

4 ‘‘(1) establishing or expanding a senior care5 giver workforce training and recruitment program 

6 described in subsection (a), including costs associ7 ated with recruitment, training, and retention of 

8 senior caregivers; and 

9 ‘‘(2) technical assistance provided by the eligi10 ble entity in connection with such program. 

11 ‘‘(d) APPLICATION.—An eligible entity seeking a 

12 grant under this section shall submit an application to the 

13 Secretary at such time, in such manner, and containing 

14 such information as the Secretary may require. 

15 ‘‘(e) REPORTS.—Each recipient of a grant under this 

16 section shall submit reports and maintain documentation 

17 by such deadlines, in such form, and containing such con18 tent as the Secretary determines necessary to ensure com19 pliance with the conditions of the grant. 

20 ‘‘(f) TAX TREATMENT.— 

21 ‘‘(1) EXCLUSION FROM GROSS INCOME.—For 

22 purposes of the Internal Revenue Code of 1986, 

23 amounts received by an eligible entity from the Sec24 retary under a grant under this section shall not be 

25 included in the gross income of such eligible entity. 


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1 ‘‘(2) EFFECT OF EXCLUSION.—An eligible enti2 ty shall not have a tax deduction denied, a tax at3 tribute reduced, or any basis increased by reason of 

4 the exclusion from gross income pursuant to para5 graph (1). 

6 ‘‘(g) DEFINITIONS.— 

7 ‘‘(1) The term ‘eligible entity’— 

8 ‘‘(A) means an assisted living facility as 

9 defined in section 399A–1; and 

10 ‘‘(B) excludes any skilled nursing facility 

11 as defined in section 1819(a) of the Social Se12 curity Act. 

13 ‘‘(2) The term ‘senior caregiver’ means an indi14 vidual who furnishes direct personal care, assistance 

15 with activities of daily living, or any other related 

16 service for older adults located on a campus of an 

17 eligible entity. 

18 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—To 

19 carry out this section, there is authorized to be appro20 priated $1,250,000,000 for fiscal year 2022, to remain 

21 available until expended.’’. 


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1 SEC. 5. NATIONAL HEALTH CARE WORKFORCE COMMIS2 SION. 

3 The National Health Care Workforce Commission es4 tablished under section 5101 of the Patient Protection and 

5 Affordable Care Act (42 U.S.C. 294q) shall— 

6 (1) not later than 180 days after the date of 

7 enactment of this Act, pursuant to subsection (d)(4) 

8 of such section 5101, designate as a ‘‘high priority 

9 area’’ the current and projected workforce needs of 

10 assisted living and other senior care settings that at11 tend to the care of the senior population; and 

12 (2) not later than 1 year after finalizing such 

13 designation, submit a report pursuant to subsection 

14 (d)(2)(D) of such section 5101 to the Congress and 

15 the Administration containing a review of, and rec16 ommendations on, such high priority area. 

Æ 


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