I 117th CONGRESS 2d Session H. R. 6530 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. Short title This Act may be cited as the Safeguarding Elderly Needs for Infrastructure and Occupational Resources Act of 2022 or the SENIOR Act of 2022 . 2. Findings The Congress finds as follows: (1) Long-term care facilities and senior congregate care homes provide direct and personalized care, where social distancing is not possible, 24 hours a day, 7 days a week. (2) Assisted living, memory care, independent living, and other senior congregate care settings are the homes of America’s seniors and critical options on the long-term care continuum; these senior residences provide safety and security for our Nation’s most vulnerable population. (3) Sixty percent of a senior’s health is based on social determinants of health which include the need for adequate nutrition, housing, and social activities; thus supporting caregivers and home- and community-based care models that prioritize the social determinants of senior health should be a priority of the Congress. (4) Investing in senior care and the caregiving workforce prevents hospitalization and skilled nursing expenses, preserving Medicare and Medicaid budgets. (5) Since March of 2020, senior care facilities have lost over 380,000 caregivers and are experiencing a workforce crisis as America’s population rapidly ages. (6) By 2030, the entire Baby Boomer Generation will be 65 years of age or older. (7) By 2060, nearly 95 million Americans will be 65 years of age or older and the portion of the population over 85 years of age will have tripled to nearly 20 million persons. (8) Fifty-two percent of individuals require long-term care by age 65. Individuals over 65 years of age are 70 percent more likely to need long-term care, with half of those seniors requiring an even higher level of care. (9) The average duration of long-term care is nearly 4 years, and 14 percent of individuals need long-term care for 5 or more years. (10) Twenty-seven percent of seniors over 65 years of age will spend at least $100,000 on long-term care, and 15 percent will have costs for long-term care surpassing $250,000. (11) The average cost for long-term care for a 65-year old today is $138,000. (12) Long-term care infrastructure must address the availability of cost-effective care and housing options to meet the growing needs of the Nation’s aging population. (13) On average, assisted living costs $4,300 per month, which equals $5.91 per hour of available care (based on 24/7 care). Nursing homes cost $8,821 per month (or $13.13 per hour based on 24/7 care). In-home care costs $4,576 per month (or $26 per hour based on 44 hours per week care). (14) An individual 85 years of age or older is 630 percent more likely to die of COVID–19. (15) Sixty-three percent of residents of long-term care facilities need assistance with bathing; 48 percent need assistance with dressing; and 40 percent need assistance with toileting. (16) More than 42 percent of residents of long-term care facilities suffer from Alzheimer’s disease or some other form of dementia. (17) The people of the United States are a compassionate people who are committed to protecting the most vulnerable in our society, and we should not jeopardize the financial underpinnings of the long-term care communities our Nation’s senior citizens depend on day-in and day-out. 3. Senior caregiver relief assistance Part K of title III of the Public Health Service Act ( 42 U.S.C. 280c et seq. ) is amended by adding at the end the following new subpart: IV Senior caregiver relief assistance 399A–1. Senior caregiver relief assistance (a) Authority The Secretary shall provide assistance under this section to eligible entities to stabilize and preserve senior congregate care operations. (b) Eligible entities (1) In general The Secretary may provide assistance under this section only to an entity that— (A) is an assisted living facility; (B) demonstrates, by providing such documentation as the Secretary shall require, financial need by having— (i) incurred uncompensated losses because of the public health emergency declared under section 319 with respect to COVID–19; and (ii) consistently maintained ongoing operations during the period from March 13, 2020, to December 31, 2020; and (C) makes a good-faith certification to the Secretary— (i) that the uncertainty of existing economic conditions makes the application for assistance under this section necessary to support ongoing operations of the entity; and (ii) that all amounts of such assistance will be used to promote the health and well-being of the facility’s population of seniors, to retain workers, to maintain the facility, and for other eligible uses under the relevant provisions of this section. (2) Basis of determinations Any individual determination of qualification of an entity as an eligible entity for purposes of this section shall be based on review of the entity’s existing versus recent historic financials, including— (A) profit-loss