I 
117TH CONGRESS 
1ST SESSION H. R. 2999 
To award grants for the recruitment, retention, and advancement of direct 
care workers. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 4, 2021 
Mr. SCOTT of Virginia (for himself, Ms. WILD, and Mrs. LEE of Nevada) in-
troduced the following bill; which was referred to the Committee on Edu-
cation and Labor, and in addition to the Committee on Energy and Com-
merce, for a period to be subsequently determined by the Speaker, in 
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee 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) Nearly 20,000,000 adults in the United 
States require assistance completing self-care and 
other daily tasks due to physical, cognitive, develop-
mental, or behavioral conditions. This number in-
cludes about 17,000,000 individuals living in the 
community, 1,500,000 residing in nursing homes, 
and nearly 1,000,000 in residential care. The num-
ber of people needing this type of assistance is ex-
pected to rise as the percentage of the population 
that is over age 65 increases dramatically in the 
coming decades. 
(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) From 2014 to 2024, home care occupations 
are projected to add more jobs than any other single 
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occupation, with an additional 633,100 new jobs. 
Home care is also among the top 10 fastest-growing 
occupations, and with the projected growth in the 
population over age 65, this may underestimate the 
number of home care workers that will be needed to 
provide care for this growing population. 
(5) 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. 
(6) As of 2018, the median wage for direct care 
workers is $12.27 per hour and 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, 44 per-
cent of such workers live in low-income households, 
and 15 percent of the workers from such households 
live below the poverty line. Nearly half of direct care 
workers rely on some form of public assistance to 
support themselves and their families. 
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(7) According to PHI, the direct care workforce 
is primarily comprised of low income women and 
people of color. Approximately 9 in 10 direct care 
workers are women, more than half are women of 
color, and one quarter of direct care workers are im-
migrants. 
(8) 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. 
(9) 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. 
(10) Training has been shown to reduce worker 
turnover, reduce rates of injury, and lead to in-
creased job satisfaction. 
(11) 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.), including any requirement, standard, or 
rule promulgated under such Act, as such require-
ment, standard, or rule was in effect on January 1, 
2020. 
(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, a joint labor-management organiza-
tion, or an employer— 
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(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 
with an established record of providing 
training to direct care workers; 
(C) a local board; 
(D) an entity carrying out an apprentice-
ship 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). 
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(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). 
(7) PROJECT PARTICIPANT.—The term ‘‘project 
participant’’ means an individual participating in a 
project assisted with a grant under this Act, includ-
ing a direct care worker or an individual training to 
be such a worker. 
(8) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Labor, except as otherwise specified 
in this Act. 
(9) 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). 
(10) SUPPORTIVE SERVICES.—The term ‘‘sup-
portive services’’ means services such as transpor-
tation, child care, dependent care, housing, and 
needs-related payments, that are necessary to enable 
an individual to participate in a project assisted with 
a grant under this Act. 
(11) WORKFORCE
INNOVATION
AND
OPPOR-
TUNITY ACT TERMS.—The terms ‘‘career pathway’’, 
‘‘career planning’’, ‘‘in-demand industry sector or 
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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’’, and ‘‘State board’’ have the meanings 
given such terms in section 3 of the Workforce Inno-
vation and Opportunity Act (29 U.S.C. 3102). 
(12) 
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.— 
(1) IN GENERAL.—Not later than 12 months 
after the date of enactment of this Act, the Sec-
retary, in consultation with the Secretary of Health 
and Human Services, shall award grants to eligible 
entities to develop and carry out projects for pur-
poses of recruiting, retaining, or providing advance-
ment opportunities to direct care workers. 
(2) PROJECTS FOR ADVANCEMENT OPPORTUNI-
TIES.—Not less than 30 percent of projects assisted 
with grants under this Act for a fiscal year shall be 
projects to provide advancement opportunities to di-
rect care workers. 
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(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.—A grant under this Act shall be for 
not less than 5 years. 
SEC. 5. PROJECT PLANS; CONSULTATION. 
(a) PROJECT PLANS.— 
(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) Demographic information regarding 
the population in the State or relevant geo-
graphic area, including a description of the pop-
ulations likely to need long-term care services, 
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such as people with significant disabilities and 
the aging population. 
(B) Projections of unmet need for direct 
care services based on enrollment waiting lists 
under home and community-based waivers 
under section 1115 of the Social Security Act 
(42 U.S.C. 1315) or section 1915(c) of such 
Act (42 U.S.C. 1396n(c)) and other relevant 
data to the extent practicable and feasible. 
(C) 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. 
(D) 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 and strategies will— 
(i) be undertaken in consultation with 
the individuals served by the entities de-
scribed in subsection (b); and 
(ii) include— 
(I) an assessment of the wages or 
other compensation or benefits nec-
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essary to recruit and retain direct 
care workers; and 
(II) a description of the project’s 
projected wages and other compensa-
tion or benefits for direct care work-
ers at the State or local level, includ-
ing a comparison of such projected 
wages to regional and national wages. 
(E) 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 to each 
project participant in such program— 
(i) relevant training regarding the 
rights of recipients of direct care services, 
including their rights to— 
(I) receive services in the most 
integrated setting; 
(II) exercise self-determination; 
and 
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essary equipment to prevent the spread of 
infectious disease among workers and re-
cipients of services; and 
(ii) will include— 
(I) a safe work environment free 
from discrimination; and 
(II) adequate training for men-
tors and qualified instructors to en-
sure compliance with this subpara-
graph, including any equipment that 
may be provided under clause (i). 
