I 

116TH CONGRESS 

1ST SESSION H. R. 4397 

To award grants for the recruitment, retention, and advancement of direct 

care workers. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 19, 2019 

Mr. SCOTT of Virginia (for himself and Mrs. LEE of Nevada) introduced the 

following bill; which was referred to the Committee on Education and 

Labor, and in addition to the Committee on Energy and Commerce, for 

a period to be subsequently determined by the Speaker, in each case for 

consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To award grants for the recruitment, retention, and 

advancement of direct care workers. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Direct Creation, Ad5 vancement, and Retention of Employment Opportunity 

6 Act’’ or the ‘‘Direct CARE Opportunity Act’’. 

7 SEC. 2. FINDINGS. 

8 Congress finds the following: 


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1 (1) Millions of older individuals and individuals 

2 with disabilities in the United States require assist3 ance with activities of daily living to live independ4 ently and participate in their communities to their 

5 fullest extent. The Bureau of the Census projects 

6 that by 2060 the population of individuals age 65 or 

7 older will double from 49,200,000 in 2016 to 

8 94,700,000. According to the Centers for Disease 

9 Control and Prevention, 1 in 4 (or 60,000,000) 

10 adults in the United States are living with a dis11 ability. 

12 (2) The assistance of direct care workers allows 

13 older individuals and individuals with disabilities to 

14 live with dignity and safety, and to exercise their 

15 right to live independently in their own homes and 

16 communities, in keeping with what is most appro17 priate for their needs and preferences. Older individ18 uals and individuals with disabilities may also par19 ticipate in the direct care workforce, further sup20 porting their ability to live independently. 

21 (3) According to PHI, direct care workers pro22 vide most of the paid, hands-on care for older indi23 viduals and individuals with disabilities. 

24 (4) According to PHI, 4,500,000 direct care 

25 workers provide care across home and communityVerDate Sep 11 2014 23:36 Sep 20, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4397.IH H4397

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1 based settings, nursing facilities, assisted living fa2 cilities, group homes, intermediate care facilities, 

3 and hospitals to care for the growing population of 

4 older individuals and individuals with disabilities. 

5 (5) PHI projects that by 2024, 5,200,000 di6 rect care workers will be needed across all care set7 tings to care for the growing population of older in8 dividuals and individuals with disabilities. 

9 (6) Many direct care workers lack access to a 

10 career pathway or advanced training opportunities. 

11 This limits their ability to build competency and ex12 pertise in their field that, when gained, may lead to 

13 an increase in their earning capacity. According to 

14 PHI, more than half of home care workers have 

15 completed no formal education beyond high school, 

16 making high-quality, transferable training essential 

17 to success on the job. 

18 (7) As of 2015, the median wage for direct care 

19 workers is approximately $11 an hour; wages and 

20 earnings for home care workers are even lower in 

21 rural areas. Because of low wages, variable work 

22 hours, and the inability to access workplace-based 

23 benefits, 19 percent of home care workers live below 

24 the Federal poverty level as compared to 9 percent 

25 of the general United States workforce. Nearly half 


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1 of direct care workers rely on some form of public 

2 assistance to support themselves and their families. 

3 (8) According to PHI, approximately 9 in 10 

4 direct care workers are women, more than half are 

5 women of color, and one quarter of direct care work6 ers are immigrants. 

7 (9) The direct care workforce is plagued with 

8 high turnover, low job satisfaction, and workforce 

9 shortages. These conditions can contribute to re10 duced quality of care and threaten the availability of 

11 supports for older individuals and individuals with 

12 disabilities. 

13 (10) Because of the nature of the work, direct 

14 care workers suffer from disproportionately high 

15 rates of injury. In 2016, the injury rate for nursing 

16 assistants was 337 per 10,000 as compared to 100 

17 per 10,000 for other occupations. 

18 (11) Training has been shown to reduce worker 

19 turnover, reduce rates of injury, and lead to in20 creased job satisfaction. 