statements; (B) account receivables; (C) Federal tax filings; and (D) such other materials that the Secretary deems relevant to meet the purposes of this section. (c) Applications The Secretary shall— (1) provide for eligible entities to submit applications for assistance under this section; and (2) require such applications— (A) to set forth the proposed uses of such assistance; and (B) to contain such other assurances and information as the Secretary may require. (d) Formula grants for health care-Related expenses and lost revenue attributable to COVID–19 (1) In general To the extent and in the amount of appropriations made in advance to carry out this section, the Secretary shall— (A) make grants to eligible entities for health care-related expenses attributable to COVID–19 or to supplant lost revenue attributable to COVID–19; and (B) distribute such amounts among eligible entities in an equitable and timely manner, but not later than December 31, 2022, based on the order in which approvable applications from such entities are received by the Secretary. (2) Limitation on administrative expenses As a condition on receipt of a grant under this section, an eligible entity shall agree to use not more than 5 percent of the amounts received through the grant for administrative expenses. (3) Amount The amount of assistance distributed to an eligible entity pursuant to this subsection shall be— (A) based on the number of beds in the facility to be assisted; and (B) proportional to the uncompensated losses of the eligible entity referred to in subsection (b)(1)(B)(i). (4) Rule of construction Nothing in this subsection shall be construed as preventing the Secretary from making assistance available to eligible entities at any time before the date specified in paragraph (1)(B). (e) Senior caregiver relief grants (1) In general To the extent and in the amount of appropriations made in advance to carry out this section, the Secretary shall make grants to eligible entities for use (subject to paragraph (2)) only for the following purposes: (A) Enhanced broadband connectivity and telehealth support To ensure regular and reliable communications connections between seniors residing in the assisted living facility of the entity and their physicians and medical support personnel. (B) Caregiver sustainability For costs of operating and maintaining the assisted living facility of the entity, including— (i) for payments of principal or interest on any mortgage obligation in connection with the facility, but not including any prepayment of principal on such a mortgage obligation; (ii) for payments of rent for a facility, including rent under a lease agreement, but not including any prepayment of rent; (iii) for costs of activities to prevent, prepare for, and mitigate the presence of COVID–19 on facility premises, including costs of purchasing and installing equipment and supplies to disinfect the premises, support emergency management operations, and provide for associated staff-related expenses; (iv) for maintenance expenses for the facility for the purposes of COVID–19 mitigation and infection control, including construction to accommodate social distancing and other preventive measures, such as plexiglass barriers; (v) for costs of supplies for the facility, including protective equipment and cleaning materials; and (vi) for any other expenses that the Secretary determines to be essential to maintaining the facility. (2) Other activities Nothing in this subsection may be construed to prevent the Secretary from approving applications providing for use of funds for other costs, purposes, and activities not specifically identified in paragraph (1) that the Secretary deems appropriate and consistent with the purposes of this section. (f) Reporting Each recipient of a grant under subsection (d) or (e) shall submit reports and maintain documentation by such deadlines, in such form, and containing such content as the Secretary determines necessary to ensure compliance with the conditions of the grant. (g) Tax treatment (1) Exclusion from gross income For purposes of the Internal Revenue Code of 1986, amounts received by an eligible entity from the Secretary under a grant under subsection (d) or (e) shall not be included in the gross income of such eligible entity. (2) Effect of exclusion An eligible entity shall not have a tax deduction denied, a tax attribute reduced, or any basis increased by reason of the exclusion from gross income pursuant to paragraph (1). (h) GAO report to Congress Not later than 2 years after the date of enactment of this Act, the Comptroller General of the United States shall submit to the Congress a report assessing the efficacy of assistance made available under this section and the activities supported with such assistance. (i) Definitions In this section: (1) The term assisted living facility means a licensed, registered, certified, listed, or State-regulated residence, managed residential community, building, or