[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 3732 Introduced in Senate (IS)]
110th CONGRESS
2d Session
S. 3732
To assist in creating substantive culture change in long-term
residential care by establishing a small house nursing home loan
program to provide for the establishment, renovation, and construction
of small house nursing homes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
December 11 (legislative day, December 10), 2008
Mr. Casey introduced the following bill; which was read twice and
referred to the Committee on Banking, Housing, and Urban Affairs
_______________________________________________________________________
A BILL
To assist in creating substantive culture change in long-term
residential care by establishing a small house nursing home loan
program to provide for the establishment, renovation, and construction
of small house nursing homes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Promoting Small House Nursing Homes
Act''.
SEC. 2. SMALL HOUSE NURSING HOME LOAN PROGRAM.
(a) Establishment.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall establish a small
house nursing home loan program (in this section referred to as the
``program'') under which the Secretary makes grants to eligible lenders
in order for such eligible lenders to make direct loans to eligible
borrowers for the establishment, renovation, and construction of small
house nursing homes that meet the requirements of this section.
(b) Eligibility.--
(1) Program grant eligibility.--To be eligible to obtain a
grant under the program, an eligible lender shall--
(A) be a nonprofit, non-Federal lender;
(B) have a track record of lending to small house
nursing homes, low income populations, or nursing homes
that serve low income populations; and
(C) submit to the Secretary an application in such
form as the Secretary may reasonably require.
(2) Small house advisory panel.--
(A) In general.--Not later than 90 days after the
date of enactment of this Act, the Secretary shall
establish an advisory panel (in this section referred
to as the ``Small House Advisory Panel'') to--
(i) evaluate applications for direct loans
under the program in conjunction with eligible
lenders; and
(ii) carry out other responsibilities
determined appropriate by the Secretary.
(B) Membership.--The Small House Advisory Panel
shall consist of not less than 5 and not more than 7
individuals who have expertise in the areas of person-
centered long-term care culture change, long-term care
financing, consumers, and direct care workers.
(3) Evaluation of eligible borrower applicants.--
(A) Establishment of evaluation tool and
criteria.--
(i) In general.--The Secretary, in
collaboration with the Small House Advisory
Panel, shall establish an evaluation tool and
evaluation criteria with which to prioritize
eligible borrowers who submit to an eligible
lender an application for a direct loan under
the program.
(ii) Evaluation tool.--The evaluation tool
established under subparagraph (A) shall be
based upon the model guideline priorities under
subsection (c)(5).
(iii) Prioritization of eligible
borrowers.--Eligible borrowers shall be
prioritized under the program in accordance
with the extent to which they meet such model
guideline priorities.
(B) Evaluation of applications and
recommendations.--
(i) In general.--Applications for a direct
loan under the program shall be evaluated by
the Secretary, in collaboration with the Small
House Advisory Panel.
(ii) Recommendations.--The Secretary shall
establish procedural guidelines under which any
recommendations of the Secretary for making
direct loans shall be provided to eligible
lenders.
(4) Loan eligibility.--To be eligible for a direct loan
from an eligible lender under the program, an eligible borrower
shall be a private or public nonprofit entity or a for-profit
entity that--
(A) agrees to use the proceeds from such direct
loan to construct or renovate a small house nursing
home that--
(i) is designed to establish substantive
culture change; and
(ii) meets the model small house nursing
home requirements and guidelines under
subsection (c);
(B) submits a detailed plan describing--
(i) the particular model or approach to
person-centered care that the small house
nursing home will implement; and
(ii) how the small house nursing home will
meet such model small house nursing home
requirements and guidelines;
(C) has been approved by a State or local entity
(in accordance with applicable State and local law) to
operate a skilled nursing facility (as defined in
section 1819(a) of the Social Security Act (42 U.S.C.
1395i-3(a)) or a nursing facility (as defined in
section 1919(a) of such Act (42 U.S.C. 1396r(a)));
(D) with respect to the facility, ensures that at
least 30 percent of the residents of the facility are
Medicaid-funded individuals under title XIX of the
Social Security Act (42 U.S.C. 1396 et seq.), as
determined in accordance with guidelines to be issued
by the Secretary that take into consideration the
number of days such residents spend in the facility,
and does not discharge residents based on their ability
to pay;
(E) complies with lending standards developed, in
consultation with the Secretary, by a task force of
experts in long-term care financing, affordable housing
with services development, and nontraditional lending;
and
(F) agrees to share financial and operating data
with researchers and Federal agencies designated by the
Secretary.
