I 
111TH CONGRESS 
1ST SESSION H. R. 4224 
To establish a pilot program to train public housing residents as home 
health aides and in home-based health services to enable such residents 
to provide covered home-based health services to residents of public 
housing and residents of federally-assisted rental housing, who are elderly 
and disabled, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 8, 2009 
Ms. VELA´ZQUEZ (for herself, Mr. FRANK of Massachusetts, and Ms. WATERS) 
introduced the following bill; which was referred to the Committee on Fi-
nancial Services 
A BILL 
To establish a pilot program to train public housing residents 
as home health aides and in home-based health services 
to enable such residents to provide covered home-based 
health services to residents of public housing and resi-
dents of federally-assisted rental housing, who are elderly 
and disabled, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Together We Care Act 
of 2009’’. 
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SEC. 2. FINDINGS AND PURPOSE. 
(a) FINDINGS.—The Congress finds the following: 
(1) The ‘‘baby boom’’ generation will require 
health care attention that will exceed the current 
supply of health care providers. 
(2) There is a shortage of training programs 
specializing in health care and long-term services 
that focus on home care instead of institutionalized 
care. 
(3) Although the need for home-based health 
services transcends all income levels, the availability 
of such services is more limited for residents of pub-
lic housing. 
(4) 
Estimates 
indicate 
that 
there 
are 
44,000,000 caregivers in the United States pro-
viding unpaid care to at least one adult, representing 
22,900,000 households. 
(5) Of working persons providing unpaid care, 
62 percent have had to make adjustments to work 
schedules or leave employment. 
(6) Many low-income families in the United 
States are placed in an untenable position of choos-
ing between work and caregiving responsibilities at 
home. 
(7) Many residents of public housing in the 
United States are aging and in need of care. 
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(8) The Department of Housing and Urban De-
velopment estimates the percentage of households 
assisted by the Department that are elderly house-
holds is 35 percent in New York, 33 percent in Bos-
ton, 35 percent in Chicago, 24 percent in Cleveland, 
40 percent in Los Angeles, and 20 percent in Puerto 
Rico. 
(9) New service programs are needed to provide 
home-based health services to residents of public 
housing and to provide job training and job place-
ment for persons receiving assistance from the De-
partment of Housing and Urban Development need-
ing employment. 
(10) The Department of Housing and Urban 
Development should establish a home-based health 
services pilot program to meet the challenges of the 
increasing number of elderly persons and persons 
with disabilities in public housing, which would si-
multaneously create an opportunity to train job 
seekers in a trade that provides home-based health 
services. 
(b) PURPOSES.—The purposes of this Act are— 
(1) to give flexibility to the Department of 
Housing and Urban Development and other entities 
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to establish training programs in home-based health 
services for public housing residents; and 
(2) to provide needed home care options to el-
derly and disabled public housing residents (includ-
ing elderly and disabled veterans who are public 
housing residents) and elderly and disabled residents 
of federally-assisted rental housing to allow them to 
remain in their homes and their communities. 
SEC. 3. PILOT GRANT PROGRAM TO TRAIN PUBLIC HOUS-
ING 
RESIDENTS 
TO 
PROVIDE 
COVERED 
HOME-BASED HEALTH SERVICES. 
Section 34 of the United States Housing Act of 1937 
(42 U.S.C. 1437z–6) is amended by adding at the end 
the following new subsections: 
‘‘(f) PILOT GRANT PROGRAM TO TRAIN PUBLIC 
HOUSING RESIDENTS TO PROVIDE COVERED HOME- 
BASED HEALTH SERVICES.— 
‘‘(1) ESTABLISHMENT OF PILOT GRANT PRO-
GRAM.—The Secretary, in consultation with the Sec-
retary of Health and Human Services, shall estab-
lish a competitive grant program to make grants to 
eligible entities under paragraph (2) for use for the 
training of public housing residents as home health 
aides and as providers of home-based health services 
(including as personal and home care aides) to en-
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able such residents to provide covered home-based 
health services to— 
‘‘(A) residents of public housing who are 
elderly or disabled, or both (including elderly 
and disabled veterans who are residents of pub-
lic housing); and 
‘‘(B) subject to the criteria set forth pur-
suant to paragraph (3), residents of federally- 
assisted rental housing who are elderly or dis-
abled, or both. 
