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 com-
mittee concerned 
A BILL 
To award grants for the recruitment, retention, and 
advancement of direct care workers. 
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 ‘‘Direct Creation, Ad-
vancement, and Retention of Employment Opportunity 
Act’’ or the ‘‘Direct CARE Opportunity Act’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
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(1) Millions of older individuals and individuals 
with disabilities in the United States require assist-
ance with activities of daily living to live independ-
ently and participate in their communities to their 
fullest extent. The Bureau of the Census projects 
that by 2060 the population of individuals age 65 or 
older will double from 49,200,000 in 2016 to 
94,700,000. According to the Centers for Disease 
Control and Prevention, 1 in 4 (or 60,000,000) 
adults in the United States are living with a dis-
ability. 
(2) The assistance of direct care workers allows 
older individuals and individuals with disabilities to 
live with dignity and safety, and to exercise their 
right to live independently in their own homes and 
communities, in keeping with what is most appro-
priate for their needs and preferences. Older individ-
uals and individuals with disabilities may also par-
ticipate in the direct care workforce, further sup-
porting their ability to live independently. 
(3) According to PHI, direct care workers pro-
vide most of the paid, hands-on care for older indi-
viduals and individuals with disabilities. 
(4) According to PHI, 4,500,000 direct care 
workers provide care across home and community- 
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based settings, nursing facilities, assisted living fa-
cilities, group homes, intermediate care facilities, 
and hospitals to care for the growing population of 
older individuals and individuals with disabilities. 
(5) PHI projects that by 2024, 5,200,000 di-
rect care workers will be needed across all care set-
tings to care for the growing population of older in-
dividuals and individuals with disabilities. 
(6) Many direct care workers lack access to a 
career pathway or advanced training opportunities. 
This limits their ability to build competency and ex-
pertise in their field that, when gained, may lead to 
an increase in their earning capacity. According to 
PHI, more than half of home care workers have 
completed no formal education beyond high school, 
making high-quality, transferable training essential 
to success on the job. 
(7) As of 2015, the median wage for direct care 
workers is approximately $11 an hour; wages and 
earnings for home care workers are even lower in 
rural areas. Because of low wages, variable work 
hours, and the inability to access workplace-based 
benefits, 19 percent of home care workers live below 
the Federal poverty level as compared to 9 percent 
of the general United States workforce. Nearly half 
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of direct care workers rely on some form of public 
assistance to support themselves and their families. 
(8) According to PHI, approximately 9 in 10 
direct care workers are women, more than half are 
women of color, and one quarter of direct care work-
ers are immigrants. 
(9) The direct care workforce is plagued with 
high turnover, low job satisfaction, and workforce 
shortages. These conditions can contribute to re-
duced quality of care and threaten the availability of 
supports for older individuals and individuals with 
disabilities. 
(10) Because of the nature of the work, direct 
care workers suffer from disproportionately high 
rates of injury. In 2016, the injury rate for nursing 
assistants was 337 per 10,000 as compared to 100 
per 10,000 for other occupations. 
(11) Training has been shown to reduce worker 
turnover, reduce rates of injury, and lead to in-
creased job satisfaction. 
(12) The Institute of Medicine found that to 
ensure that the United States is prepared to meet 
the health care needs of older individuals during the 
21st century, it is essential that the capacity of the 
direct care workforce be enhanced in both the num-
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ber of workers available and their ability to meet 
their own health care and quality of life needs. 
SEC. 3. DEFINITIONS. 
In this Act: 
(1) APPRENTICESHIP
PROGRAM.—The term 
‘‘apprenticeship program’’ means an apprenticeship 
program registered under the Act of August 16, 
1937 (commonly known as the ‘‘National Appren-
ticeship Act’’; 50 Stat. 664, chapter 663; 29 U.S.C. 
50 et seq.). 
(2) DIRECT CARE WORKER.—The term ‘‘direct 
care worker’’ has the meaning given the term in sec-
tion 799B of the Public Health Service Act (42 
U.S.C. 295p). 