21 (12) The Institute of Medicine found that to 

22 ensure that the United States is prepared to meet 

23 the health care needs of older individuals during the 

24 21st century, it is essential that the capacity of the 

25 direct care workforce be enhanced in both the numVerDate Sep 11 2014 23:36 Sep 20, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4397.IH H4397

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1 ber of workers available and their ability to meet 

2 their own health care and quality of life needs. 

3 SEC. 3. DEFINITIONS. 

4 In this Act: 

5 (1) APPRENTICESHIP PROGRAM.—The term 

6 ‘‘apprenticeship program’’ means an apprenticeship 

7 program registered under the Act of August 16, 

8 1937 (commonly known as the ‘‘National Appren9 ticeship Act’’; 50 Stat. 664, chapter 663; 29 U.S.C. 

10 50 et seq.). 

11 (2) DIRECT CARE WORKER.—The term ‘‘direct 

12 care worker’’ has the meaning given the term in sec13 tion 799B of the Public Health Service Act (42 

14 U.S.C. 295p). 

15 (3) ELIGIBLE ENTITY.—The term ‘‘eligible enti16 ty’’ means— 

17 (A) a State; 

18 (B) a nonprofit organization, a labor orga19 nization, or an entity with shared labor-man20 agement oversight— 

21 (i) with an established record of re22 cruiting or providing training to direct care 

23 workers; or 

24 (ii) that establishes a training pro25 gram in consultation with an organization 


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1 with an established record of providing 

2 training to direct care workers; 

3 (C) a local board; 

4 (D) a nonprofit entity carrying out an ap5 prenticeship program; 

6 (E) an Indian tribe or tribal organization; 

7 or 

8 (F) a consortium of entities listed in sub9 paragraph (A), (B), (C), (D), or (E) that may 

10 also include an institution of higher education. 

11 (4) EMPLOY; EMPLOYER.—The terms ‘‘employ’’ 

12 and ‘‘employer’’ have the meanings given the terms 

13 in section 3 of the Fair Labor Standards Act (29 

14 U.S.C. 203 et seq.). 

15 (5) INDIAN TRIBE; TRIBAL ORGANIZATION.— 

16 The terms ‘‘Indian tribe’’ and ‘‘tribal organization’’ 

17 have the meanings given such terms in section 4 of 

18 the Indian Self-Determination and Education Assist19 ance Act (25 U.S.C. 5304). 

20 (6) INSTITUTION OF HIGHER EDUCATION.—The 

21 term ‘‘institution of higher education’’ has the 

22 meaning given the term in section 101 of the Higher 

23 Education Act of 1965 (20 U.S.C. 1001). 


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1 (7) SECRETARY.—The term ‘‘Secretary’’ means 

2 the Secretary of Labor, except as otherwise specified 

3 in this Act. 

4 (8) STATE.—The term ‘‘State’’ has the mean5 ing given the term in section 3 of the Carl D. Per6 kins Career and Technical Education Act of 2006 

7 (20 U.S.C. 2302). 

8 (9) WORKFORCE INNOVATION AND OPPOR9 TUNITY ACT TERMS.—The terms ‘‘career pathway’’, 

10 ‘‘career planning’’, ‘‘in-demand industry sector or 

11 occupation’’, ‘‘individual with a barrier to employ12 ment’’, ‘‘individual with a disability’’, ‘‘local board’’, 

13 ‘‘older individual’’, ‘‘one-stop center’’, ‘‘on-the-job 

14 training’’, ‘‘recognized postsecondary credential’’, 

15 ‘‘region’’, ‘‘State board’’, and ‘‘supportive services’’ 

16 have the meanings given such terms in section 3 of 

17 the Workforce Innovation and Opportunity Act (29 

18 U.S.C. 3102). 

19 (10) WORK-BASED LEARNING.—The term 

20 ‘‘work-based learning’’ has the meaning given the 

21 term in section 3 of the Carl D. Perkins Career and 

22 Technical Education Act of 2006 (20 U.S.C. 2302). 

23 SEC. 4. AUTHORITY TO AWARD GRANTS; DURATION. 

24 (a) AUTHORITY TO AWARD GRANTS.—Not later than 

25 12 months after the date of enactment of this Act, the 


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1 Secretary, in consultation with the Secretary of Health 

2 and Human Services, shall award grants— 

3 (1) to not fewer than 15 eligible entities to de4 velop and carry out projects for purposes of recruit5 ing, retaining, or providing advancement opportuni6 ties to direct care workers; and 

7 (2) 5 of which shall be awarded for projects 

8 that focus on providing such advancement opportu9 nities. 