(K) How the eligible entity will consult on 
the implementation of the project, or coordinate 
the project with, the entities described in sub-
section (b). 
(L) An assurance that the eligible entity 
will take such steps necessary to reduce or 
eliminate costs to project participants for any 
benefit or service provided under the project. 
(M) 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. 
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(N) Outreach efforts to individuals for par-
ticipation in such project, including targeted 
outreach efforts to— 
(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 among 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 
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described in clauses (i) and (ii) of paragraph 
(2)(N). 
(b) CONSULTATION.—Each eligible entity receiving a 
grant under this Act shall consult on the implementation 
of each project assisted with such grant, or coordinate the 
project with— 
(1) each applicable State board or local board; 
and 
(2) to the extent practicable— 
(A) institutions of higher education in the 
State or local areas to be served by the project; 
(B) the State Apprenticeship Agency rec-
ognized under the Act of August 16, 1937 
(commonly known as the ‘‘National Apprentice-
ship 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 agen-
cy has been recognized in the State or region, 
the Office of Apprenticeship of the Department 
of Labor; 
(C) one-stop centers in the State or local 
areas to be served by the project; 
(D) the State agency responsible for ad-
ministering the State plan under title XIX of 
the Social Security Act (42 U.S.C. 1396 et 
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seq.) (or waiver of the plan), or the State agen-
cy with primary responsibility for providing 
services and supports for individuals with intel-
lectual disabilities and individuals with develop-
mental disabilities; 
(E) in the case of a project that carries out 
an education and training program, a nonprofit 
organization with demonstrated experience in 
the development or delivery of curricula or 
coursework; 
(F) an organization that fosters the profes-
sional development and collective engagement of 
direct care workers, including labor organiza-
tions or joint labor-management organizations; 
(G) a nonprofit organization with expertise 
in identifying and addressing the care needs of 
older individuals and individuals with disabil-
ities and their caregivers (including area agen-
cies on aging, as defined in section 102 of the 
Older Americans 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.)); 
(H) the State Developmental Disability 
Council (as such term is used in subtitle B of 
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title I of the Developmental Disabilities Assist-
ance and Bill of Rights Act of 2000 (42 U.S.C. 
15021 et seq.); 
(I) Aging and Disability Resource Centers 
(as defined in section 102 of the Older Ameri-
cans Act of 1965 (42 U.S.C. 3002)); 
(J) a nonprofit State provider association 
that represents providers who employ direct 
care workers, where such associations exist; and 
(K) an entity that employs direct care 
workers. 
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 
(B) provide compensation to each project 
participant for any training received under the 
project or activities. 
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(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 project participants to support the financial needs 
of such individuals 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.— 
(1) ELIGIBLE ENTITIES.— 
(A) IN GENERAL.—Each eligible entity re-
ceiving a grant under this Act shall submit to 
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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 project partici-
pants, including— 
(I) the number of such partici-
pants who completed an education 
and training program offered by such 
project, disaggregated by the type of 
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education and training completed (in-
cluding work-based learning, on-the- 
job training, an apprenticeship pro-
gram, and a professional development 
or mentoring program); and 
(II) the number of such partici-
pants who— 
(aa) completed an education 
and training program offered by 
such project; and 
(bb) attained employment as 
a direct care worker after partici-
pating in such project. 
(ii) The number of individuals or fam-
ilies assisted by project participants. 
(iii) Other services, benefits, or sup-
ports (other than the services, benefits, or 
supports described in clause (i)) 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. 
(iv) How the project assessed satisfac-
tion with respect to— 
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(I) project participants assisted 
by the project; 
(II) individuals receiving services 
delivered by project participants, in-
cluding— 
(aa) any impact on the 
health or health outcomes of such 
individuals; and 
(bb) any impact on the abil-
ity of individuals to transition to 
or remain in the community in 
an environment that meets the 
criteria established in the section 
441.301(c)(4) of title 42, Code of 
Federal Regulations (or successor 
regulations); and 
(III) employers of such project 
participants, as determined in accord-
ance with section 116(b)(2)(A)(i)(VI) 
of the Workforce Innovation and Op-
portunity 
Act 
(29 
U.S.C. 
3141(b)(2)(A)(i)(VI)). 
(v) The performance of the eligible en-
tity with respect to the indicators of per-
formance on unsubsidized employment, me-
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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)). 
(vi) Any other information with re-
spect to outcomes of the project, including 
outcomes related to cost savings achieved 
by the project based on increased access to 
an 
environment 
described 
in 
clause 
(v)(II)(bb) and cost savings related to re-
duced emergency care or hospitalizations. 
(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)(N). 
(2) REVIEW AND REPORTS.— 
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(A) ANNUAL
PERFORMANCE
REVIEW.— 
The Secretary shall annually conduct a per-
formance review of each project carried out by 
an eligible entity receiving 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)— 
(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 shall prepare and submit to Congress, 
and make publicly available, a report con-
taining— 
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(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. 
(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 5 
months after the date of enactment of this Act, the Sec-
retary shall provide technical assistance to eligible entities 
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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)). 
SEC. 8. AUTHORIZATION OF APPROPRIATIONS. 
There 
are 
authorized 
to 
be 
appropriated 
$300,000,000 to carry out this Act for each of fiscal years 
2022 through 2027. 
Æ 
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