Geriatric Health Act

:111'2 or effect teter TWENTIETH CONGRESS OF THE REPUBLIC OF THE PHILIPPINES First Regular Session 25 ML 14 110:26 SENATE S. No._ 461 Introduced by Senator Jinggoy Ejercito Estrada AN ACT ESTABLISHING THE NATIONAL CENTER FOR GERIATRIC HEALTH AND RESEARCH INSTITUTE, DEFINING ITS POWERS AND FUNCTIONS, CREATING REGIONAL GERIATRIC SPECIALTY CENTERS IN THE DEPARTMENT OF HEALTH-RETAINED HOSPITALS, AND APPROPRIATING FUNDS THEREFOR EXPLANATORY NOTE Filipino culture ingrains respect to the elderly that promoted extended families since time immemorial. It is lamenting to know, however, that Filipino elderly are neglected in various aspects. The study conducted by Ibon Foundation, "The Filipino elderly are left behind" published on May 13, 2021 discussed the various concerns of Filipino senior citizens including poverty, employment, retirement and health. It states that the elderly Filipinos have poor health status and fail to consult a physician mainly because of financial reasons. According to the study, "More than half (58%) of older Filipinos have at least one of COVID-19s known comorbidities, such as high blood pressure (45.5%), diabetes (12.6%), heart disease (12.2%), and renal failure (11.8%). However, healthcare utilization among the elderly is low." Related to this, there are many challenges in the government's effort to provide holistic and effective health care to Filipino senior citizens, especially those who belong to the lower strata of the society. According to the article, "Gaps and

opportunities in addressing the needs of older adults in the Philippines and Vietnam: a qualitative exploration of health and social workers' experiences in urban care settings" published on March 22, 2024, "In less developed countries, it is challenging to distribute healthcare resources efficiently due to the economics of aging and care financing, requiring consideration of various factors such as healthcare financing and delivery systems, social security, and long-term care, while the awareness of the issues related to the older population is low." It further stated that, "In the Philippines, a critical challenge comes from the local scarcity of healthcare workers, especially as the demand for Filipino nurses keeps growing in other developed countries, leaving the country with a lack of experienced workforce."! According to the American Geriatrics Society, geriatrics is the specialty focused of high-quality, person-centered care as a person ages, which aims to improve health, independence, and quality of life for elder people.? Undeniably, as people advance in age, they need special care particularly in terms of health and psychological support. The "Geriatric Health Act" defines Geriatric Medicine or Geriatrics as "sub- specialty of internal and family medicine that diagnoses and treats a wide range of conditions and diseases that affect people as they age and aims to promote health and treat disabilities for older adults." The measure aims to provide accessible and holistic health services to senior citizens through the classification of the National Center for Geriatric Health and Research Institute (NCGH), which shall be renamed as National Center for Geriatric Health and Research Institute (NCGHRI). NCGHRI will be a specialized hospital for geriatric care and at the same time, a teaching, research and training institute in that field. At the same time, it will serve as an apex hospital or end-referral facility for senior citizens in the country. To ensure the sustainability of operations of the NCHGRI, provisions for its income retention, privilege and tax exemptions are included in the bill. 1 Frontiers / Gaps and opportunities in addressing the needs of older adults in the Philippines and Vietnam: a qualitative exploration of health and social workers' experiences in urban care settings ≥ About Geriatrics | American Geriatrics Society

In line with the objectives and mission of NCHGRI, the NCGH that is currently under the Jose R. Reyes Memorial Medical Center (JRRMMC) will be absorbed by the NCGHRI and its independence from JRRMMC shall be fully realized within a period of two (2) years. The measure also seeks to establish geriatric specialty centers in DOH regional hospitals and make geriatric health services available in all government primary health services. In view of the foregoing, the swift passage of this measure is earnestly sought. fight l MINGGOY EJERCITO ESTRADA

Ofter in dye TWENTIETH CONGRESS OF THE REPUBLIC OF THE PHILIPPINES First Regular Session ) 25 JUL 14 AIO :26 SENATE S. No. _ Introduced by Senator Jinggoy Ejercito Estrada AN ACT ESTABLISHING THE NATIONAL CENTER FOR GERIATRIC HEALTH AND RESEARCH INSTITUTE, DEFINING ITS POWERS AND FUNCTIONS, CREATING REGIONAL GERIATRIC SPECIALTY CENTERS IN THE DEPARTMENT OF HEALTH-RETAINED HOSPITALS, AND APPROPRIATING FUNDS THEREFOR Be it enacted by the Senate and House of Representatives of the Philippines in Congress assembled:

Section 1. Short Title. - This Act shall be known as the "Geriatric Health Act".

