S 2708
110th CONGRESS
2d Session
S. 2708
To amend the Public Health Service Act to attract and retain
trained health care professionals and direct care workers dedicated
to providing quality care to the growing population of older Americans.
IN THE SENATE OF THE UNITED STATES
March 5, 2008
Mrs. BOXER introduced the following bill; which was read twice and
referred to the Committee on Health, Education, Labor, and Pensions
A BILL
To amend the Public Health Service Act to attract and retain
trained health care professionals and direct care workers dedicated
to providing quality care to the growing population of older Americans.
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 `Caring for an Aging America Act of 2008'.
SEC. 2. FINDINGS.
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.
SEC. 3. GERIATRIC AND GERONTOLOGY LOAN REPAYMENT PROGRAM.
Part 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:
`Subpart 3--Strengthening Recruitment and Retention for Geriatric
Care Practice
`SEC. 771. GERIATRIC AND GERONTOLOGY LOAN REPAYMENT PROGRAM.
`(a) Establishment- 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) Contracts- 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 Service- In 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) Eligible Individuals- An individual described in this subsection
is an individual--
`(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
`(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 Provisions- With 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) ESTABLISHMENT- 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) DUTIES- 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 PROVISIONS- Members 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) Reports- 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) Definition- In this section:
`(1) GERIATRICS- The term `geriatrics' means the branch of medicine
that deals with the problems and diseases of older adults and aging.
`(2) GERONTOLOGY- 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) SPECIALTY TRAINING- The term `specialty training' means coursework
in geriatrics and gerontology and clinical training, including internships
or fellowships, in a geriatric setting.
`(i) Authorization of Appropriations- There 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.'.
SEC. 4. EXPANSION OF NURSING EDUCATION LOAN REPAYMENT PROGRAM.
Section 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) LOAN REPAYMENTS- 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) DEFINITION- 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 APPROPRIATIONS- There 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.'.
SEC. 5. EXPANSION OF CAREER LADDER PROGRAMS.
Section 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.'.
SEC. 6. HEALTH AND LONG-TERM CARE WORKFORCE ADVISORY PANEL FOR AN
AGING AMERICA.
Subpart 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:
`SEC. 772. HEALTH AND LONG-TERM CARE WORKFORCE ADVISORY PANEL FOR
AN AGING AMERICA.
`(a) Establishment- 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) Membership- The Panel shall be composed of not to exceed 20 individuals
to be appointed by the Secretary.
`(c) Duties- 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 Project- In 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 Provisions- Members 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) Reports- 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 Appropriations- There 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.'.
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