Bolstering Workforce Will Be Integral Part of National Health Care Reform

WASHINGTON - Today U.S. Senate Special Committee on Aging Chairman Herb Kohl (D-WI) introduced legislation to address the impending severe shortage of health care workers who are adequately trained and prepared to care for older Americans. The bill incorporates the major recommendations for improving and expanding the skills and preparedness of the health care workforce put forth in an Institute of Medicine (IOM) report, titled "Retooling for an Aging America: Building the Healthcare Workforce." 
"The number of health care workers devoted to caring for older Americans is experiencing a shortage-one that will only grow more desperate as our country ages rapidly. The United States will not be able to meet the approaching demand for health care and long-term care without a workforce that is prepared for the job," said Chairman Kohl. "I look forward to working with Finance and HELP Committee leaders on addressing this shortage in the context of broader health care reform."
The Retooling the Health Care Workforce for an Aging America Act aims to expand education and training opportunities in geriatrics and long-term care for licensed health professionals, direct care workers, and family caregivers by amending the Public Health Service Act, the Workforce Investment Act, the Older Americans Act and the Social Security Act. According to the IOM report, only 1 percent of all physicians (approximately 7,000) are certified geriatricians today, even as the population of older people is on track to double by 2030, and fewer than 1 percent of all nurses are certified gerontological nurses. Absent any change, by 2020, the supply of nurses in the United States will fall 29 percent below projected requirements, resulting in a severe shortage of nursing expertise relative to the demand for care of frail older adults.
The bill also addresses the training and support of personal and home care aides, which are are among the top three fastest-growing occupations.  In spite of this, they are not subject to any federal requirements related to training and education, and state requirements vary widely.          Finally, the bill will offer training and support to an estimated 44 million family caregivers that must provide increasingly complex support services to frail and elderly loved ones wishing to live at home.  Multiple surveys have documented that basic training and access to other targeted services are needed to enable family caregivers to provide such support on an ongoing basis. Kohl plans to reintroduce the bill early next year.
At a hearing in April, the Aging Committee reviewed key factors that are contributing to the deficiency, such as the lack of geriatric training in the medical education system and the need for federal and state training requirements for direct care workers, such as home health aides and personal care attendants. The panel also heard from family caregivers that enhanced education and training would help them develop the necessary skills to provide the best possible care for an ailing family member. Currently there are over 44 million Americans serving voluntarily as the sole source of care for an older family member or loved one.
A summary of the bill follows:
Overview of Legislation
Amends Title VII of the Public Health Service Act to:
·          Expand funding for Geriatric Education Centers (GECs) for grants to offer short-term intensive courses (mini-fellowships) in geriatrics to faculty members of medical schools and other health professions schools, including psychology, nursing, and social work. GECs receiving these grants would also be required to develop and offer training courses to direct care workers and family caregivers, or to incorporate mental health and dementia "best practices" training into their courses.      
·          Expand the reach of the Geriatric Academic Career Awards (GACA) program to include junior faculty in nursing, social work, clinical psychology, and other allied health disciplines.          
·          Authorize a new Geriatric Career Incentive Awards (GCIA) program to provide financial support for Masters level clinical social workers and psychologists who wish to pursue a doctorate or other advanced degree in geriatrics.    
·          Provide full funding for the National Center for Workforce Analysis to analyze current and projected needs for health care professionals and paraprofessionals in the long-term care sector.      
Amends Title VIII of the Public Health Service Act to:
·          Expand the Nursing Comprehensive Geriatric Education Program to support additional training in geriatrics for nurses and nursing faculty as well as traineeships for individuals pursuing advanced degrees in geriatric nursing.           
Amends the Workforce Investment Act to:
·          Require state workforce investment boards (WIBs) to provide information on training and employment opportunities in geriatrics and long-term care for veterans who receive job counseling services at WIB "One Stop Centers."            
·          Require the VA to provide veterans seeking employment assistance through the Local Veterans' Employment Representatives (LVERS) program and the Transition Assistance Program (TAP) with information about training and employment opportunities in geriatrics and long-term care.
·          Establish tuition stipends for direct care workers (nurse aides, home health aides and personal or home care aides) in the long-term care sector to acquire a nursing degree.        
Amends the Older Americans Act to:
·          Establish a National Resource Center on Students, Volunteers and Seniors to develop partnerships with aging service network providers to give high school and college students in social work, nursing, gerontology, dental hygiene, music therapy, nutrition and other disciplines the opportunity to work with low-income seniors. Also establishes best practices in training of mid-level professionals to advance in the aging services field. 
·          Develop online training for caregivers to demonstrate techniques for activities of daily living (ADL) assistance, such as safe lifting and transferring of a disabled individual.     
Amends the Social Security Act to:
·          Establish a national demonstration program in four states to develop, test and evaluate: 1) core training competencies for personal and home care aides and 2) additional training content, to supplement training required by federal law, for home health aides and nurse aides.       
·          Integrate the needs of family caregivers into routine assessment procedures of Medicaid beneficiaries who are deemed eligible for HCBS services.        
·          Provide information and referral to family caregivers of Medicare beneficiaries at the point of discharge from a skilled nursing facility, a rehabilitation hospital, or other post-acute care facility to available community support services.         
Calls for Additional Research by:
·          Authorizing appropriations to commission an IOM report on the composition of the mental health workforce that is needed to meet the needs of the aging population.    
·          Requiring a GAO study on the needs of the aging services network over the next two decades to project needs of lower-income individuals eligible for home and community-based services and supports.           
·          Requiring a GAO study on successfully practices that reduce turnover and improve retention among direct care staff in nursing homes, assisted living facilities, and home health agencies.
·          Requiring a GAO study to examine NIH spending on conditions and illnesses that disproportionately affect the health of older adults. The study would examine the number of older adults included in clinical trials supported by NIH institutes.
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