(3) ELIGIBLE ENTITY.—The term ‘‘eligible enti-
ty’’ means— 
(A) a State; 
(B) a nonprofit organization, a labor orga-
nization, or an entity with shared labor-man-
agement oversight— 
(i) with an established record of re-
cruiting or providing training to direct care 
workers; or 
(ii) that establishes a training pro-
gram in consultation with an organization 
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with an established record of providing 
training to direct care workers; 
(C) a local board; 
(D) a nonprofit entity carrying out an ap-
prenticeship program; 
(E) an Indian tribe or tribal organization; 
or 
(F) a consortium of entities listed in sub-
paragraph (A), (B), (C), (D), or (E) that may 
also include an institution of higher education. 
(4) EMPLOY; EMPLOYER.—The terms ‘‘employ’’ 
and ‘‘employer’’ have the meanings given the terms 
in section 3 of the Fair Labor Standards Act (29 
U.S.C. 203 et seq.). 
(5) INDIAN
TRIBE; TRIBAL
ORGANIZATION.— 
The terms ‘‘Indian tribe’’ and ‘‘tribal organization’’ 
have the meanings given such terms in section 4 of 
the Indian Self-Determination and Education Assist-
ance Act (25 U.S.C. 5304). 
(6) INSTITUTION OF HIGHER EDUCATION.—The 
term ‘‘institution of higher education’’ has the 
meaning given the term in section 101 of the Higher 
Education Act of 1965 (20 U.S.C. 1001). 
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(7) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Labor, except as otherwise specified 
in this Act. 
(8) STATE.—The term ‘‘State’’ has the mean-
ing given the term in section 3 of the Carl D. Per-
kins Career and Technical Education Act of 2006 
(20 U.S.C. 2302). 
(9) WORKFORCE
INNOVATION
AND
OPPOR-
TUNITY ACT TERMS.—The terms ‘‘career pathway’’, 
‘‘career planning’’, ‘‘in-demand industry sector or 
occupation’’, ‘‘individual with a barrier to employ-
ment’’, ‘‘individual with a disability’’, ‘‘local board’’, 
‘‘older individual’’, ‘‘one-stop center’’, ‘‘on-the-job 
training’’, ‘‘recognized postsecondary credential’’, 
‘‘region’’, ‘‘State board’’, and ‘‘supportive services’’ 
have the meanings given such terms in section 3 of 
the Workforce Innovation and Opportunity Act (29 
U.S.C. 3102). 
(10) 
WORK-BASED
LEARNING.—The 
term 
‘‘work-based learning’’ has the meaning given the 
term in section 3 of the Carl D. Perkins Career and 
Technical Education Act of 2006 (20 U.S.C. 2302). 
SEC. 4. AUTHORITY TO AWARD GRANTS; DURATION. 
(a) AUTHORITY TO AWARD GRANTS.—Not later than 
12 months after the date of enactment of this Act, the 
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Secretary, in consultation with the Secretary of Health 
and Human Services, shall award grants— 
(1) to not fewer than 15 eligible entities to de-
velop and carry out projects for purposes of recruit-
ing, retaining, or providing advancement opportuni-
ties to direct care workers; and 
(2) 5 of which shall be awarded for projects 
that focus on providing such advancement opportu-
nities. 
(b) TREATMENT OF CONTINUATION ACTIVITIES.— 
An eligible entity that carries out activities for purposes 
of recruiting, retaining, or providing advancement oppor-
tunities to direct care workers prior to receipt of a grant 
under this Act may use such grant to continue carrying 
out such activities, and shall be treated as an eligible enti-
ty carrying out a project described in subsection (a)(1). 
(c) DURATION.— 
(1) GRANT PERIOD.—A grant under this Act 
shall be for not less than 5 years. 
(2) LENGTH OF PROJECT.—A project assisted 
with a grant awarded under this Act shall be carried 
out for not less than 3 years. 
SEC. 5. PROJECT PLANS; CONSULTATION. 
(a) PROJECT PLANS.— 
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(1) IN GENERAL.—To receive a grant under 
this Act, an eligible entity shall submit to the Sec-
retary a project plan for each project to be developed 
and carried out (or for activities to be continued) 
with the grant at such time and in such manner as 
the Secretary may determine, and which shall con-
tain the information described in paragraph (2). 
(2) CONTENTS.—A project plan submitted by 
an eligible entity under paragraph (1) shall include 
a description of each of the following: 
(A) Current or projected job openings for, 
or relevant labor market information related to, 
direct care workers in the State or region to be 
served by the project, and the geographic scope 
of the workforce to be served by the project. 