Sec. 2. Declaration of Policy. - It is the policy of the State to protect and

promote the right to health of senior citizens all over the country by ensuring that holistic health services are available and accessible to them through the establishment of a specialized hospital and research institute as well as geriatric specialty centers in the Department of Health (DOH)-retained hospitals in every region.

Sec. 3. Definition of Terms. - As used in this Act:

a) Acute care - refers to a specialized program that addresses the needs of hospitalized older adults in a multidisciplinary team approach to prevent functional and cognitive decline and to improve outcomes; b) Apex or end-referral hospital - refers to a hospital offering specialized services as determined by DOH, which is contracted as a stand-alone facility by the Philippine Health Insurance Corporation (PhilHealth);

c) Geriatric health services - refer to the medical services or interventions provided by a multidisciplinary team to older adult patients; d) Geriatric medicine or Geriatrics - refers to the sub-specialty of internal and family medicine that diagnoses and treats a wide range of conditions and diseases that affect people as they age and aims to promote health and treat disabilities for older adults; e) Geriatric palliative care - refers to a specialized medical care that focuses on providing elderly patients relief from pain and other symptoms of a serious illness, regardless of diagnosis or stage of disease, and provided alongside curative and other forms of treatment. It is a field of inter-specialty collaboration to respond to the socio- demographic changes and challenges of older adults with severe and life-limiting conditions; f) Geriatric specialty center - refers to a unit or department in a DOH- retained hospital that offers specialized care to the aging population, particularly of frail older persons, addressing their particular conditions and providing specific procedures and management of cases, requiring specialized training and/or equipment; g) Geriatrician - refers to a medical doctor who has passed the necessary training and specialty examination for the practice of Geriatric Medicine; h) Gerontology - refers to the study of the biological, psychological, spiritual, social, economic, and the demographic aspects of the aging process; i) Home-based healthcare and reablement program - refers to a community-based service which primarily caters to the frail older persons who have lost or are experiencing problems with mobility; j) Integrated delivery of geriatric health services - refers to hospital and community-based medical and psycho-social services provided to senior citizens by a multidisciplinary team; k) Multi-disciplinary team - refers to a team composed of health professionals headed by a geriatrician and includes surgeons, organ-

system specialists, nurses, clinical pharmacists, rehabilitation therapists, nutritionists, dentists, social workers, caregivers, family members, and patients themselves; 1) People-centered service - refers to an approach to geriatric care that consciously adopts the perspectives of individuals, families and communities, and sees them as participants as well as beneficiaries of trusted health systems that respond to their needs and preferences in holistic and humane ways; m) Senior citizen - refers to an elderly Filipino who is at least sixty (60) years old; n) Sub-acute care - refers to care for patients who no longer require hospitalization, but still need skilled medical care through rehabilitative medicine. Sub-acute rehabilitation is recommended when a patient is not functionally able to return home; and o) Transitional care - refers to a form of health care in geriatric medicine designed to ensure coordination and continuity of care as patients transfer between different locations or different levels of care, and the safe and effective management of both chronic and acute illness in older adults.

Sec. 4. National Center for Geriatric Health and Research Institute. - The

National Center for Geriatric Health (NCGH) is hereby classified as a teaching, research and training hospital that shall specialize in geriatric care and serve as an apex hospital or end-referral facility for senior citizens in the country. The NCGH shall be renamed as the National Center for Geriatric Health and Research Institute (NCGHRI) and shall be under the direct control and supervision of the DOH. The bed capacity, service capabilities, healthcare facilities, expansion, organizational structure and human resource requirements of the NCGHRI shall be based on the hospital and human resource development plan to be prepared by the NCGHRI and approved by the DOH.

