[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4445 Introduced in House (IH)]
113th CONGRESS
2d Session
H. R. 4445
To amend the Older Americans Act of 1965 to develop and test an
expanded and advanced role for direct care workers who provide long-
term services and supports to older individuals in efforts to
coordinate care and improve the efficiency of service delivery.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 10, 2014
Mr. Cartwright (for himself, Mr. Grayson, and Ms. Jackson Lee)
introduced the following bill; which was referred to the Committee on
Education and the Workforce
_______________________________________________________________________
A BILL
To amend the Older Americans Act of 1965 to develop and test an
expanded and advanced role for direct care workers who provide long-
term services and supports to older individuals in efforts to
coordinate care and improve the efficiency of service delivery.
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 ``Improving Care for Vulnerable Older
Citizens through Workforce Advancement Act of 2014''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) As of 2012, more than 41,000,000 Americans are age 65
or older. More than 75 percent of them suffer from chronic
conditions which require person-centered, coordinated care that
helps them to live in a home- or community-based setting. In
2012, the Government Accountability Office found that 34
percent of Americans 60 and older reported needing assistance
performing Activities of Daily Living.
(2) Direct-care workers (referred to in this section as
``DCWs'') provide an estimated 70 to 80 percent of the paid
hands-on long-term care and personal assistance received by
elders and people with disabilities or other chronic conditions
in the United States. These workers help their clients bathe,
dress, and negotiate a host of other daily tasks. They are a
lifeline for those they serve, as well as for families and
friends struggling to provide quality care.
(3) Eldercare and disability services positions account for
nearly one-third of the 18,000,000 health care jobs in the
United States. The direct-care workforce alone accounts for
more than 4,000,000 jobs, expected to add 1,600,000 new
positions by 2020.
(4) The majority of DCWs are now employed in home- and
community-based settings, and not in institutional settings
such as nursing care facilities or hospitals. By 2020, home-
and community-based DCWs are likely to outnumber facility
workers by more than 2 to 1.
(5) A 2008 Institute of Medicine report, entitled ``Re-
tooling for an Aging America: Building the Health Care
Workforce'', called for new models of care delivery and
coordination, and dedicated a chapter to the central importance
of the direct-care workforce in a ``re-tooled'' eldercare
delivery system.
(6) An Institute of Medicine report on the future of
nursing, released in October of 2010, recommended nurses should
practice to the full extent of their education and training.
The report also states that all health care professionals
should work collaboratively in team-based models, and that the
goal should be to encourage care models that use every member
of the team to the full capacity of his or her training and
skills.
(7) The Patient Protection and Affordable Care Act (Public
Law 111-148) emphasizes the need for improving care and
lowering costs by better coordination of care and integration
of services, particularly for consumers with multiple chronic
conditions. This will require developing new models of care for
those receiving long-term services and supports.
SEC. 3. DEMONSTRATION PROGRAM ON CARE COORDINATION AND SERVICE
DELIVERY.
Part A of title IV of the Older Americans Act of 1965 (42 U.S.C.
3032 et seq.) is amended by adding at the end the following:
``SEC. 423. DEMONSTRATION PROGRAM ON CARE COORDINATION AND SERVICE
DELIVERY.
``(a) Establishment of Demonstration Program.--
``(1) In general.--The Assistant Secretary shall carry out
a demonstration program in accordance with this section. Under
such program, the Assistant Secretary shall award grants to
eligible entities to carry out demonstration projects that
focus on care coordination and service delivery redesign for
older individuals with chronic illness or at risk of
institutional placement by--
``(A) designing and testing new models of care
coordination and service delivery that thoughtfully and
effectively deploy advanced aides to improve efficiency
and quality of care for frail older individuals; and
``(B) giving direct-care workers opportunities for
career advancement through additional training, an
expanded role, and increased compensation.
``(2) Direct-care worker.--In this section, the term
`direct-care worker' has the meaning given that term in the
2010 Standard Occupational Classifications of the Department of
Labor for Home Health Aides [31-1011], Psychiatric Aides [31-
1013], Nursing Assistants [31-1014], and Personal Care Aides
[39-9021].
``(b) Demonstration Projects.--The demonstration program shall be
composed of 6 demonstration projects, as follows:
``(1) Two demonstration projects shall focus on using the
abilities of direct-care workers to promote smooth transitions
in care and help to prevent unnecessary hospital readmissions.
Under these projects, direct-care workers shall be incorporated
as essential members of interdisciplinary care coordination
teams.
``(2) Two demonstration projects shall focus on maintaining
the health and improving the health status of those with
multiple chronic conditions and long-term care needs. Under
these projects, direct-care workers shall assist in monitoring
health status, ensuring compliance with prescribed care, and
educating and coaching the older individual involved and any
family caregivers.