10 (b) TREATMENT OF CONTINUATION ACTIVITIES.— 

11 An eligible entity that carries out activities for purposes 

12 of recruiting, retaining, or providing advancement oppor13 tunities to direct care workers prior to receipt of a grant 

14 under this Act may use such grant to continue carrying 

15 out such activities, and shall be treated as an eligible enti16 ty carrying out a project described in subsection (a)(1). 

17 (c) DURATION.— 

18 (1) GRANT PERIOD.—A grant under this Act 

19 shall be for not less than 5 years. 

20 (2) LENGTH OF PROJECT.—A project assisted 

21 with a grant awarded under this Act shall be carried 

22 out for not less than 3 years. 

23 SEC. 5. PROJECT PLANS; CONSULTATION. 

24 (a) PROJECT PLANS.— 


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1 (1) IN GENERAL.—To receive a grant under 

2 this Act, an eligible entity shall submit to the Sec3 retary a project plan for each project to be developed 

4 and carried out (or for activities to be continued) 

5 with the grant at such time and in such manner as 

6 the Secretary may determine, and which shall con7 tain the information described in paragraph (2). 

8 (2) CONTENTS.—A project plan submitted by 

9 an eligible entity under paragraph (1) shall include 

10 a description of each of the following: 

11 (A) Current or projected job openings for, 

12 or relevant labor market information related to, 

13 direct care workers in the State or region to be 

14 served by the project, and the geographic scope 

15 of the workforce to be served by the project. 

16 (B) Specific efforts and strategies that the 

17 project will undertake to reduce barriers to re18 cruitment, retention, or advancement of direct 

19 care workers, including an assurance that such 

20 efforts will include— 

21 (i) an assessment of the wages or 

22 other compensation or benefits necessary 

23 to recruit and retain direct care workers; 

24 and 


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1 (ii) a description of the project’s pro2 jected wages and other compensation or 

3 benefits for direct care workers at the 

4 State or local level, including a comparison 

5 of such projected wages to regional and 

6 national wages. 

7 (C) In the case of a project offering an 

8 education and training program, a description 

9 of such program (including any curricula, mod10 els, and standards used under the program, and 

11 any associated recognized postsecondary creden12 tials for which the program provides prepara13 tion, as applicable), which shall include an as14 surance that such program will provide— 

15 (i) an apprenticeship program, work16 based learning, or on-the-job training op17 portunities; 

18 (ii) supervision or mentoring; and 

19 (iii) a progressively increasing, clearly 

20 defined schedule of wages to be paid to the 

21 direct care worker that— 

22 (I) is consistent with skill gains 

23 or attainment of a recognized postsec24 ondary credential; and 


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1 (II) ensures the entry wage is not 

2 less than the greater of— 

3 (aa) the minimum wage re4 quired under section 6(a) of the 

5 Fair Labor Standards Act of 

6 1938 (29 U.S.C. 206(a)); or 

7 (bb) the applicable wage re8 quired by other applicable Fed9 eral or State law, or a collective 

10 bargaining agreement. 

11 (D) If applicable, any other innovative 

12 models or processes the eligible entity will im13 plement to support the retention of direct care 

14 workers. 

15 (E) The supportive services and benefits to 

16 be provided to direct care workers to support 

17 the retention of employment of direct care 

18 workers. 

19 (F) How the eligible entity will make use 

20 of career planning to support the identification 

21 of advancement opportunities and career path22 ways for direct care workers in the State or re23 gion to be served by the project. 


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1 (G) How the eligible entity will collect and 

2 submit to the Secretary workforce data and 

3 outcomes of the project. 

