S.Amdt. 534

SA 534. Mr. WYDEN (for himself and Mr. Kohl) submitted an amendment
intended to be proposed to amendment SA 98 proposed by Mr. Inouye (for
himself and Mr. Baucus) to the bill H.R. 1, making supplemental
appropriations for job preservation and creation, infrastructure
investment, energy efficiency and science, assistance to the
unemployed, and State and local fiscal stabilization, for fiscal year
ending September 30, 2009, and for other purposes; which was ordered to
lie on the table; as follows:

On page 698, after line 25, insert the following:

SEC. 4204A. LONG-TERM CARE WORKER RECRUITMENT AND INVESTMENT
DEMONSTRATION PROGRAM.

(a) Findings.--Congress makes the following findings:
(1) Meeting the health needs of baby boomers will create
new jobs for individuals trained in geriatric care, in
addition to meeting the current high demand for such
individuals.
(2) Direct care workers, nurse aides, home health aides,
and personal and home care aides are the primary providers of
paid hands-on care, supervision, and emotional support for
older adults in the United States.
(3) The Bureau of Labor Statistics of the Department of
Labor predicts that personal or home care aides and home
health aides will represent the second and third fastest-
growing occupations between 2006 and 2016. In spite of such
growth, personal or home care aides are not subject to any
Federal requirements related to training or education, and
States have very different requirements for personal or home
care aides.
(4) The Institute of Medicine report, entitled ``Retooling
for an Aging America'' described direct care workers, nurse
aides, home health aides, and personal and home care aides as
the linchpin of the formal health care delivery system for
older adults.
(5) Research shows that inadequate training is a major
contributor to high turnover rates among direct care workers
and that more training is correlated with better staff
recruitment and retention rates.
(6) The Institute of Medicine recommends that State
Medicaid programs increase pay and fringe benefits for direct
care workers.
(7) Investment in these jobs would benefit the economy in
multiple ways, such as providing more income and greater
economic opportunity to low-income workers and strengthening
health services for aging and disabled populations in the
United States.
(b) Establishment.--
(1) In general.--The Secretary shall establish a
demonstration program (in this section referred to as the
``program'') to make grants to States to evaluate recruitment
and retention strategies (including wage enhancements) for
personal or home care aides, nurse aides, and home health
aides (in this section referred to as ``recruitment and
retention activities'') and, separately, to develop core
training competencies for eligible personal or home care
aides and additional training content for nurse aides and
home health aides to supplement training for nurse aides and
home health aides that is required under Federal law or
regulation, including an evaluation of the effectiveness of

[[Page S1869]]