(B) Specific efforts and strategies that the 
project will undertake to reduce barriers to re-
cruitment, retention, or advancement of direct 
care workers, including an assurance that such 
efforts will include— 
(i) an assessment of the wages or 
other compensation or benefits necessary 
to recruit and retain direct care workers; 
and 
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(ii) a description of the project’s pro-
jected wages and other compensation or 
benefits for direct care workers at the 
State or local level, including a comparison 
of such projected wages to regional and 
national wages. 
(C) In the case of a project offering an 
education and training program, a description 
of such program (including any curricula, mod-
els, and standards used under the program, and 
any associated recognized postsecondary creden-
tials for which the program provides prepara-
tion, as applicable), which shall include an as-
surance that such program will provide— 
(i) an apprenticeship program, work- 
based learning, or on-the-job training op-
portunities; 
(ii) supervision or mentoring; and 
(iii) a progressively increasing, clearly 
defined schedule of wages to be paid to the 
direct care worker that— 
(I) is consistent with skill gains 
or attainment of a recognized postsec-
ondary credential; and 
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(II) ensures the entry wage is not 
less than the greater of— 
(aa) the minimum wage re-
quired under section 6(a) of the 
Fair Labor Standards Act of 
1938 (29 U.S.C. 206(a)); or 
(bb) the applicable wage re-
quired by other applicable Fed-
eral or State law, or a collective 
bargaining agreement. 
(D) If applicable, any other innovative 
models or processes the eligible entity will im-
plement to support the retention of direct care 
workers. 
(E) The supportive services and benefits to 
be provided to direct care workers to support 
the retention of employment of direct care 
workers. 
(F) How the eligible entity will make use 
of career planning to support the identification 
of advancement opportunities and career path-
ways for direct care workers in the State or re-
gion to be served by the project. 
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(G) How the eligible entity will collect and 
submit to the Secretary workforce data and 
outcomes of the project. 
(H) How the project will— 
(i) provide adequate and safe equip-
ment, and facilities for training and super-
vision, including a safe work environment 
free from discrimination; 
(ii) provide safety training for direct 
care workers as part of the education and 
training program described in subpara-
graph (C), as applicable; and 
(iii) provide adequate training for 
mentors and qualified instructors to ensure 
compliance with clause (i) and, as applica-
ble, clause (ii). 
(I) How the eligible entity will consult on 
the implementation of the project, or coordinate 
the project with, each of the following entities, 
to the extent that each such entity is not a part 
of the eligible entity: 
(i) The State agency responsible for 
administering the State plan under title 
XIX of the Social Security Act (42 U.S.C. 
1396 et seq.) (or waiver of the plan), or 
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the State agency with primary responsi-
bility for providing services and supports 
for individuals with intellectual disabilities 
and individuals with developmental disabil-
ities, for the State to be served by the 
project. 
(ii) The local board and State board 
for the State or for each region to be 
served by the project. 
(iii) A nonprofit organization with 
demonstrated experience with respect to di-
rect care workers. 
(iv) In the case of a project that car-
ries out an education and training pro-
gram, a nonprofit organization with dem-
onstrated experience in the development or 
delivery of curricula or coursework. 
(v) A nonprofit organization that fos-
ters the professional development and col-
lective engagement of direct care workers, 
including labor organizations. 
(vi) A nonprofit organization with ex-
pertise in identifying and addressing the 
care needs of older individuals and individ-
uals with disabilities and their caregivers 
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(including area agencies on aging, as de-
fined in section 102 of the Older Ameri-
cans Act of 1965 (42 U.S.C. 3002), and 
centers for independent living, as described 
in part C of title VII of the Rehabilitation 
Act of 1973 (29 U.S.C. 796f et seq.)). 
(vii) A nonprofit State provider asso-
ciation that represents providers who em-
ploy direct care workers, where such asso-
ciations exist. 
(viii) An entity that employs direct 
care workers. 
(J) An assurance that any benefit or serv-
ice provided under the project will be provided 
at no cost to a direct care worker or individuals 
assisted by such workers. 
(K) How the eligible entity will consult 
with individuals employed as direct care work-
ers, representatives of such workers, individuals 
assisted by such workers, and the families of 
such individuals throughout the project. 