4 (H) How the project will— 

5 (i) provide adequate and safe equip6 ment, and facilities for training and super7 vision, including a safe work environment 

8 free from discrimination; 

9 (ii) provide safety training for direct 

10 care workers as part of the education and 

11 training program described in subpara12 graph (C), as applicable; and 

13 (iii) provide adequate training for 

14 mentors and qualified instructors to ensure 

15 compliance with clause (i) and, as applica16 ble, clause (ii). 

17 (I) How the eligible entity will consult on 

18 the implementation of the project, or coordinate 

19 the project with, each of the following entities, 

20 to the extent that each such entity is not a part 

21 of the eligible entity: 

22 (i) The State agency responsible for 

23 administering the State plan under title 

24 XIX of the Social Security Act (42 U.S.C. 

25 1396 et seq.) (or waiver of the plan), or 


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1 the State agency with primary responsi2 bility for providing services and supports 

3 for individuals with intellectual disabilities 

4 and individuals with developmental disabil5 ities, for the State to be served by the 

6 project. 

7 (ii) The local board and State board 

8 for the State or for each region to be 

9 served by the project. 

10 (iii) A nonprofit organization with 

11 demonstrated experience with respect to di12 rect care workers. 

13 (iv) In the case of a project that car14 ries out an education and training pro15 gram, a nonprofit organization with dem16 onstrated experience in the development or 

17 delivery of curricula or coursework. 

18 (v) A nonprofit organization that fos19 ters the professional development and col20 lective engagement of direct care workers, 

21 including labor organizations. 

22 (vi) A nonprofit organization with ex23 pertise in identifying and addressing the 

24 care needs of older individuals and individ25 uals with disabilities and their caregivers 


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1 (including area agencies on aging, as de2 fined in section 102 of the Older Ameri3 cans Act of 1965 (42 U.S.C. 3002), and 

4 centers for independent living, as described 

5 in part C of title VII of the Rehabilitation 

6 Act of 1973 (29 U.S.C. 796f et seq.)). 

7 (vii) A nonprofit State provider asso8 ciation that represents providers who em9 ploy direct care workers, where such asso10 ciations exist. 

11 (viii) An entity that employs direct 

12 care workers. 

13 (J) An assurance that any benefit or serv14 ice provided under the project will be provided 

15 at no cost to a direct care worker or individuals 

16 assisted by such workers. 

17 (K) How the eligible entity will consult 

18 with individuals employed as direct care work19 ers, representatives of such workers, individuals 

20 assisted by such workers, and the families of 

21 such individuals throughout the project. 

22 (L) Outreach efforts to individuals for par23 ticipation in such project, including targeted 

24 outreach efforts to— 


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1 (i) individuals who are recipients of 

2 assistance under a State program funded 

3 under part A of title IV of the Social Secu4 rity Act (42 U.S.C. 601 et seq.) or individ5 uals who are eligible for such assistance; 

6 and 

7 (ii) individuals with barriers to em8 ployment. 

9 (3) CONSIDERATIONS.—In selecting eligible en10 tities to receive a grant under this Act, the Secretary 

11 shall— 

12 (A) ensure— 

13 (i) equitable geographic and demo14 graphic diversity, including rural and 

15 urban areas; and 

16 (ii) that selected eligible entities will 

17 serve areas where direct care, or a related 

18 occupation, is an in-demand industry sec19 tor or occupation; and 

20 (B) give priority to eligible entities pro21 posing to predominantly serve the individuals 

22 described in clauses (i) and (ii) of paragraph 

23 (2)(L). 


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1 (b) CONSULTATION.—The Secretary shall encourage 

2 each eligible entity receiving a grant under this Act, in 

3 developing and carrying out a project, to consult with— 

4 (1) institutions of higher education; 

5 (2) the State Apprenticeship Agency recognized 

6 under the Act of August 16, 1937 (commonly known 

7 as the ‘‘National Apprenticeship Act’’; 50 Stat. 664, 

8 chapter 663; 29 U.S.C. 50 et seq.), for the State or 

9 region to be served by the eligible entity or, if no 

10 such agency has been recognized in the State or re11 gion, the Office of Apprenticeship of the Department 

12 of Labor; and 

13 (3) one-stop centers. 

