I 
116TH CONGRESS 
2D SESSION 
H. R. 9057 
To amend the Public Health Service Act to develop and test an expanded 
and advanced role for direct-care workers who provide long-term services 
and supports to older adults and people with disabilities in efforts to 
coordinate care and improve the efficiency of service delivery, and for 
other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 31, 2020 
Mr. CARTWRIGHT introduced the following bill; which was referred to the 
Committee on Energy and Commerce 
A BILL 
To amend the Public Health Service Act to develop and 
test an expanded and advanced role for direct-care work-
ers who provide long-term services and supports to older 
adults and people with disabilities in efforts to coordinate 
care and improve the efficiency of service delivery, 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 ‘‘Improving Care for 
Vulnerable Older Citizens and People with Disabilities 
through Workforce Advancement Act of 2020’’. 
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SEC. 2. FINDINGS. 
Congress finds the following: 
(1) As of 2016, more than 49,000,000 Ameri-
cans were age 65 or older. By 2030, the Census Bu-
reau projects that one in five Americans will be 65 
or older. More than 75 percent of older Americans 
suffer from chronic conditions which require person- 
centered, coordinated care that helps them to live in 
a home- or community-based setting. In 2012, the 
Government Accountability Office (GAO) found that 
34 percent of Americans who are age 60 or older re-
ported needing assistance performing activities of 
daily living. According to a 2015 GAO report, be-
tween 67 and 78 percent of older adults who likely 
need home-based care receive limited or no help with 
their difficulties. 
(2) Direct-care workers (referred to in this sec-
tion as ‘‘DCWs’’) provide an estimated 70 to 80 per-
cent of the paid hands-on long-term care and per-
sonal assistance received by elders and people with 
disabilities or other chronic conditions in the United 
States. These workers help their clients bathe, dress, 
and negotiate a range of other daily tasks. They are 
a lifeline for those they serve, as well as for families 
and friends struggling to provide high-quality care. 
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(3) Eldercare and disability services positions 
account for nearly one-third of the 18,000,000 
health care jobs in the United States. The direct- 
care workforce alone accounts for nearly 4,500,000 
jobs and is expected to add more than 1,300,000 
new positions within the next decade. 
(4) The majority of DCWs are now employed in 
home- and community-based settings, and not in in-
stitutional settings such as nursing care facilities or 
hospitals. In 2018, DCWs providing home-based 
care already outnumbered DCWs in nursing homes 
by more than 4 to 1. 
(5) A 2008 Institute of Medicine report, enti-
tled ‘‘Re-tooling for an Aging America: Building the 
Health Care Workforce’’, called for new models of 
care delivery and coordination, and dedicated a 
chapter to the central importance of the direct-care 
workforce in a ‘‘re-tooled’’ eldercare delivery system. 
(6) An Institute of Medicine report on the fu-
ture of nursing, released in October of 2010, rec-
ommended nurses should practice to the full extent 
of their education and training. The report also 
states that all health care professionals should work 
collaboratively in team-based models, and that the 
goal should be to encourage care models that use 
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