Improving Care for Vulnerable Older Citizens and People with Disabilities through Workforce Advancement Act of 2021
This bill establishes demonstration projects to improve care and service delivery through the use of direct care workers (e.g., nursing assistants and home health aides) for older adults and individuals with disabilities who have chronic illness or are at risk of institutional placement.
The Health Resources and Services Administration (HRSA) must award grants to partnerships of health care providers, long-term care facilities, and other organizations to carry out the projects.
Specifically, HRSA must award grants for incorporating direct care workers into interdisciplinary care coordination teams to support transitions in care and prevent unnecessary hospital readmissions. HRSA must also award grants for (1) using the abilities of direct care workers to manage and improve the health of individuals with multiple chronic conditions and long-term care needs; or (2) training direct care workers to take on greater responsibilities in managing specific diseases, such as Alzheimer's disease and diabetes.
To amend the Public Health Service Act to develop and test an expanded 
    and advanced role for direct-care workers who provide long-term 
 services and supports to older adults and people with disabilities in 
   efforts to coordinate care and improve the efficiency of service 
                   delivery, and for other purposes.

    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 and People with Disabilities through Workforce Advancement Act 
of 2021''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) As of 2019, more than 54,000,000 Americans were age 65 
        or older. By 2030, the Census Bureau projects that one in five 
        Americans will be 65 or older. More than 80 percent of older 
        Americans 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 (GAO) found that 34 percent of Americans 
        who are age 60 or older reported needing assistance performing 
        activities of daily living. According to a 2015 GAO report, 
        between 67 and 78 percent of older adults who likely need home-
        based care receive limited or no help with their difficulties.
            (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 range of other daily tasks. They are a 
        lifeline for those they serve, as well as for families and 
        friends struggling to provide high-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 
        nearly 4,600,000 jobs and is expected to add nearly 1,300,000 
        new positions within the next decade.
            (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. In 2019, DCWs 
        providing home-based care already outnumbered DCWs in nursing 
        homes by more than 4 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 2016, 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 has required developing new models of care for 
        those receiving long-term services and supports.

SEC. 3. DEMONSTRATION PROGRAM ON CARE COORDINATION AND SERVICE 
              DELIVERY.

    Title III of the Public Health Service Act is amended by inserting 
after section 330N of such Act (42 U.S.C. 254c-20) the following:

``SEC. 330O. DEMONSTRATION PROGRAM ON CARE COORDINATION AND SERVICE 
              DELIVERY.

    ``(a) Establishment of Demonstration Program.--
            ``(1) In general.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration, shall carry out a demonstration program in 
        accordance with this section. Under such program, the Secretary 
        shall award grants to eligible entities to carry out 
        demonstration projects that focus on care coordination and 
        service delivery redesign for older adults and people with 
        disabilities who have chronic illness or are at risk of 
        institutional placement by--
                    ``(A) designing and testing new models of care 
                coordination and service delivery that thoughtfully and 
                effectively deploy direct-care workers in advanced 
                roles to improve efficiency and quality of care for 
                older adults and people with disabilities; 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 under this 
section shall be composed of 4 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 or on 
        training direct-care workers to take on greater 
        responsibilities related to specific diseases, including 
        Alzheimer's disease and dementia, congestive heart failure, and 
        diabetes. Under these projects, direct-care workers shall 
        assist in monitoring health status, ensuring compliance with 
        prescribed care, and educating and coaching the older adults 
        and people with disabilities involved, as well as any family 
        caregivers and other members of the care team.
    ``(c) Eligible Entity.--In this section, the term `eligible entity' 
means a consortium that consists of--
            ``(1) at least 1--
                    ``(A) skilled nursing facility or other residential 
                long-term care provider; or
                    ``(B) home health and 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 and disability services 
                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 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 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, encompassing workforce outcomes, care 
                outcomes, and cost outcomes.
            ``(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 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 adults and people with disabilities.
            ``(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; 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, 
                        and 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 under 
                        this section 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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Improving Care for Vulnerable Older Citizens and People with Disabilities through Workforce Advancement Act of 2021
To amend the Public Health Service Act to develop and test an expanded and advanced role for direct-care workers who provide long-term services and supports to older adults and people with disabilities in efforts to coordinate care and improve the efficiency of service delivery, and for other purposes.
Improving Care for Vulnerable Older Citizens and People with Disabilities through Workforce Advancement Act of 2021
Rep. Cartwright, Matt