Sec. 5. Powers and Functions. - To carry out the provisions of this Act, the

NCGHRI shall have the following powers and functions:

a) Serve as an apex hospital or end-referral facility which shall specialize in geriatric health services; b) Formulate a hospital development plan which shall be regularly updated to reflect the expansion and future development of the NCGHRI; c) Provide and maintain affordable, quality, and timely people-centered hospital care through an efficient health service delivery system for senior citizens; d) Provide higher and up-to-date geriatric training for professionals, postgraduates, academic, and allied healthcare providers especially from the geriatric specialty centers in the regions and LGUs, and other government hospitals; e) Develop and implement cutting-edge research studies on diseases related to old age with a view to translating research outcomes into policy and specialized health care solutions, and publish research studies that shall serve as a critical information resource for the medical and research community, in coordination with the Philippine Council on Health Research and Development (PCHRD) and the Institute on Aging of the National Institutes of Health (IA-NIH); f) Conduct and participate in international and local gerontological research activities; g) Provide consultancy service and technical assistance in the setting of standards for geriatric wards in every tertiary level hospital, nursing home and residential center catering to the health and functioning needs of senior citizens, in coordination with the PCHRD and the IA- NIH; h) Develop and maintain a core information hub on geriatric and gerontological studies in coordination with the IA-NIH and concerned offices in the DOH and its attached agencies, such as the Disease Prevention and Control Bureau and the Knowledge Management and Information Technology Service;

i) Extend medical services to senior citizens pursuant to the goals, objectives and rules of the National Health Insurance Program and in accordance with Republic Act No. 11223, otherwise known as the "Universal Health Care Act;" j) Provide an integrated and effective approach in the delivery of geriatric health services in collaboration with other government agencies, local government agencies, local government units (LGUs) and other stakeholders; k) Conduct specialty training and technical assistance in collaboration with concerned DOH offices and other relevant professional organizations; 1) Finance, sponsor, hold or participate in congresses, convention, conferences, seminars, workshops, and training programs on geriatric health services or related fields in the Philippines and abroad; and m) Establish a standardized referral system for psycho-social services.

Sec. 6. Scope of Services. - The NCGHRI shall provide the following services:

a) Hospital-based services to ensure the availability of medical facilities and equipment for senior citizens needing acute and sub-acute care, geriatric palliative care, transitional and outpatient care services, and such other necessary services; b) Community-based services utilizing multidisciplinary team approaches such as home-based healthcare and reablement programs, research and external resource outsourcing for community-based integrated geriatric health services and trainings necessary for the psycho-social functioning of senior citizens and their families, in coordination with LGUs; c) Technical assistance and capacity building in the establishment and maintenance of nursing homes and residential care facilities and senior citizens' wards in government hospitals pursuant to Republic Act No. 9994, otherwise known as the "Expanded Senior Citizens Act of 2010"; d) Technical assistance and capacity building in the establishment of geriatric specialty centers and services to strengthen the network of

geriatric care service providers across the country and ensure the delivery of quality health services for senior citizens; e) Education programs and scholarships to pursue excellence and the highest level of quality in the practice of the specialized field of geriatrics and other related fields, including postgraduate training and short-term courses for medical doctors and other allied medical health professions, in coordination with the IA-NIH; and, f) Education programs in geriatrics and gerontology subjects in undergraduate health and allied professions, including training of students, as well as postgraduate medical education of physicians, nurses, allied professionals, pharmacists, dentists and social workers. The Geriatric Specialty Fellowship Training Program of the NCGHRI shall seek and maintain full accreditation status in the Philippine College of Geriatric Medicine. The NCGHRI shall ensure the accessibility of all its programs and services and take into consideration the special needs of senior citizens with disabilities.

Sec. 7. Organizational Structure and Staffing Pattern. - The Secretary of the

DOH shall determine the organizational structure and staffing pattern of the NCGHRI in accordance with the revised compensation and position classification system subject to the evaluation and approval of the Department of Budget and Management (DBM) and in compliance with the civil service laws, rules and regulations.

Sec. 8. Establishment of Geriatric Specialty Centers. - Geriatric specialty

centers are hereby established in DOH regional hospitals, which shall serve as apex or end-referral hospitals of the health care provider networks and training and research facilities on geriatric specialty care services. Geriatric health services shall be available in all government primary health facilities. The level of geriatric services and corresponding facilities in specialty centers and their respective health human resource requirements shall be determined by the DOH, in coordination with NCGHRI and other stakeholders: Provided, That the standards to be adopted thereon shall be consistent with the Philippine Health Facility Development Plan and Section 6 of this Act.

Sec. 9. Categorization of Patients. - The DOH shall ensure that the NCGHRI

shall adopt and enforce a categorization of paying and non-paying patients. The allocation of beds for non-paying patients shall be not less than seventy percent (70%) of the total number of hospital beds.

Sec. 10. Income Retention. - All income generated from the operations of the

NCGHRI shall be deposited in an authorized government depository bank and shall 7 be used to augment the funds allocated for its maintenance, other operating expenses and capital outlay requirements, subject to the guidelines set by the DOH and the DBM.