(5) Loan disqualification.--In no case may an entity which
has displayed a pattern of failing to comply with State and
Federal quality of care standards (as determined by the
Secretary) or an entity with a pattern of violating State and
Federal labor laws (as determined by the Secretary) be an
eligible borrower under the program.
(c) Model Small House Nursing Home Requirements and Guidelines.--
(1) In general.--
(A) Development.--Not later than 90 days after the
date of enactment of this Act, the Secretary shall
develop model small house nursing home guidelines that
meet the requirements of this subsection.
(B) Consistency with requirements applicable under
the social security act.--The guidelines established
under subparagraph (A) shall be consistent with, and in
addition to, any requirements applicable to an eligible
borrower under sections 1819 and 1919 of the Social
Security Act (42 U.S.C. 1395i-3; 1396r).
(2) Practice research and implementation.--
(A) In general.--Under the guidelines under
paragraph (1), a small house nursing home that obtains
proceeds from a direct loan made under this section
shall be based on methods and practices that have been
tested through pilot programs and other research
carried out at not less than 1 implementation site in
the United States for at least a 2-year period.
(B) Improvements in quality of life.--Pilot
programs and research referred to in subparagraph (A)
shall be designed to establish a clearly articulated,
evidence-based approach to creating improvements in the
quality of life and care outcomes of residents of small
house nursing homes as well as providing for
improvements in the professional satisfaction and
career development of the staff of small house nursing
homes.
(C) Research requirement.--Research referred to in
subparagraph (A) shall be conducted by a researcher--
(i) who has expertise in long-term care;
and
(ii) who has no financial or professional
interests in the success of the methods or
practices involved.
(3) Requirements of small house nursing homes.--Under the
guidelines developed under paragraph (1), a small house nursing
home that obtains proceeds from a direct loan made under this
section shall--
(A) establish a self-directed model of care for
residents that incorporates collaborative
decisionmaking by residents and nursing assistants;
(B) provide for a universal worker approach to
resident care (including care available from a nursing
assistant, personal care, socialization services, meal
preparation services, and laundry housekeeping
services) that is organized to support and empower all
staff to respond to the needs and desires of residents;
(C) provide for consistent staff assignments;
(D) consist of a physical environment designed as a
home, rather than an institution--
(i) that contains residential style design
elements and materials throughout the home that
are similar to the residential style design
elements and materials in the immediate
surrounding community, including residential
style design elements in areas that have mixed-
zoning purposes, and do not use commercial and
institutional elements and products (such as a
nurses' station, medication carts, hospital or
office type florescent lighting, acoustical
tile ceilings, institutional style railings and
corner guards, and room numbering and labeling)
unless mandated by authorities with appropriate
jurisdiction over the small house nursing home;
(ii) which is designed to be a fully
independent and disabled accessible house,
apartment, or independent wing of an existing
structure with not more than 25 residents in
the house, apartment, or independent wing;
(iii) that contains a full private bathroom
for each bedroom that, at a minimum, provides a
toilet, sink, and accessible shower;
(iv) which has a life-safety rating that is
sufficient to appropriately accommodate
individuals who cannot self-evacuate; and
(v) in which the percentage of residents of
the small house nursing home who are short stay
rehabilitation residents does not exceed 20
percent at any time unless the small house
nursing home is entirely devoted to providing
rehabilitation services, except that a long-
term resident returning to a small house
nursing home after an acute episode and who is
receiving rehabilitation services for which
payment is made under the Medicare program
under title XVIII of the Social Security Act
shall not be counted toward such 20 percent
limitation;
(E) provide for meals cooked in the small house
nursing home and not prepared in a central kitchen and
transported to the small house nursing home; and
(F) provide for the training of staff in accordance
with paragraph (4).