such competencies and additional training content (in this
section referred to as ``competencies and additional training
content activities''. Under such programs, the Secretary, in
consultation with the expert panel established under
subsection (c)(1), shall--
(A) with respect to recruitment and retention activities,
select recruitment and retention strategies (including wage
enhancements) for personal or home care aides, nurse aides,
and home health aides for evaluation under the program,
provide technical assistance to States in implementing the
strategies selected, and evaluate the impact of such
strategies on the recruitment and retention of personal or
home care aides, nurse aides, and home health aides in
accordance with subsection (e)(1)(A); and
(B) with respect to competencies and additional training
content activities, evaluate the efficacy of the core
training competencies developed under subsection (c)(2)(B),
the additional training content developed under subsection
(c)(2)(C), and the method of implementation of such core
training competencies and additional training content in
accordance with subsection (e)(1)(B).
(2) Duration.--The program shall be conducted for not less
than 3 years with respect to each of the recruitment and
retention activities and the competencies and additional
training content activities.
(3) Implementation.--
(A) Recruitment and retention activities.--The Secretary
shall, in consultation with the expert panel, implement the
program with respect to recruitment and retention activities
not later than 1 year after the date of enactment of this
Act.
(B) Core training competencies.--The Secretary shall, in
consultation with the expert panel, implement the program
with respect to competencies and additional training content
activities not later than 18 months after such date of
enactment.
(c) Establishment of Expert Panel.--
(1) In general.--Not later than 90 days after the date of
enactment of this Act, the Secretary shall establish a panel
of long-term care workforce experts (in this section referred
to as the ``expert panel'').
(2) Duties.--The expert panel shall carry out the following
duties:
(A) Provide advice to the Secretary on recruitment and
retention activities, as requested by the Secretary.
(B)(i) Subject to clause (ii), developing core training
competencies for personal or home care aides, including such
competencies with respect to the following areas:
(I) The role of the personal or home care aide (including
differences between a personal or home care aide employed by
an agency and a personal or home care aide employed directly
by the health care consumer or an independent provider).
(II) Consumer rights, ethics, and confidentiality
(including the role of proxy decision-makers in the case
where a health care consumer has impaired decision-making
capacity).
(III) Communication, cultural and linguistic competence and
sensitivity, problem solving, behavior management, and
relationship skills.
(IV) Personal care skills.
(V) Health care support.
(VI) Nutritional support.
(VII) Infection control.
(VIII) Safety and emergency training.
(IX) Training specific to an individual consumer's needs
(including older individuals, younger individuals with
disabilities, individuals with developmental disabilities,
individuals with dementia, and individuals with mental and
behavioral health needs).
(X) Self-Care.
(ii) For purposes of the program with respect to
competencies and additional training content activities, the
core training competencies developed under clause (i) shall
only apply with respect to newly hired personal or home care
aides.
(C)(i) Subject to clause (ii), developing additional
training content for home health aides and nurse aides which
is not required under Federal law as of the date of enactment
of this Act, including such content with respect to the
following areas:
(I) Culturally and linguistically competent practice.
(II) Standardized direct care worker communication
protocols (such as Situation, Background, Assessment, and
Recommendation communication tools).
(III) Palliative and end-of-life care.
(IV) Injury prevention.
(V) Wound and decubitus care.
(VI) Medication management, adherence, and safe disposal.
(VII) Mental and behavioral health.
(VIII) Additional aspects of dementia care training (such
as understanding dementia and Alzheimer's disease, dealing
with challenging behavior, developing communication skills,
working with family caregivers, and ensuring physical health
and safety).
(IX) Prevention and reporting of abuse and caregiver
burnout.