Sec. 11. Privilege. - The NCGHRI may request and receive assistance from

11 the different agencies, bureaus, offices or instrumentalities of the government, including the Philippine Charity Sweepstakes Office and Philippine Amusement and Gaming Corporation, in pursuit of its purposes and objectives.

Sec. 12. Tax Exemptions. - All donations, endowments, contributions, grants

and bequests used actually, directly and exclusively for an in accordance with the purposes and functions of the NCGHRI shall be exempt from donor's tax, and the same shall be considered as allowable deductions from gross income for purposes of computing the taxable income of the donor, in accordance with the provisions of the National Internal Revenue Code of 1997, as amended. The NCGHRI shall be exempt from income tax and customs duty levied by the government and its political subdivisions, agencies and instrumentalities subject to the provisions of the National Internal Revenue Code of 1997, as amended, and Republic Act No. 10863, otherwise known as the "Customs Modernization and Tariff Act". The NCGHRI shall avail of the tax expenditure subsidy administered by the Fiscal Incentives Review Board (FIRB), subject to the provisions of Title XIII (Tax Incentives) of the National Internal Revenue Code of 1997, as amended, Executive Order No. 93, as amended, and the General Appropriations Act.

Sec. 13. Coordination with and Assistance from Other Government Agencies.

- The NCGHRI shall collaborate with the National Commission of Senior Citizens (NCSC) in the development of its programs and services. It may likewise call upon

any department, bureau, office, agency or instrumentality of the government for assistance, in the pursuit of the purposes and objectives of this Act.

Sec. 14. Appropriations. - The amount necessary for the implementation of

this Act shall be charged against the current year's appropriation of the DOH. Thereafter, the funding of which shall be included in the annual General 6 Appropriations Act.

Sec. 15. Annual Report. - The NCGHRI shall submit an annual report to the

President of the Philippines, the Senate Committee on Health and Demography, the House of Representatives Committee on Health, and the NCSC, on its activities, accomplishments and recommendations to further improve the delivery of geriatric health services.

Sec. 16. Transitory Provisions. - In accomplishing organizational changes and

improvements that have to be implemented, the following transitory provisions shall be complied with: a) The National Center for Geriatric Health (NCGH) currently under the Jose R. Reyes Memorial Medical Center (JRRMMC) shall be absorbed by NCGHRI including its existing personnel regardless of status, and all buildings and equipment, fixtures and furnishings, other assets and liabilities, and current appropriations; b) The independence of the NCGHRI from the JRRMMC shall be fully realized within a period of two (2) years. The DOH shall ensure that no disruption of service will occur during this transitory period; c) The existing officials and employees of the NCGH shall continue to assume the duties of their positions until new appointments are issued. They shall be placed in the new staffing pattern of the NCGHRI in accordance with R.A. No. 6656, entitled "An Act to Protect the Security of Tenure of Civil Service Officers and Employees in the Implementation of Government Reorganization" and the rules and regulations governing reorganization. Officials and employees, including casual and temporary employees, who shall not be absorbed in the new staffing pattern due to redundancy shall avail of the applicable retirement benefits and separation incentives as provided

under existing laws: Provided, That officials and employees holding permanent appointment shall also be given the option to be transferred to other units or offices within the DOH without a reduction in rank, status, pay and benefits; d) Research grants acquired by the NCGHRI during the transition shall be utilized solely for their intended purposes and of the affected units or offices; and e) Existing contracts and agreement entered into with third parties prior to the enactment of this Ac shall remain valid.

Sec. 17. Implementing Rules and Regulations. - The Secretary of Heaith shall,

11 in consultation with the Secretary of Budget and Management, Secretary of Social 12 Welfare and Development, and the Chairperson of the NCSC, promulgate rules and regulations for the effective implementation of this Act within ninety (90) days after its effectivity.

Sec. 18. Separability Clause. - If any provision or part hereof is held invalid or

unconstitutional, the remainder of the law or the provision or part not otherwise affected shall remain valid and subsisting.

Sec. 19. Repealing Clause. - Any law, presidential decree or issuance,

executive order, letter of instruction, administrative order, rule, or regulation contrary to or inconsistent with the provisions of this Act are hereby repealed, modified, or amended accordingly.

Sec. 20. Effectivity. - This Act shall take effect fifteen (15) days after its

publication in the Official Gazette or in a newspaper of general circulation. Approved,