,i #aacth ,,congress #b;d ,session ,h4 ,r4 #ddde ,,in ,,the ,,house ,,of ,,representatives ,april #aj1 #bjad ,mr4 ,cartwright 7for himself1 ,mr4 ,grayson1 and ,ms4 ,jackson ,lee7 introduced the following bill2 which was referred to the ,committee on ,education and the ,workforce ,a ,,bill ,to amend the ,older ,americans ,act of #aife 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 delivery4 #a4 ,short title ,this ,act may be cited as the ,improving ,care for ,vulnerable ,older ,citizens through ,workforce ,advancement ,act of #bjad4 #b4 ,findings ,congress finds the following3 7#a7 ,as of #bjab1 more than #da1jjj1jjj ,americans are age #fe or older4 ,more than #ge percent of them suffer from chronic conditions which require person-centered1 coordinated care that helps them to live in a home- or community-based setting4 ,in #bjab1 the ,government ,accountability ,office found that #cd percent of ,americans #fj and older reported needing assistance performing ,activities of ,daily ,living4 7#b7 ,direct-care workers 7referred to in this section as ,d,c,ws7 provide an estimated #gj to #hj 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 ,states4 ,these workers help their clients bathe1 dress1 and negotiate a host of other daily tasks4 ,they are a lifeline for those they serve1 as well as for families and friends struggling to provide quality care4 7#c7 ,eldercare and disability services positions account for nearly one-third of the #ah1jjj1jjj health care jobs in the ,united ,states4 ,the direct-care workforce alone accounts for more than #d1jjj1jjj jobs1 expected to add #a1fjj1jjj new positions by #bjbj4 7#d7 ,the majority of ,d,c,ws are now employed in home- and community-based settings1 and not in institutional settings such as nursing care facilities or hospitals4 ,by #bjbj1 home- and community-based ,d,c,ws are likely to outnumber facility workers by more than #b to #a4 7#e7 ,a #bjjh ,institute of ,medicine report1 entitled ,re-tooling for an ,aging ,america3 ,building the ,health ,care ,workforce1 called for new models of care delivery and coordination1 and dedicated a chapter to the central importance of the direct-care workforce in a re-tooled eldercare delivery system4 7#f7 ,an ,institute of ,medicine report on the future of nursing1 released in ,october of #bjaj1 recommended nurses should practice to the full extent of their education and training4 ,the report also states that all health care professionals should work collaboratively in team-based models1 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 skills4 7#g7 ,the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh7 emphasizes the need for improving care and lowering costs by better coordination of care and integration of services1 particularly for consumers with multiple chronic conditions4 ,this will require developing new models of care for those receiving long-term services and supports4 #c4 ,demonstration program on care coordination and service delivery ,part ,a of title ,,iv of the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjcb et seq47 is amended by adding at the end the following3 #dbc4 ,demonstration program on care coordination and service delivery 7a7 ,establishment of demonstration program 7#a7 ,in general ,the ,assistant ,secretary shall carry out a demonstration program in accordance with this section4 ,under such program1 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-- 7,a7 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 individuals2 and 7,b7 giving direct-care workers opportunities for career advancement through additional training1 an expanded role1 and increased compensation4 7#b7 ,direct-care worker ,in this section1 the term direct-care worker has the meaning given that term in the #bjaj ,standard ,occupational ,classifications of the ,department of ,labor for ,home ,health ,aides #ca-ajaa1 ,psychiatric ,aides #ca-ajac1 ,nursing ,assistants #ca-ajad1 and ,personal ,care ,aides #ci-ijba4 7b7 ,demonstration projects ,the demonstration program shall be composed of #f demonstration projects1 as follows3 7#a7 ,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 readmissions4 ,under these projects1 direct-care workers shall be incorporated as essential members of interdisciplinary care coordination teams4 7#b7 ,two demonstration projects shall focus on maintaining the health and improving the health status of those with multiple chronic conditions and long-term care needs4 ,under these projects1 direct-care workers shall assist in monitoring health status1 ensuring compliance with prescribed care1 and educating and coaching the older individual involved and any family caregivers4 7#c7 ,two demonstration projects shall focus on training direct-care workers to take on deeper clinical responsibilities related to specific diseases1 including ,alzheimer's and dementia1 congestive heart failure1 and diabetes4 7c7 ,eligible entity ,in this section1 the term eligible entity means