(ii) For purposes of the program with respect to
competencies and additional training content activities, the
additional training content developed under clause (i) shall
only apply with respect to newly hired home health aides and
nurse aides.
(D)(i) Subject to clause (ii), making recommendations
regarding how training shall be provided under the program
with respect to competencies and additional training content
activities, including recommendations with respect to the
following:
(I) The length of the training.
(II) The appropriate trainer to student ratio.
(III) The amount of instruction time spent in the classroom
as compared to on-site in the home or a facility.
(IV) Trainer qualifications.
(V) Content for a ``hands-on'' and written certification
exam.
(VI) Continuing education requirements.
(VII) Ways to integrate the core training competencies
developed for personal and home care aides under subparagraph
(A) with the additional training content developed for home
health aides and nurse aides under subparagraph (B).
(ii) The recommendations under clause (i) shall ensure that
the number of hours of training provided under the program
with respect to competencies and additional training content
activities are not less than the number of hours of training
required under any applicable State or Federal law or
regulation.
(3) Membership.--
(A) In general.--Subject to subparagraph (B), the expert
panel shall be composed of 11 members appointed by the
Secretary from among leading experts in the long-term care
field, including representatives of--
(i) personal or home care agencies;
(ii) home health care agencies;
(iii) nursing homes and residential care facilities;
(iv) the disability community (including the mental
retardation and developmental disability communities);
(v) the nursing community;
(vi) national advocacy organizations and unions that
represent direct care workers;
(vii) older individuals and family caregivers;
(viii) State Medicaid waiver program officials;
(ix) curriculum developers with expertise in adult
learning;
(x) researchers on direct care workers and the long-term
care workforce; and
(xi) geriatric pharmacists.
(B) Inclusion of representatives of certain individuals.--
Not less than 2 of the 11 members appointed by the Secretary
under subparagraph (A) shall represent the interests of
individuals who rely on long-term care services, including
the interests of those individuals described in clause (vii)
of such subparagraph.
(4) Report.--Not later than 1 year after the date of
enactment of this Act, the expert panel shall submit to the
Secretary a report containing--
(A) any advice on recruitment and retention activities
provided under paragraph (2)(A);
(B) the core training competencies developed under
paragraph (2)(B);
(C) the additional training content developed under
paragraph (2)(C);
(D) any recommendations of the expert panel under paragraph
(2)(D); and
(E) recommendations for such legislation or administrative
action as the expert panel determines appropriate.
(5) Termination.--The expert panel shall terminate 180 days
after it submits the report under paragraph (4).
(d) Application and Selection Criteria.--
(1) In general.--
(A) Solicitation.--
(i) Recruitment and retention activities.--Not later than 6
months after the date of enactment of this Act, the Secretary
shall issue a proposal soliciting States to voluntarily
participate in the program with respect to recruitment and
retention activities.
(ii) Core training competencies.--Not later than 18 months
after such date of enactment, the Secretary shall issue a
proposal soliciting States to voluntarily participate in the
program with respect to competencies and additional training
content activities.
(B) Agreements.--
(i) Recruitment and retention activities.--The Secretary
shall enter into agreements with not more than 6 States to
conduct the program in such States with respect to
recruitment and retention activities.
(ii) Core training competencies.--The Secretary shall enter
into agreements with not more than 6 States (in addition to
those States the Secretary enters into an agreement with
under clause (i)) to conduct the program in such States with
respect to competencies and additional training content
activities.
(C) Requirements for states.--An agreement entered into
under subparagraph (B) shall require that a participating
State--
(i) use grant funds made available to the State under the
program to recruit eligible health and long-term care
providers to participate in the program; and
(ii) in the case of an agreement entered into under
subparagraph (B)(ii)--