‘‘(2) ELIGIBLE ENTITIES.—A grant under this 
subsection may be made only to an entity that— 
‘‘(A) is a public housing agency or other 
unit of State or local government (including an 
agency of such unit), community health center, 
home care provider organization, faith-based or-
ganization, labor organization, or other organi-
zation determined to be qualified by the Sec-
retary; and 
‘‘(B) demonstrates to the satisfaction of 
the Secretary that it has established, or pro-
vides such assurances that it will establish, an 
employment training program to train public 
housing residents to provide covered home- 
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based health services that complies with regula-
tions that the Secretary shall issue. 
‘‘(3) 
RESIDENTS
OF
FEDERALLY-ASSISTED 
RENTAL
HOUSING.—The Secretary may set forth 
criteria under which an entity receiving funding 
under this subsection may train public housing resi-
dents to provide covered home-based health services 
to elderly and disabled residents of federally-assisted 
rental housing. 
‘‘(4) APPLICATION.—To be eligible for a grant 
under this subsection an eligible entity under para-
graph (2) shall submit to the Secretary an applica-
tion at such time, in such manner, and containing 
such information as the Secretary shall require. 
‘‘(5) COMPETITIVE GRANT AWARDS.— 
‘‘(A) GENERAL
CRITERIA
FOR
SELEC-
TION.—The Secretary shall establish policies 
and procedures for reviewing and approving 
funding for eligible entities through a competi-
tive process taking into consideration— 
‘‘(i) with respect to the service area in 
which public housing residents trained 
under an employment training program de-
scribed in paragraph (2)(B) will provide 
covered home-based health services— 
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‘‘(I) the percentage of residents 
age 62 and older; 
‘‘(II) the percentage of disabled 
residents; and 
‘‘(III) the percentage of unem-
ployed or underemployed residents; 
‘‘(ii) the ability of an eligible entity to 
provide training that leads to the provision 
of quality care; 
‘‘(iii) the record of the quality of care 
of an eligible entity; and 
‘‘(iv) such other criteria as determined 
by the Secretary. 
‘‘(B) GEOGRAPHIC
CONSIDERATION.—In 
awarding grants, the Secretary shall consider a 
geographic mix of a variety of eligible entities 
so that the grant program will include at 
least— 
‘‘(i) one employment training program 
described in paragraph (2)(B) that pri-
marily serves an urban population; 
‘‘(ii) one employment training pro-
gram described in paragraph (2)(B) that 
primarily serves a rural population; 
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‘‘(iii) one employment training pro-
gram described in paragraph (2)(B) that 
primarily serves an Indian population; and 
‘‘(iv) one employment training pro-
gram described in paragraph (2)(B) that 
primarily serves a population in the Com-
monwealth of Puerto Rico, the United 
States Virgin Islands, Guam, American 
Samoa, or the Commonwealth of the 
Northern Mariana Islands. 
‘‘(6) USE OF GRANT FUNDS.—An entity receiv-
ing funding under this subsection may use such 
funds— 
‘‘(A) to establish (or maintain) and carry- 
out an employment training program to train 
public housing residents to provide covered 
home-based health care services to elderly and 
disabled public housing residents and elderly 
and disabled residents of federally-assisted rent-
al housing; 
‘‘(B) for the transportation expenses of 
public housing residents in training under such 
an employment training program; 
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‘‘(C) for the child care expenses of public 
housing residents in training under such an em-
ployment training program; 
‘‘(D) for the administrative expenses of 
carrying out such an employment training pro-
gram; and 
‘‘(E) for any other activity the Secretary 
determines appropriate. 
‘‘(7) REPORT TO CONGRESS.—Not later than 
24 months after the date of the enactment of the 
Together We Care Act of 2009, the Secretary shall 
submit to Congress a report on the use and impact 
of the grant program established by this subsection. 
The report shall include— 
‘‘(A) a review of the effectiveness of the 
program in— 
‘‘(i) providing jobs for public housing 
residents; 
‘‘(ii) meeting the unmet health and 
long-term care needs of elderly and dis-
abled residents of public housing and elder-
ly and disabled residents of federally-as-
sisted rental housing; and 
‘‘(iii) enabling the provision of quality 
care; and 
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‘‘(B) any recommendations the Secretary 
determines appropriate regarding the grant pro-
gram. 