14 SEC. 6. USES OF FUNDS; SUPPLEMENT, NOT SUPPLANT. 

15 (a) USES OF FUNDS.— 

16 (1) IN GENERAL.—Each eligible entity receiving 

17 a grant under this Act shall use such funds to carry 

18 out at least 1 project or to continue activities com19 menced prior to receipt of such grant that— 

20 (A) develop and implement a strategy for 

21 the recruitment, retention, or advancement of 

22 direct care workers, which includes the activi23 ties described in section 5(a)(2); and 


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1 (B) provide compensation to each eligible 

2 direct care worker for any training received 

3 under the project or activities. 

4 (2) ADMINISTRATIVE COSTS.—Each eligible en5 tity receiving a grant under this Act shall not use 

6 more than 5 percent of the funds of such grant for 

7 costs associated with the administration of activities 

8 under this Act. 

9 (3) DIRECT SUPPORT.—Each eligible entity re10 ceiving a grant under this Act shall use not less than 

11 5 percent of the funds of such grant to provide di12 rect financial assistance, such as supportive services, 

13 to direct care workers to support the financial needs 

14 of such workers to enter, remain enrolled in, and 

15 complete the project (or activities) assisted with such 

16 grant. 

17 (b) SUPPLEMENT, NOT SUPPLANT.—An eligible enti18 ty receiving a grant under this Act shall use such grant 

19 only to supplement, and not supplant, the amount of funds 

20 that, in the absence of such grant, would be available to 

21 address the recruitment, retention, or advancement of di22 rect care workers in the State or region served by the eligi23 ble entity. 

24 SEC. 7. EVALUATIONS AND REPORTS. 

25 (a) REPORTS.— 


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1 (1) ELIGIBLE ENTITIES.— 

2 (A) IN GENERAL.—Each eligible entity re3 ceiving a grant under this Act shall submit to 

4 the Secretary and the Secretary of Health and 

5 Human Services, with respect to each project 

6 assisted with such grant— 

7 (i) for each year of the grant period, 

8 an annual report on the progress and out9 comes of the project; and 

10 (ii) not later 6 months after the com11 pletion of such project, a final report on 

12 the progress and outcomes of the project. 

13 (B) DISAGGREGATION.—Each report sub14 mitted under paragraph (A) shall— 

15 (i) include the information described 

16 in subparagraph (C); and 

17 (ii) disaggregate such information in 

18 the manner described in subparagraph 

19 (D). 

20 (C) CONTENTS.—Each report submitted 

21 under subparagraph (A) shall include each of 

22 the following: 

23 (i) The number of individuals served 

24 by the project, including— 


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1 (I) the number of individuals re2 cruited to be employed as a direct 

3 care worker; and 

4 (II) the number of individuals 

5 who attained employment as a direct 

6 care worker. 

7 (ii) The number of individuals or fam8 ilies assisted by direct care workers. 

9 (iii) The number of direct care work10 ers who participated in and completed— 

11 (I) work-based learning; 

12 (II) on-the-job training; 

13 (III) an apprenticeship program; 

14 or 

15 (IV) a professional development 

16 or mentoring program. 

17 (iv) Other services, benefits, or sup18 ports (other than the services, benefits, or 

19 supports described in clause (iii)) provided 

20 to assist in the recruitment, retention, or 

21 advancement of direct care workers, the 

22 number of individuals who accessed such 

23 services, benefits, or supports, and the im24 pact of such services, benefits, or supports. 


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1 (v) How the project assessed satisfac2 tion with respect to— 

3 (I) direct care workers assisted 

4 by the project; 

5 (II) individuals receiving services 

6 delivered by such workers, including 

7 any impact on the health or health 

8 outcomes of such individuals; and 

9 (III) employers of such workers, 

10 as determined in accordance with sec11 tion 116(b)(2)(A)(i)(VI) of the Work12 force Innovation and Opportunity Act 

13 (29 U.S.C. 3141(b)(2)(A)(i)(VI)). 