(L) Outreach efforts to individuals for par-
ticipation in such project, including targeted 
outreach efforts to— 
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(i) individuals who are recipients of 
assistance under a State program funded 
under part A of title IV of the Social Secu-
rity Act (42 U.S.C. 601 et seq.) or individ-
uals who are eligible for such assistance; 
and 
(ii) individuals with barriers to em-
ployment. 
(3) CONSIDERATIONS.—In selecting eligible en-
tities to receive a grant under this Act, the Secretary 
shall— 
(A) ensure— 
(i) equitable geographic and demo-
graphic diversity, including rural and 
urban areas; and 
(ii) that selected eligible entities will 
serve areas where direct care, or a related 
occupation, is an in-demand industry sec-
tor or occupation; and 
(B) give priority to eligible entities pro-
posing to predominantly serve the individuals 
described in clauses (i) and (ii) of paragraph 
(2)(L). 
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(b) CONSULTATION.—The Secretary shall encourage 
each eligible entity receiving a grant under this Act, in 
developing and carrying out a project, to consult with— 
(1) institutions of higher education; 
(2) the State Apprenticeship Agency recognized 
under the Act of August 16, 1937 (commonly known 
as the ‘‘National Apprenticeship Act’’; 50 Stat. 664, 
chapter 663; 29 U.S.C. 50 et seq.), for the State or 
region to be served by the eligible entity or, if no 
such agency has been recognized in the State or re-
gion, the Office of Apprenticeship of the Department 
of Labor; and 
(3) one-stop centers. 
SEC. 6. USES OF FUNDS; SUPPLEMENT, NOT SUPPLANT. 
(a) USES OF FUNDS.— 
(1) IN GENERAL.—Each eligible entity receiving 
a grant under this Act shall use such funds to carry 
out at least 1 project or to continue activities com-
menced prior to receipt of such grant that— 
(A) develop and implement a strategy for 
the recruitment, retention, or advancement of 
direct care workers, which includes the activi-
ties described in section 5(a)(2); and 
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(B) provide compensation to each eligible 
direct care worker for any training received 
under the project or activities. 
(2) ADMINISTRATIVE COSTS.—Each eligible en-
tity receiving a grant under this Act shall not use 
more than 5 percent of the funds of such grant for 
costs associated with the administration of activities 
under this Act. 
(3) DIRECT SUPPORT.—Each eligible entity re-
ceiving a grant under this Act shall use not less than 
5 percent of the funds of such grant to provide di-
rect financial assistance, such as supportive services, 
to direct care workers to support the financial needs 
of such workers to enter, remain enrolled in, and 
complete the project (or activities) assisted with such 
grant. 
(b) SUPPLEMENT, NOT SUPPLANT.—An eligible enti-
ty receiving a grant under this Act shall use such grant 
only to supplement, and not supplant, the amount of funds 
that, in the absence of such grant, would be available to 
address the recruitment, retention, or advancement of di-
rect care workers in the State or region served by the eligi-
ble entity. 
SEC. 7. EVALUATIONS AND REPORTS. 
(a) REPORTS.— 
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(1) ELIGIBLE ENTITIES.— 
(A) IN GENERAL.—Each eligible entity re-
ceiving a grant under this Act shall submit to 
the Secretary and the Secretary of Health and 
Human Services, with respect to each project 
assisted with such grant— 
(i) for each year of the grant period, 
an annual report on the progress and out-
comes of the project; and 
(ii) not later 6 months after the com-
pletion of such project, a final report on 
the progress and outcomes of the project. 
(B) DISAGGREGATION.—Each report sub-
mitted under paragraph (A) shall— 
(i) include the information described 
in subparagraph (C); and 
(ii) disaggregate such information in 
the manner described in subparagraph 
(D). 
(C) CONTENTS.—Each report submitted 
under subparagraph (A) shall include each of 
the following: 
(i) The number of individuals served 
by the project, including— 
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(I) the number of individuals re-
cruited to be employed as a direct 
care worker; and 
(II) the number of individuals 
who attained employment as a direct 
care worker. 
(ii) The number of individuals or fam-
ilies assisted by direct care workers. 
(iii) The number of direct care work-
ers who participated in and completed— 
(I) work-based learning; 
(II) on-the-job training; 
(III) an apprenticeship program; 
or 
(IV) a professional development 
or mentoring program. 
