I 
118TH CONGRESS 
1ST SESSION H. R. 4720 
To direct the Secretary of Labor to award grants for the recruitment, 
retention, and advancement of direct care workers. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 18, 2023 
Mr. SCOTT of Virginia (for himself, Ms. WILD, Ms. LEE of Nevada, Mr. 
DESAULNIER, and Ms. BONAMICI) introduced the following bill; which 
was referred to the Committee on Education and the Workforce, 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 con-
cerned 
A BILL 
To direct the Secretary of Labor 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 of 2023’’ or the ‘‘Direct CARE Opportunity Act of 
2023’’. 
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SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Nearly 25,000,000 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 approximately 22,700,000 individuals living 
in the community, 1,300,000 residing in nursing 
homes, and 900,000 in residential care. 
(2) According to the PHI, direct care workers 
provide most of the paid, hands-on care for older in-
dividuals and individuals with disabilities. 
(3) 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. 
(4) The direct care workforce is diverse. Almost 
9 in 10 direct care workers are women, and 61 per-
cent are people of color, with women of color grow-
ing as a share of the workforce across every long- 
term care setting between 2009 and 2019. 
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(5) From 2021 to 2031, home care occupations 
are projected to create nearly a million new jobs. 
Home care is also among the fastest-growing occu-
pations, and with the projected growth in the popu-
lation over age 65, this may underestimate the num-
ber of home care workers that will be needed to pro-
vide care for this growing population. 
(6) Due to transitions to other occupations or 
exits from the labor force, there will be an estimated 
7,900,000 total job openings in direct care from 
2020 to 2030. 
(7) 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. 
(8) The median wage for direct care workers is 
$14.27 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, 40 percent of di-
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rect care workers live in low-income households, and 
14 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. 
(9) Direct care workers face high injury rates, 
as they are up to three or more times likelier to ex-
perience workplace injuries than the typical worker 
in the United States. 
(10) The poor quality of these jobs contribute 
to high turnover, low job satisfaction, and workforce 
shortages. This impacts the quality of care and 
availability of supports for older individuals and in-
dividuals with disabilities. 
(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-
ber of workers available and their ability to meet 
their own health care and quality of life needs. 
(12) Training has been shown to reduce worker 
turnover, reduce rates of injury, and lead to in-
creased job satisfaction. 
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(13) Wraparound services, such as career navi-
gation support, mentoring, and vouchers for child 
care or transportation, have been shown to have a 
positive effect on program completion and employ-
ment outcomes, like increased wages. 
(14) Career pathways are an evidence-based ap-
proach to workforce development that aligns sec-
ondary and postsecondary education to labor market 
needs. It involves articulated steps of education, 
training, and employment within an industry sector 
or occupation that leads to the progressive attain-
ment of skills and wages. 
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’’ means— 
(A) a direct support professional; 
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(B) a worker providing direct care services, 
which may include palliative care, in a home or 
community-based setting; 
(C) a respite care provider who provides 
short-term support and care to an individual in 
order to provide relief to a family caregiver; 
(D) a direct care worker, as defined in sec-
tion 799B of the Public Health Service Act (42 
U.S.C. 295p); or 
(E) an individual in any other position or 
job related to those described in subparagraphs 
(A) through (D), as determined by the Sec-
retary of Labor, in consultation with the Sec-
retary of Health and Human Services. 
(3) DIRECT
SUPPORT
PROFESSIONAL.—The 
term ‘‘direct support professional’’ means a worker 
who provides services, in a home or community- 
based setting, to individuals with disabilities that 
promote their independence, well-being, and commu-
nity inclusion, including— 
(A) providing services related to coaching 
and career development, employment assistance, 
or the pursuit of personal goals; 
(B) aiding activities of daily living; 
(C) supporting communication; or 
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