14 (vi) The performance of the eligible 

15 entity with respect to the indicators of per16 formance on unsubsidized employment, me17 dian earnings, credential attainment, meas18 urable skill gains, and employer satisfac19 tion, as described under section 

20 116(b)(2)(A)(i) of the Workforce Innova21 tion and Opportunity Act (29 U.S.C. 

22 3141(b)(2)(A)(i)). 

23 (vii) Any other information with re24 spect to outcomes of the project. 


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1 (D) DISAGGREGATION.—The information 

2 described under subparagraph (C) shall be 

3 disaggregated by race, ethnicity, sex, and age in 

4 accordance with section 116(d)(2)(B) of the 

5 Workforce Innovation and Opportunity Act (29 

6 U.S.C. 3141(d)(2)), by each population listed in 

7 section 3(24) of the Workforce Innovation and 

8 Opportunity Act (29 U.S.C. 3102(24)), and by 

9 the individuals described in clauses (i) and (ii) 

10 of section 5(a)(2)(L). 

11 (2) SECRETARIES.— 

12 (A) ANNUAL PERFORMANCE REVIEW.— 

13 The Secretary, in consultation with the Sec14 retary of Health and Human Services, shall an15 nually conduct a performance review of each 

16 project carried out by an eligible entity receiv17 ing a grant under this Act, including— 

18 (i) the performance of the project with 

19 respect to the indicators of performance 

20 described in paragraph (1)(C)(vi), and 

21 disaggregated in the manner described in 

22 paragraph (1)(D); and 

23 (ii) the efficacy of the project plan 

24 submitted under section 5(a)— 


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1 (I) for recruiting, retaining, or 

2 providing advancement opportunities 

3 for direct care workers; and 

4 (II) on the methods used to re5 cruit, retain, or provide advancement 

6 opportunities to direct care workers. 

7 (B) REPORT TO CONGRESS.—Not later 

8 than 1 year after the completion of each project 

9 assisted with a grant under this Act, the Sec10 retary, in consultation with the Secretary of 

11 Health and Human Services, shall prepare and 

12 submit to Congress, and make publicly avail13 able, a report containing— 

14 (i) the progress and outcomes of the 

15 project as identified in the final report sub16 mitted by the eligible entity under para17 graph (1)(A)(ii); 

18 (ii) an analysis of the workforce sup19 ply, current and projected shortages, and 

20 distribution of direct care workers at the 

21 national, regional, and State levels; and 

22 (iii) recommendations for such legisla23 tive or administrative action, as the Sec24 retary determines appropriate. 


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1 (3) GAO REPORT.—Not later than 1 year after 

2 the completion of each project assisted with a grant 

3 under this Act, the Comptroller General of the 

4 United States shall conduct a study and submit to 

5 Congress a report including— 

6 (A) an assessment of how the project as7 sisted in the recruitment, retention, or advance8 ment of direct care workers; and 

9 (B) recommendations for such legislative 

10 or administrative actions, as the Comptroller 

11 General determines appropriate. 

12 (b) TECHNICAL ASSISTANCE.—Not later than 15 

13 months after the date of enactment of this Act, the Sec14 retary shall provide technical assistance to eligible entities 

15 receiving a grant under this Act, for purposes of compli16 ance with subsection (a)(1) of this section, on— 

17 (1) the disaggregation requirements of section 

18 116(d)(2)(B) of the Workforce Innovation and Op19 portunity Act (29 U.S.C. 3141(d)(2)); and 

20 (2) the data collection requirements of section 

21 116(b)(2)(A)(i) of such Act (29 U.S.C. 

22 3141(b)(2)(A)(i)). 


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1 SEC. 8. AUTHORIZATION OF APPROPRIATIONS. 

2 There are authorized to be appropriated such sums 

3 as may be necessary to carry out this Act for each of fiscal 

4 years 2021 through 2025. 

Æ 


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