part of a building that provides, or contracts to provide, housing with supportive services on a continuing basis to individuals who— (A) are elderly or have a mental health, developmental, or physical disability; and (B) are unrelated by blood or marriage to the owner or operator of the residence, community, building, or part of a building if the owner or operator is an individual. (2) The term eligible entity means an entity that is eligible under subsection (b) to be provided assistance under this section. (3) The term health care-related expenses attributable to COVID–19 means health care-related expenses to prevent, prepare for, and respond to COVID–19, including the building or construction of a temporary structure, the leasing of a property, the purchase of medical supplies and equipment (including personal protective equipment and testing supplies), providing for an expanded workforce (including by training staff, maintaining staff, and hiring additional staff), the operation of an emergency operation center, retrofitting a facility, providing for surge capacity, and other expenses determined appropriate by the Secretary. (4) The term lost revenue attributable to COVID–19 means the cost of services that were received, building modifications made, and tangible property ordered for mitigation and prevention of COVID–19, including the difference between such provider’s budgeted and actual revenue if such budget was established and approved before March 27, 2020, for the purposes of preventing, preparing for, and responding to COVID–19. (j) Authorization of appropriations To carry out this section, there is authorized to be appropriated $10,000,000,000 for fiscal year 2022, to remain available until expended. . 4. Senior caregiving workforce development sustainment grants Part K of title III of the Public Health Service Act ( 42 U.S.C. 280c et seq. ) is amended by inserting after section 399A–1, as added by section 3 of this Act, the following: 399A–2. Senior caregiving workforce development sustainment grants (a) In general The Secretary may award grants to eligible entities to establish or expand a senior caregiver workforce training and recruitment program on the campus of the respective eligible entity. (b) Amount; duration A grant under this section shall be for— (1) an amount of not more than $1,000,000; and (2) a term of not more than 4 years. (c) Use of funds Amounts provided to an eligible entity through a grant under this section shall be used to cover the costs of— (1) establishing or expanding a senior caregiver workforce training and recruitment program described in subsection (a), including costs associated with recruitment, training, and retention of senior caregivers; and (2) technical assistance provided by the eligible entity in connection with such program. (d) Application An eligible entity seeking a grant under this section shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require. (e) Reports Each recipient of a grant under this section shall submit reports and maintain documentation by such deadlines, in such form, and containing such content as the Secretary determines necessary to ensure compliance with the conditions of the grant. (f) Tax treatment (1) Exclusion from gross income For purposes of the Internal Revenue Code of 1986, amounts received by an eligible entity from the Secretary under a grant under this section shall not be included in the gross income of such eligible entity. (2) Effect of exclusion An eligible entity shall not have a tax deduction denied, a tax attribute reduced, or any basis increased by reason of the exclusion from gross income pursuant to paragraph (1). (g) Definitions (1) The term eligible entity — (A) means an assisted living facility as defined in section 399A–1; and (B) excludes any skilled nursing facility as defined in section 1819(a) of the Social Security Act. (2) The term senior caregiver means an individual who furnishes direct personal care, assistance with activities of daily living, or any other related service for older adults located on a campus of an eligible entity. (h) Authorization of appropriations To carry out this section, there is authorized to be appropriated $1,250,000,000 for fiscal year 2022, to remain available until expended. . 5. National Health Care Workforce Commission The National Health Care Workforce Commission established under section 5101 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 294q ) shall— (1) not later than 180 days after the date of enactment of this Act, pursuant to subsection (d)(4) of such section 5101, designate as a high priority area the current and projected workforce needs of assisted living and other senior care settings that attend to the care of the senior population; and (2) not later than 1 year after finalizing such designation, submit a report pursuant to subsection (d)(2)(D) of such section 5101 to the Congress and the Administration containing a review of, and recommendations on, such high priority area.