(iv) Other services, benefits, or sup-
ports (other than the services, benefits, or 
supports described in clause (iii)) provided 
to assist in the recruitment, retention, or 
advancement of direct care workers, the 
number of individuals who accessed such 
services, benefits, or supports, and the im-
pact of such services, benefits, or supports. 
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(v) How the project assessed satisfac-
tion with respect to— 
(I) direct care workers assisted 
by the project; 
(II) individuals receiving services 
delivered by such workers, including 
any impact on the health or health 
outcomes of such individuals; and 
(III) employers of such workers, 
as determined in accordance with sec-
tion 116(b)(2)(A)(i)(VI) of the Work-
force Innovation and Opportunity Act 
(29 U.S.C. 3141(b)(2)(A)(i)(VI)). 
(vi) The performance of the eligible 
entity with respect to the indicators of per-
formance on unsubsidized employment, me-
dian earnings, credential attainment, meas-
urable skill gains, and employer satisfac-
tion, 
as 
described 
under 
section 
116(b)(2)(A)(i) of the Workforce Innova-
tion and Opportunity Act (29 U.S.C. 
3141(b)(2)(A)(i)). 
(vii) Any other information with re-
spect to outcomes of the project. 
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(D) DISAGGREGATION.—The information 
described under subparagraph (C) shall be 
disaggregated by race, ethnicity, sex, and age in 
accordance with section 116(d)(2)(B) of the 
Workforce Innovation and Opportunity Act (29 
U.S.C. 3141(d)(2)), by each population listed in 
section 3(24) of the Workforce Innovation and 
Opportunity Act (29 U.S.C. 3102(24)), and by 
the individuals described in clauses (i) and (ii) 
of section 5(a)(2)(L). 
(2) SECRETARIES.— 
(A) ANNUAL
PERFORMANCE
REVIEW.— 
The Secretary, in consultation with the Sec-
retary of Health and Human Services, shall an-
nually conduct a performance review of each 
project carried out by an eligible entity receiv-
ing a grant under this Act, including— 
(i) the performance of the project with 
respect to the indicators of performance 
described in paragraph (1)(C)(vi), and 
disaggregated in the manner described in 
paragraph (1)(D); and 
(ii) the efficacy of the project plan 
submitted under section 5(a)— 
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(I) for recruiting, retaining, or 
providing advancement opportunities 
for direct care workers; and 
(II) on the methods used to re-
cruit, retain, or provide advancement 
opportunities to direct care workers. 
(B) REPORT
TO
CONGRESS.—Not later 
than 1 year after the completion of each project 
assisted with a grant under this Act, the Sec-
retary, in consultation with the Secretary of 
Health and Human Services, shall prepare and 
submit to Congress, and make publicly avail-
able, a report containing— 
(i) the progress and outcomes of the 
project as identified in the final report sub-
mitted by the eligible entity under para-
graph (1)(A)(ii); 
(ii) an analysis of the workforce sup-
ply, current and projected shortages, and 
distribution of direct care workers at the 
national, regional, and State levels; and 
(iii) recommendations for such legisla-
tive or administrative action, as the Sec-
retary determines appropriate. 
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(3) GAO REPORT.—Not later than 1 year after 
the completion of each project assisted with a grant 
under this Act, the Comptroller General of the 
United States shall conduct a study and submit to 
Congress a report including— 
(A) an assessment of how the project as-
sisted in the recruitment, retention, or advance-
ment of direct care workers; and 
(B) recommendations for such legislative 
or administrative actions, as the Comptroller 
General determines appropriate. 
(b) TECHNICAL ASSISTANCE.—Not later than 15 
months after the date of enactment of this Act, the Sec-
retary shall provide technical assistance to eligible entities 
receiving a grant under this Act, for purposes of compli-
ance with subsection (a)(1) of this section, on— 
(1) the disaggregation requirements of section 
116(d)(2)(B) of the Workforce Innovation and Op-
portunity Act (29 U.S.C. 3141(d)(2)); and 
(2) the data collection requirements of section 
116(b)(2)(A)(i) 
of 
such 
Act 
(29 
U.S.C. 
3141(b)(2)(A)(i)). 
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SEC. 8. AUTHORIZATION OF APPROPRIATIONS. 
There are authorized to be appropriated such sums 
as may be necessary to carry out this Act for each of fiscal 
years 2021 through 2025. 
Æ 
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