‘‘(8) DEFINITIONS.—As used in this subsection, 
subsection (g), and subsection (h): 
‘‘(A) HOME-BASED
HEALTH
SERVICES.— 
The term ‘home-based health services’ means 
health care and long-term services provided to 
an individual in a place of residence used as 
such individual’s home and includes— 
‘‘(i) home health services described in 
section 1861(m) of the Social Security Act 
(42 U.S.C. 1395x(m)); 
‘‘(ii) personal care services described 
in section 1905(a)(24) of such Act (42 
U.S.C. 1396d(a)(24)); and 
‘‘(iii) home-based services which may 
be covered under a waiver under subsection 
(c) or (d) of section 1915 of such Act (42 
U.S.C. 1396n). 
‘‘(B) HOME
HEALTH
AIDE.—The term 
‘home health aide’ has the meaning given the 
term in section 1891(a)(3)(E) of the Social Se-
curity Act (42 U.S.C. 1395bbb(a)(3)(E)). 
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‘‘(C) 
COVERED.—The 
term 
‘covered’ 
means, with respect to home-based health serv-
ices, such services— 
‘‘(i) for which medical assistance is 
available under a State plan under title 
XIX of the Social Security Act; or 
‘‘(ii) for which financial assistance is 
available under subsection (g). 
‘‘(D) 
FEDERALLY-ASSISTED
RENTAL 
HOUSING.—The term ‘federally-assisted rental 
housing’ means— 
‘‘(i) housing assisted under section 
202 of the Housing Act of 1959 (12 
U.S.C. 1701q); 
‘‘(ii) housing assisted under section 
515 of the Housing Act of 1949 (42 
U.S.C. 1485); 
‘‘(iii) housing assisted under section 8 
of the United States Housing Act of 1937 
(42 U.S.C. 1437f) (including project-based 
and tenant-based assistance); 
‘‘(iv) housing assisted under the block 
grant program under the Native American 
Housing Assistance and Self-Determina-
tion Act of 1996 (25 U.S.C. 4101 et seq.); 
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‘‘(v) housing financed by a mortgage 
insured under section 221(d)(3) of the Na-
tional 
Housing 
Act 
(12 
U.S.C. 
1715l(d)(3)) or held by the Secretary, a 
State, or State agency; and 
‘‘(vi) housing assisted under section 
811 of the Cranston-Gonzalez National Af-
fordable Housing Act (42 U.S.C. 8013). 
‘‘(9) INAPPLICABILITY
OF
PREVIOUS
SUB-
SECTIONS.—Subsections (a) through (e) shall not 
apply to this subsection, subsection (g), and sub-
section (h). 
‘‘(10) RULE
OF
CONSTRUCTION.—This sub-
section and subsection (g) may not be construed as 
affecting any requirement under State law for train-
ing, licensure, or any other certification as a home 
health aide or as a provider of any home-based 
health service under this subsection and subsection 
(g). 
‘‘(11) REGULATIONS.—Not later than 6 months 
after the date of enactment of the Together We Care 
Act of 2009, the Secretary shall issue regulations to 
carry out this subsection. 
‘‘(12) AUTHORIZATION OF APPROPRIATIONS.— 
There are authorized to be appropriated $2,500,000 
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for each of the fiscal years 2010, 2011, and 2012, 
for grants under this subsection. 
‘‘(g) FINANCIAL
ASSISTANCE
FOR
HOME-BASED 
HEALTH SERVICES IN CERTAIN JURISDICTIONS.— 
‘‘(1) FINANCIAL ASSISTANCE.—The Secretary, 
in consultation with the Secretary of Health and 
Human Services, may provide financial assistance 
under this subsection to entities receiving grant 
funds under the pilot program established under 
subsection (f) that provide training for public hous-
ing residents as home health aides and as providers 
of home-based health services and provide (or pay 
for) such services for use only for their costs in pro-
viding (or paying for) such services to— 
‘‘(A) residents of public housing who are 
elderly or disabled, or both (including elderly or 
disabled veterans who are residents of public 
housing); or 
‘‘(B) at the discretion of the Secretary, 
residents of federally-assisted rental housing 
who are elderly or disabled, or both. 
‘‘(2) REQUIREMENTS.— 
‘‘(A) LOCATION.—Assistance under para-
graph (1) may be provided only for services fur-
nished in locations in which medical assistance 
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