1.This Act may be cited as
the Caring for an Aging America Act of
2008
.
2.Congress makes the following
findings:
(1)The projected
growth in the number and proportion of older adults is unprecedented in United
States history.
(2)By 2030, the
population of the United States aged 65 and older will exceed 70,000,000, about
twice the number of such individuals in 2000.
(3)In the December
2007 final report titled From Isolation to Integration: Recommendations
to Improve Quality in Long-Term Care
the National Commission for
Quality Long-Term Care reported that there is abundant evidence that the health
and long-term care workforce is not equipped in skills or in numbers to respond
adequately to the aging of the United States population.
(4)Inadequate
training in geriatrics and gerontology often results in misdiagnoses,
medication errors, inappropriate services, and a lack of care coordination,
particularly in transitions from one setting to another, that are harmful to
older patients and costly to our health and long-term care system.
(5)Twenty-five
percent of medical students report inadequate amounts of time devoted to
geriatric training, 30 percent feel unprepared to care for older adults in
acute care settings, and 42 percent say they are unprepared to care for frail
older people in nursing homes.
(6)Only 3 percent of
psychologists view geriatrics as their primary area of practice and only 28
percent of psychologists have some graduate training in geriatrics or
gerontology.
(7)Less than 1
percent of nurses are certified gerontological nurses and only 3 percent of
advance practice nurses specialize in aging.
(8)Only 5 percent of
social workers are trained in aging issues, yet 70 percent of licensed clinical
social workers have worked in some capacity with older adults and their
families.
(9)By 2050, the
United States will need three times as many direct care workers in home,
community-based and facility-based long-term care settings as are employed now
to meet the needs of the baby boom generation.
3.Geriatric and
gerontology loan repayment programPart E of title VII of the Public Health
Service Act (42 U.S.C. 295 et seq.) is amended by adding at the end the
following:
3Strengthening
recruitment and retention for geriatric care practice
771.Geriatric and
gerontology loan repayment program
(a)The
Secretary shall establish a Geriatric and Gerontology Loan Repayment Program
within the Health Resources and Services Administration to ensure an adequate
supply of physicians, physician assistants, nurse practitioners, clinical nurse
specialists, psychologists, and social workers trained in geriatrics or
gerontology and to reduce critical workforce shortages in geriatric care
practice.
(b)Under the program established under
subsection (a), the Secretary shall enter into contracts with individuals
described in subsection (d) under which the individuals agree to provide
full-time clinical practice and service to older adults for a minimum of 2
years.
(c)Payment for
years of serviceIn
consideration of the Federal Government agreeing to pay, for each year of
service under a contract under this section, not more than $35,000 of the
principal and interest of the educational loans of the individual involved for
each of the first 2 years of service, the individual shall carry out activities
in accordance with subsection (d)(4). For subsequent years, loan repayments of
up to $40,000 per year for a third or fourth year of service may be made
available.
(d)An individual described in this subsection is an
individual—
(1)who—
(A)is a physician,
including an osteopathic physician, who has completed specialty training in
geriatric medicine or geriatric psychiatry;
(B)is a nurse
practitioner or clinical nurse specialist who has completed specialty training
in geriatrics or gerontology;
(C)is a physician
assistant who has completed specialty training in geriatrics;
(D)is a social
worker who has completed specialty training in gerontology;
(E)is a psychologist
who has completed specialty training in gerontology; or
(F)otherwise—
(i)has a degree in
medicine, osteopathic medicine, clinical or counseling psychology (doctoral
degree program), social work (master’s or doctoral degree program), or who is a
certified nurse practitioner, certified clinical nurse specialist, or physician
assistant; and
(ii)is enrolled in,
or has successfully completed, an accredited program of specialty training in
geriatric medicine, geriatric psychiatry, geropsychology, gerontological social
work, gerontological nursing, or equivalent geriatric care practice (as
determined by the Secretary);
(2)who has obtained
an educational loan for costs associated with graduate training in medicine,
psychology, or social work, or costs associated with becoming a nurse
practitioner, clinical nurse specialist, or physician assistant;
(3)who is
appropriately licensed, without restriction (as determined by the Secretary),
in the State in which the individual practices; and
(4)who agrees to
provide clinical services to older adults for a period of not less than 2 years
in a setting determined appropriate by the Secretary.