a consortium that consists of-- 7#a7 at least #a-- 7,a7 long-term care and rehabilitation facility2 or 7,b7 home personal care service provider2 and 7#b7 at least #a-- 7,a7 hospital or health system2 7,b7 labor organization or labor-management partnership2 7,c7 community-based aging service provider2 7,d7 patient-centered medical home2 7,e7 federally qualified health center2 7,f7 managed care entity1 including a managed health and long-term care program2 7,g7 entity that provides health services training2 7,h7 ,state-based public entity engaged in building new roles and related curricula for direct-care workers2 or 7,i7 any other entity that the ,assistant ,secretary deems eligible based on integrated care criteria4 7d7 ,application ,to be eligible to receive a grant under this section1 an eligible entity shall submit to the ,assistant ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require1 which shall include-- 7#a7 a description of the care coordination and service delivery models of the entity1 detailed on a general1 organizational1 and staff level2 7#b7 a description of how the demonstration project carried out by the entity will improve care quality1 including specific objectives and anticipated outcomes that will be used to measure success2 and 7#c7 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 practice4 7e7 ,planning awards under demonstration program 7#a7 ,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 entity1 including-- 7,a7 designing the implementation of the project2 7,b7 identifying competencies and developing curricula for the training of participating direct-care workers2 7,c7 developing training materials and processes for other members of the interdisciplinary care team2 7,d7 articulating a plan for identifying and tracking cost savings gained from implementation of the project and for achieving long-term financial sustainability2 and 7,e7 articulating a plan for evaluating the project4 7#b7 ,amount and term 7,a7 ,total amount ,the amount awarded under paragraph 7#a7 for all grants shall not exceed #fjj1jjj4 7,b7 ,term ,activities carried out under a grant awarded under paragraph 7#a7 shall be completed not later than #a year after the grant is awarded4 7f7 ,implementation awards under demonstration program 7#a7 ,in general ,each eligible entity may receive a grant for implementation activities related to the demonstration project to be carried out by the entity1 if the ,assistant ,secretary determines the entity-- 7,a7 has successfully carried out the activities under the grant awarded under subsection 7e72 7,b7 offers a feasible plan for long-term financial sustainability2 7,c7 has constructed a meaningful model of advancement for direct-care workers2 and 7,d7 aims to provide training to a sizeable number of direct-care workers and to serve a sizeable number of older individuals4 7#b7 ,use of funds ,the implementation activities described under paragraph 7#a7 shall include-- 7,a7 training of all care team members in accordance with the design of the demonstration project2 and 7,b7 evaluating the competency of all staff based on project design4 7#c7 ,evaluation and report 7,a7 ,evaluation ,each recipient of a grant under paragraph 7#a71 in consultation with an independent evaluation contractor1 shall evaluate-- 7i7 the impact of training and deployment of direct-care workers in advanced roles1 as described in this section1 within each participating entity on outcomes1 such as direct-care worker job satisfaction and turnover1 beneficiary and family caregiver satisfaction with services1 rate of hospitalization of beneficiaries1 and additional measures determined by the ,secretary2 7ii7 the impact of such training and deployment on the long-term services and supports delivery system and resources2 7iii7 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 program2 and 7iv7 long-term financial sustainability of the model used under the grant and the impact of such model on quality of care4 7,b7 ,reports ,not later than #ahj days after completion of the demonstration program under this section1 each recipient of a grant under paragraph 7#a7 shall submit to the ,secretary a report on the implementation of activities conducted under the demonstration project1 including-- 7i7 the outcomes1 performance benchmarks1 lessons learned from the project2 7ii7 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 care2 and 7iii7 results of the evaluation conducted under subparagraph 7,a7 with respect to such activities1 together with such recommendations for legislation or administrative action for expansion of the demonstration program on a broader scale as the ,secretary determines appropriate4 7#d7 ,amount and term 7,a7 ,total amount ,the amount awarded under paragraph 7#a7 for all grants shall not exceed #b1ijj1jjj4 7,b7 ,term ,activities carried out under a grant awarded under paragraph 7#a7 shall be completed not later than #c years after the grant is awarded4 4