``(3) Two demonstration projects shall focus on training
direct-care workers to take on deeper clinical responsibilities
related to specific diseases, including Alzheimer's and
dementia, congestive heart failure, and diabetes.
``(c) Eligible Entity.--In this section, the term `eligible entity'
means a consortium that consists of--
``(1) at least 1--
``(A) long-term care and rehabilitation facility;
or
``(B) home personal care service provider; and
``(2) at least 1--
``(A) hospital or health system;
``(B) labor organization or labor-management
partnership;
``(C) community-based aging service provider;
``(D) patient-centered medical home;
``(E) federally qualified health center;
``(F) managed care entity, including a managed
health and long-term care program;
``(G) entity that provides health services
training;
``(H) State-based public entity engaged in building
new roles and related curricula for direct-care
workers; or
``(I) any other entity that the Assistant Secretary
deems eligible based on integrated care criteria.
``(d) Application.--To be eligible to receive a grant under this
section, an eligible entity shall submit to the Assistant Secretary an
application at such time, in such manner, and containing such
information as the Secretary may require, which shall include--
``(1) a description of the care coordination and service
delivery models of the entity, detailed on a general,
organizational, and staff level;
``(2) a description of how the demonstration project
carried out by the entity will improve care quality, including
specific objectives and anticipated outcomes that will be used
to measure success; and
``(3) a description of how the coordinated care team
approach with an enhanced role for the direct-care worker under
the demonstration project will increase efficiency and cost
effectiveness compared to past practice.
``(e) Planning Awards Under Demonstration Program.--
``(1) In general.--Each eligible entity that receives a
grant under this section shall receive a grant for planning
activities related to the demonstration project to be carried
out by the entity, including--
``(A) designing the implementation of the project;
``(B) identifying competencies and developing
curricula for the training of participating direct-care
workers;
``(C) developing training materials and processes
for other members of the interdisciplinary care team;
``(D) articulating a plan for identifying and
tracking cost savings gained from implementation of the
project and for achieving long-term financial
sustainability; and
``(E) articulating a plan for evaluating the
project.
``(2) Amount and term.--
``(A) Total amount.--The amount awarded under
paragraph (1) for all grants shall not exceed $600,000.
``(B) Term.--Activities carried out under a grant
awarded under paragraph (1) shall be completed not
later than 1 year after the grant is awarded.
``(f) Implementation Awards Under Demonstration Program.--
``(1) In general.--Each eligible entity may receive a grant
for implementation activities related to the demonstration
project to be carried out by the entity, if the Assistant
Secretary determines the entity--
``(A) has successfully carried out the activities
under the grant awarded under subsection (e);
``(B) offers a feasible plan for long-term
financial sustainability;
``(C) has constructed a meaningful model of
advancement for direct-care workers; and
``(D) aims to provide training to a sizeable number
of direct-care workers and to serve a sizeable number
of older individuals.
``(2) Use of funds.--The implementation activities
described under paragraph (1) shall include--
``(A) training of all care team members in
accordance with the design of the demonstration
project; and
``(B) evaluating the competency of all staff based
on project design.
``(3) Evaluation and report.--
``(A) Evaluation.--Each recipient of a grant under
paragraph (1), in consultation with an independent
evaluation contractor, shall evaluate--
``(i) the impact of training and deployment
of direct-care workers in advanced roles, as
described in this section, within each
participating entity on outcomes, such as
direct-care worker job satisfaction and
turnover, beneficiary and family caregiver
satisfaction with services, rate of
hospitalization of beneficiaries, and
additional measures determined by the
Secretary;
``(ii) the impact of such training and
deployment on the long-term services and
supports delivery system and resources;
``(iii) statement of the potential of the
use of direct-care workers in advanced roles to
lower cost and improve quality of care in the
Medicaid program; and
``(iv) long-term financial sustainability
of the model used under the grant and the
impact of such model on quality of care.
``(B) Reports.--Not later than 180 days after
completion of the demonstration program under this
section, each recipient of a grant under paragraph (1)
shall submit to the Secretary a report on the
implementation of activities conducted under the
demonstration project, including--
``(i) the outcomes, performance benchmarks,
lessons learned from the project;
``(ii) a statement of cost savings gained
from implementation of the project and how the
cost savings have been reinvested to improve
direct-care job quality and quality of care;
and
``(iii) results of the evaluation conducted
under subparagraph (A) with respect to such
activities, together with such recommendations
for legislation or administrative action for
expansion of the demonstration program on a
broader scale as the Secretary determines
appropriate.
``(4) Amount and term.--
``(A) Total amount.--The amount awarded under
paragraph (1) for all grants shall not exceed
$2,900,000.
``(B) Term.--Activities carried out under a grant
awarded under paragraph (1) shall be completed not
later than 3 years after the grant is awarded.''.
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