(e)Applicability of certain
provisionsWith respect to
the National Health Service Corps Loan Repayment Program established in subpart
III of part D of title III of this Act, the provisions of such subpart shall,
except as inconsistent with this section, apply to the program established in
this section in the same manner and to the same extent as such provisions apply
to the National Health Service Corps Loan Repayment Program.
(f)National
Advisory Council on the Geriatric and Gerontology Loan Repayment
Program
(1)The
Secretary shall establish a National Advisory Council on the Geriatric and
Gerontology Loan Repayment Program (referred to in this section as the
Council
) that shall be composed of not to exceed 11 members to
be appointed by the Secretary.
(2)The
Council shall consult with, advise, and make recommendations to the Secretary
with respect to the Secretary's administration of the program established under
subsection (a).
(3)Administrative
provisionsMembers of the Council shall be appointed for a term
of 3 years and shall be representative of the health professions, and
professional associations, that are eligible to enter into agreements under
this section.
(g)Not
later than 2 years after the date of the enactment of this section, and
annually thereafter, the Secretary shall prepare and submit to the appropriate
committees of Congress a report that describes—
(1)the program
established under this section (including the number and amount of loan
repayments, the number and practice locations of the loan repayment recipients,
the demographics of the individuals participating in the program, the default
rate and actions required upon default, and to the extent that it can be
determined, the reasons for such defaults);
(2)how the program
interacts with other Federal loan repayment programs for primary health care
professionals; and
(3)the overall costs
and benefits of the program.
(h)In
this section:
(1)The
term geriatrics means the branch of medicine that deals with the
problems and diseases of older adults and aging.
(2)The
term gerontology means the multidisciplinary study of the aging
process and individuals as they grow from middle age through later life. Such
term encompasses the social, psychological, biological and economic aspects of
aging.
(3)The term specialty training
means
coursework in geriatrics and gerontology and clinical training, including
internships or fellowships, in a geriatric setting.
(i)Authorization
of appropriationsThere is authorized to be appropriated to carry
out this section, $4,000,000 for fiscal year 2009, $9,500,000 for fiscal year
2010, $16,000,000 for fiscal year 2011, $24,000,000 for fiscal year 2012, and
$30,500,000 for fiscal year
2013.
.
4.Expansion of
nursing education loan repayment programSection 846 of the Public Health Service Act
(42 U.S.C. 297n) is amended—
(1)by redesignating subsection (i) as
subsection (j); and
(2)by inserting
after subsection (h), the following:
(i)Geriatric care
practice in long-term care settings
(1)In providing for loan repayments under this section,
the Secretary shall ensure that eligible individuals include registered nurses
who complete specialty training in geriatrics or gerontology and who elect to
provide nursing services to older adults in home and community-based or
facility-based long-term care settings, or any other program determined
appropriate by the Secretary.
(2)In
this subsection, the term specialty training
means coursework in
geriatrics and gerontology and clinical training, including internships or
fellowships, in a geriatric setting.
(3)Authorization
of appropriationsThere is authorized to be appropriated to carry
out this subsection, $1,500,000 for fiscal year 2009, $3,000,000 for fiscal
year 2010, $5,000,000 for fiscal year 2011, $7,000,000 for fiscal year 2012,
and $8,500,000 for fiscal year
2013.
.
