Casey Bill Would Improve the Lives of Older Citizens and Direct Care Workers

WASHINGTON, DC- U.S. Senator Bob Casey (D-PA), a member of the Senate Aging Committee, introduced the Promoting Small House Nursing Homes Act (S.3732) to improve and increase person-centered long-term residential care and coordinated health care for older Americans.  Senator Casey’s statement on the bill is attached.  

“This is a bill I expect will play a significant role in the way we care for our older citizens in this country,” said Senator Casey.  “I also hope and expect this bill to make an important contribution to the framing and substance of the landmark health care reform we anticipate in the coming year.  The bill provides a dramatically different approach to long term residential care for older citizens than is offered by the traditional nursing home model.”

In July, Senator Casey chaired an Aging Committee hearing on the small house nursing home model. 

The Promoting Small House Nursing Homes Act would foster significant culture change in long term care for older citizens by providing favorable loan funding for entities that provide person-centered care within a “small house” nursing facility framework.  Specifically, it would:

Create a low-interest loan fund for building new or renovating existing long term care facilities that follow articulated small house nursing home model guidelines; 

Establish clear and specific program requirements and guidelines that build upon existing programs that have successfully implemented substantial culture change and person-centered care; 

Create a home-like and non-institutional model of care for long term care residential facilities that is based upon the principles of: collaborative decision-making; respect; and significantly improved quality of life for residents and staff alike.   
 

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Mr. President, I rise today to introduce the Promoting Small House Nursing Homes Act.  This is a bill I expect will play a significant role in the way we care for our older citizens in this country.  I also hope and expect this bill to make an important contribution to the framing and substance of the landmark health care reform we anticipate in the coming year.  Moreover, because our current economic problems are interwoven with out-of-control health care costs, this bill will contribute to a revitalization of our economy and the creation of new jobs.  Finally, it will establish solid criteria for long term residential care that will not only improve the quality of life of older citizens, but save money through cost-effective, comprehensive and coordinated long term and health care.  

This bill provides a dramatically different approach to long term residential care for older citizens than is offered by the traditional nursing home model.  

The Promoting Small House Nursing Home Act incorporates the principles of person-centered care as a cornerstone of all aspects of long term residential care.  What do we mean by person-centered care?  The philosophy is simple:  Our older citizens deserve to live lives of dignity and respect through all stages of life.  About 10 years ago, the Philadelphia Inquirer reported, “Life can have quality and meaning even until the very last breath.”  Our older citizens have a profound right to be decision-makers in their own care – to be at the center of their own care, with a partnership of family and providers.  And our older citizens are critically important to the overall health and well being of our society.  I quote a well known expert in person-centered care, Dr. Bill Thomas, who says, “People of all ages will live better lives when we succeed in bringing elders back to the heart of our society.”

My bill translates this profound philosophy into a specific policy prescription by doing the following:

Creating a low-interest loan fund for building new or renovating existing long term care facilities that follow articulated small house nursing home model guidelines; 

Establishing clear and specific program requirements and guidelines that build upon existing programs that have successfully implemented substantial culture change and person-centered care; 

Creating a home-like and non-institutional model of care for long term care residential facilities that is based upon the principles of: collaborative decision-making; respect; and significantly improved quality of life for residents and staff alike.  
We currently have an estimated 38 million Americans over the age of 65, and that number is expected to double within the next twenty years.  In the midst of this, health care costs are rising exponentially, the quality of outcomes is not consistent, and older citizens are often abandoned to navigate a confusing and complex health care system.  Older citizens also report extremely low levels of satisfaction with life in nursing homes.  This $122 billion industry includes 16,000 nursing homes and significant concerns persist about maltreatment and neglect of our older citizens in 20% of these homes.  As I know from my work in state government, most nursing homes provide quality care but that 20% is what we hear most about.  However, a recent survey by the AARP found that fewer than 1% of individuals over 50 with a disability want to move to a nursing home.  There has to be a better way, and in fact there is. 
Person-centered care provides that better way.  It is a straightforward concept and yet it has taken years of hard work to get concrete initiatives underway.   We have a long way to go and much to learn.  But in order to succeed, we must pass legislation like the bill I have introduced today.  

Traditional nursing facilities require residents’ lives to revolve around institutional schedules for waking, bathing and dressing.  Traditional facilities far too often identify residents by their health conditions, vulnerabilities and room numbers rather than their unique strengths and gifts.  Staff members are attracted to the field of direct care service because they want to help older citizens but they are just as ill-served by this institutionalized culture as are the residents.  Workers are minimally trained, over-worked and carry patient loads that make it impossible to engage in any personal time with residents – in fact, such relationships are often discouraged.  They have little or no say in decision-making, relegated – like the residents – to the fringes of a system that places the needs of the institution over those of the human beings in it.  

In July of this year, I chaired a hearing for the Aging Committee that examined this small house nursing home model.  One of our witnesses was a nursing assistant who previously worked for a traditional nursing home and now works in a small house nursing home in Pennsylvania.  She recounted the difference, saying, ”Looking back on it, now, I realize that while we offered our residents excellent nursing care, that did not always translate into a high quality of life.”  She described handling a wider range of duties now, yet having more time to spend with individual residents and really getting to know – and even love -  them because the staffing is consistent and the turnover is almost non-existent.  Another witness at our July hearing was the daughter of a woman who moved from a traditional nursing home to a small house nursing home.  She summed up the dramatic change in her mother with this simple phrase, “Suddenly, life mattered again.”  

Mr. President, it should be a given that “life matters” for every person.   While every citizen has this fundamental right, our older citizens who have worked hard their whole lives truly deserve to enjoy their later years in homes that offer them comfort, respect and autonomy.  I strongly believe the Promoting Small House Nursing Homes Act will make this possible and I urge my Senate colleagues to join me in supporting this effort in its own right as well as the significant role it can play in the larger issues of comprehensive health care reform and revitalizing our economy.  Mr. President, I ask unanimous consent that the text of my bill, S. 3732, the Promoting Small House Nursing Homes Act, appear in the record with this statement and I yield the floor.