(I) implement the core training competencies developed
under subsection (c)(2)(B) and the additional training
content developed under subsection (c)(2)(C); and
(II) develop written materials and protocols for such core
training competencies and such additional training content,
including the development of a certification test for
personal or home care aides who have completed such training
competencies and, if applicable, additional training content.

(D) Consultation and collaboration with community and
vocational colleges.--The Secretary shall encourage
participating States to consult with community and vocational
colleges regarding the development of

[[Page S1870]]

curricula to implement the program with respect to
activities, as applicable, which may include consideration of
such colleges as partners in such implementation.
(2) Application and eligibility.--A State seeking to
participate in the program shall--
(A) submit an application to the Secretary containing such
information and at such time as the Secretary may specify;
(B) meet the selection criteria established under paragraph
(3); and
(C) meet such additional criteria as the Secretary may
specify.
(3) Selection criteria.--In selecting States to participate
in the program, the Secretary shall establish criteria to
ensure (if applicable with respect to the activities
involved)--
(A) geographic and demographic diversity;
(B) that participating States offer medical assistance for
personal care services under the State Medicaid plan;
(C) that the existing training standards for personal or
home care aides, home health aides, and nurse aides in each
participating State--
(i) are different from such standards in the other
participating States; and
(ii) are different from the core training competencies
developed under subsection (c)(2)(B) and the additional
training content developed under subsection (c)(2)(C);
(D) that participating States do not reduce the number of
hours of training required under applicable State law or
regulation after being selected to participate in the
program; and
(E) that participating States recruit a minimum number of
eligible health and long-term care providers to participate
in the program.
(4) Technical assistance.--The Secretary shall provide
technical assistance to States in developing written
materials and protocols for such core training competencies
and such additional training content under paragraph
(1)(C)(ii)(II).
(e) Evaluation and Report.--
(1) Evaluation.--The Secretary shall develop an
experimental or control group testing protocol in
consultation with an independent evaluation contractor
selected by the Secretary. Such testing protocol shall be
developed separately under the program with respect to the
evaluation of recruitment and retention activities and
competencies and additional training content activities. Such
contractor shall evaluate--
(A) with respect to recruitment and retention activities,
the impact of such activities within each participating State
on the recruitment and retention of personal or home care
aides, nurse aides, and home health aides; and
(B) with respect to competencies and additional training
content activities--
(i) the impact of core training competencies developed
under subsection (c)(2)(B), including curricula developed to
implement such core training competencies, for personal or
home care aides within each participating State on job
satisfaction, mastery of job skills, beneficiary and family
caregiver satisfaction with services, and additional measures
determined by the Secretary in consultation with the expert
panel;
(ii) the impact of incorporating the additional training
content developed under subsection (c)(2)(C) into existing
training standards for home health aides and certified nurse
aides within each participating State;
(iii) the impact of providing such core training
competencies and additional training content on the existing
training infrastructure and resources of States;
(iv) whether the minimum number of hours of initial
training required for nurse aides under sections
1819(f)(2)(A)(i)(II) and 1919(f)(2)(A)(i)(II) of the Social
Security Act (42 U.S.C. 1395i-3(f)(2)(A)(i)(II);
1396r(f)(2)(A)(i)(II)) should be increased; and
(v) whether a minimum number of hours of initial training
should be required for personal or home care aides and, if
so, what minimum number of hours should be required.
(2) Reports.--
(A) Report on initial implementation of recruitment and
retention activities.--Not later than 2 years after the date
of enactment of this Act, the Secretary shall submit to
Congress a report on the initial implementation of
recruitment and retention activities under the program,
including the results of any evaluations conducted under
paragraph (1)(A) with respect to such activities, together
with such recommendations for legislation or administrative
action as the Secretary determines appropriate.
(B) Final report.--Not later than 1 year after the
completion of the program, the Secretary shall submit to
Congress a report containing the results of the evaluations
conducted under subparagraphs (A) and (B) of paragraph (1),
together with such recommendations for legislation or
administrative action as the Secretary determines
appropriate.
(f) Funding.--
(1) In general.--Out of any funds in the Treasury not
otherwise appropriated, there are appropriated to the
Secretary to carry out the program under this section for the
period of fiscal years 2010 through 2015, $44,000,000.
(2) Transfer of unused funding to medicare improvement
fund.--Any funds appropriated under paragraph (1) that are
not obligated as of September 31, 2015, shall be transferred
to the Medicare Improvement Fund established under section
1898 of the Social Security Act (42 U.S.C. 1395iii) on that
date and shall be available for expenditure from the Medicare
Improvement Fund during the period that begins on that date
and ends on the last day on which funds are available for
obligation in that Fund.
(g) Definitions and Inclusion of Providers Under Medicare
and Medicaid Programs.--
(1) Definitions.--In this section:
(A) Eligible health and long-term care provider.--The term
``eligible health and long-term care provider'' means a
personal or home care agency (including personal or home care
public authorities), a nursing home, a home health agency (as
defined in section 1861(o)) of the Social Security Act (42
U.S.C. 1395x(o)), or any other health care provider the
Secretary determines appropriate which--
(i) is licensed or authorized to provide services in a
participating State; and
(ii) receives payment for services under title XVIII or XIX
of the Social Security Act.
(B) Home health aide.--The term ``home health aide'' has
the meaning given such term in section 1891(a)(3)(E) of the
Social Security Act (42 U.S.C. 1395bbb(a)(3)(E)).
(C) Nurse aide.--The term ``nurse aide'' has the meaning
given such term in section 1819(b)(5)(F) of the Social
Security Act (42 U.S.C. 1395i-3(b)(5)(F)).
(D) Personal care services.--The term ``personal care
services'' has the meaning given such term for purposes of
title XIX of the Social Security Act (42 U.S.C. 1396 et
seq.).
(E) Personal or home care aide.--The term ``personal or
home care aide'' means an individual who helps individuals
who are elderly, disabled, ill, or mentally disabled
(including an individual with Alzheimer's disease or other
dementia) to live in their own home or a residential care
facility (such as a nursing home, assisted living facility,
or any other facility the Secretary determines appropriate)
by providing routine personal care services and other
appropriate services to the individual.
(F) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(2) Inclusion of providers under medicare and medicaid
programs.--For purposes of the program, the terms ``home
health aide'', ``nurse aide'', and ``personal or home care
aide'' include such individuals who provide services under
title XVIII or XIX of the Social Security Act.
______