5.Expansion of
career ladder programsSection
831 of the Public Health Service Act (42 U.S.C. 296p) is amended—
(1)in subsection
(c)(1)(A)—
(A)by striking
to promote career
and inserting the following: “to—
(i)promote
career
;
and
(B)by adding at the
end the following:
(ii)focus on
specialty training in providing long-term care services for nursing personnel
(including registered nurses, licensed practical nurses, licensed vocational
nurses, certified nurse assistants, home health aides, personal care
attendants, or any other related worker category designated by the Secretary)
who provide services in home and community-based or facility-based long-term
care settings; and
;
and
(2)in subsection
(h), by adding at the end the following: There is authorized to be
appropriated for grants under subsection (c)(1)(A)(ii), $4,000,000 for fiscal
year 2009, $4,000,000 for each of fiscal years 2010 through 2012, and
$3,500,000 for fiscal year 2013.
.
6.Health and
Long-Term Care Workforce Advisory Panel for an Aging AmericaSubpart 3 of part E of title VII of the
Public Health Service Act (as added by section 2) is further amended by adding
at the end the following:
772.Health and
Long-Term Care Workforce Advisory Panel for an Aging America
(a)The
Secretary, in consultation with the Secretary of Labor, shall establish a
Health and Long-Term Care Workforce Advisory Panel (referred to in this section
as the Panel
) to—
(1)examine workforce
issues related to health and long-term care for the aging population;
and
(2)provide advice to
each such Secretary and to the appropriate committees of Congress concerning
workforce issues related to health and long-term care for the aging
population.
(b)The
Panel shall be composed of not to exceed 20 individuals to be appointed by the
Secretary.
(c)The
Panel shall—
(1)analyze the
existing geriatric health and long-term care workforce data
infrastructure;
(2)make
recommendations for new or additional uniform data elements across regions and
States that is necessary to track supply, demand, and workforce shortages
related to health and long-term care for the aging population;
(3)conduct a
research project to identify incentives for recruitment and retention of new
populations of clinicians and providers who agree to serve vulnerable older
adults in geriatric and long-term care settings and make recommendations for
one or more demonstrations, including the design, implementation and evaluation
of outcomes; and
(4)carry out other
activities determined appropriate by the Secretary.
(d)Focus of
research projectIn carrying out the research project under
subsection (c)(3), the Secretary in consultation with the Panel shall focus on
individuals who are not otherwise eligible for loan repayment incentives under
this title or title VIII, such as retired military clinicians or other retired
health professionals, health care professionals seeking a mid-career change,
and direct care workers in long-term care settings. To carry out such research
project, the Secretary may award grants or contracts. Eligible entities shall
include State or local government, health professions schools, academic health
centers, and other appropriate public or private non-profit entities.
(e)Administrative
provisionsMembers of the Panel shall be appointed for a term of
not to exceed 3 years (as determined by the Secretary at the time of
appointment), shall convene at least twice per year, and shall be
representative of diverse public and private sector expertise and interests,
including representation from the Department of Health and Human Services
(including the Health Resources and Services Administration, the Agency for
Healthcare Research and Quality, and the Administration on Aging), the
Department of Labor (including the Bureau of Labor Statistics, the Employment
and Training Administration, and the Employment Standards Administration),
other Federal officials as the Secretary determines appropriate, academic
institutions, consumer organizations, national aging advocates, health
professional and paraprofessional associations, organized labor,
nationally-recognized researchers in the area of geriatric care and long-term
care workforce issues, health care and long-term care associations (including
those representing home and community-based and facility-based settings), and
private foundations that have sponsored initiatives to expand health
professionals to care for the aging population.
(f)Not
later than 2 years after the date of enactment of this section, and every 2
years thereafter, the Secretary, based on the advice and recommendations of the
Panel, shall submit to the appropriate committees of Congress a report on the
status of the health professions and long-term care workforce for the aging
population.
(g)Authorization
of appropriationsThere is authorized to be appropriated to carry
out this section, $1,500,000 for fiscal year 2009, and such sums as may be
necessary for each of fiscal years 2010 through
2013.
.