(4) Training of staff.--
(A) In general.--Under the guidelines under
paragraph (1), a small house nursing home that obtains
proceeds from a direct loan made under this section
shall provide training for all staff involved in the
operations of the small house nursing home concerning
the philosophy, operations, and skills required to
implement and maintain self-directed care, self-managed
work teams, a noninstitutional approach to life and
care in long-term care, appropriate safety and
emergency skills, and other elements required for the
successful operation of and outcomes in the small house
nursing home.
(B) Collaboration.--
(i) In general.--Training under
subparagraph (A) shall be interdisciplinary and
collaborative.
(ii) Collective bargaining.--
(I) In general.--In the case where
staff involved in the operations of the
small house nursing home are
represented by a collective bargaining
organization, the organization shall be
provided an opportunity to fully
participate in the development of a
program for providing such training.
(II) Prioritization.--In the case
where there is an existing jointly
funded employer-labor training
partnership, or where a training
program is funded through collective
bargaining, the small house nursing
home shall prioritize the utilization
of or collaboration with those existing
training programs in meeting the
requirements of this paragraph.
(C) Amount.--Training under subparagraph (A) shall
be not less than 120 hours for each universal worker
employed by the small house nursing home and not less
than 60 hours for each leadership and clinical team
member employed by such small house nursing home. Such
training shall be in addition to any other State
training requirements and shall be completed for the
majority of the staff prior to the initial start-up of
the small house nursing home.
(5) Model guideline priorities for loan applicants.--An
eligible borrower applying for a direct loan under this section
shall be given priority in evaluation of loan applications in
proportion to their compliance with 1 or more of the following
model guidelines:
(A) Residential model priorities.--Priority in
evaluation for loan eligibility shall be given to small
house nursing home models that--
(i) have private, single occupancy bedrooms
that are shared only at the request of a
resident to accommodate a spouse, partner,
family member, or friend;
(ii) contain a living area where residents
and staff may socialize, dine, and prepare food
together that, at a minimum, provides a living
room seating area, a dining area large enough
for a single table serving all residents and
not less than 2 staff members, and an open full
kitchen;
(iii) contain ample natural light in each
habitable space that is provided through
exterior windows and other means, with window
areas, exclusive of skylights and clearstories,
being a minimum of 10 percent of the area of
the room; and
(iv) have built-in safety features to allow
all areas of the house to be accessible to the
residents during the majority of the day and
night.
(B) Direct care worker model priorities.--Priority
in evaluation for loan eligibility shall be given to
small house nursing home model operators that have a
legally binding collective bargaining agreement and a
signed labor-management partnership agreement covering
the planning and implementation of small house nursing
homes. Where employees are represented by a labor
organization, a signed labor management implementation
agreement will be required.
(d) Loan Provisions.--
(1) In general.--Except as otherwise provided in this
subsection, each direct loan made under this section shall be
subject to such terms, conditions, and covenants relating to
repayment of principal, payment of interest, and other matters
as may be established by the eligible lender.
(2) Maximum loan amount.--The Secretary, in consultation
with the Small House Advisory Panel, shall determine the
maximum amount of any direct loan made under this section.
(3) Rate of interest.--A direct loan made under this
section shall bear interest at an annual rate of not more than
3 percent, or as determined by the Secretary.
(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $50,000,000 for each of fiscal
years 2009 through 2013. Amounts appropriated under this subsection
shall be available until expended.
(f) Termination.--The program shall terminate, and no loan may be
made under this section, on or after the date that is 25 years after
the date on which amounts are initially appropriated under subsection
(e).
SEC. 3. REPORT.
Not later than 5 years after the date of enactment of this Act, the
Secretary of Health and Human Services shall submit to the appropriate
committees of Congress a report on the small house nursing home loan
program established under section 2(a). Such report shall include
information on--
(1) the use of direct loans made under the program to
establish, renovate, and construct small house nursing homes
that meet the requirements of section 2;
(2) the quality of health care, quality of life, emotional
well-being, ability to perform functions of daily living, and
other outcomes found for residents of small house nursing
homes, as compared to such outcomes found for residents of
traditional nursing homes; and
(3) staff wages, retention, and absenteeism rates, measures
of staff satisfaction, and workload and staffing levels for
small house nursing homes, as compared to traditional nursing
homes.
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