[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2999 Introduced in House (IH)]
<DOC>
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)
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 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 Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Direct Creation, Advancement, and
Retention of Employment Opportunity Act'' or the ``Direct CARE
Opportunity Act''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Nearly 20,000,000 adults in the United States require
assistance completing self-care and other daily tasks due to
physical, cognitive, developmental, or behavioral conditions.
This number includes 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 number of people needing
this type of assistance is expected 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 appropriate for their needs and preferences.
Older individuals and individuals with disabilities may also
participate in the direct care workforce, further supporting
their ability to live independently.
(3) According to PHI, direct care workers provide most of
the paid, hands-on care for older individuals and individuals
with disabilities.
(4) From 2014 to 2024, home care occupations are projected
to add more jobs than any other single 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 expertise 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 percent 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.
(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 immigrants.
(8) The direct care workforce is plagued with high
turnover, low job satisfaction, and workforce shortages. These
conditions can contribute to reduced 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 increased 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 number 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
Apprenticeship 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 requirement, 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 section 799B of the Public
Health Service Act (42 U.S.C. 295p).
(3) Eligible entity.--The term ``eligible entity'' means--
(A) a State;
(B) a nonprofit organization, a labor organization,
a joint labor-management organization, or an employer--
(i) with an established record of
recruiting or providing training to direct care
workers; or
(ii) that establishes a training program 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 apprenticeship
program;
(E) an Indian tribe or tribal organization; or
(F) a consortium of entities listed in subparagraph
(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 Assistance 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).
(7) Project participant.--The term ``project participant''
means an individual participating in a project assisted with a
grant under this Act, including 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 meaning given the
term in section 3 of the Carl D. Perkins Career and Technical
Education Act of 2006 (20 U.S.C. 2302).
(10) Supportive services.--The term ``supportive services''
means services such as transportation, 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 opportunity act terms.--The
terms ``career pathway'', ``career planning'', ``in-demand
industry sector or occupation'', ``individual with a barrier to
employment'', ``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 Innovation 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 Secretary, in consultation with the
Secretary of Health and Human Services, shall award grants to
eligible entities to develop and carry out projects for
purposes of recruiting, retaining, or providing advancement
opportunities to direct care workers.
(2) Projects for advancement opportunities.--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 direct care workers.
(b) Treatment of Continuation Activities.--An eligible entity that
carries out activities for purposes of recruiting, retaining, or
providing advancement opportunities 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
entity 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 Secretary 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
contain 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 geographic area,
including a description of the populations likely to
need long-term care services, 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
recruitment, 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 described in
subsection (b); and
(ii) include--
(I) an assessment of the wages or
other compensation or benefits
necessary to recruit and retain direct
care workers; and
(II) a description of the project's
projected 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.
(E) In the case of a project offering an education
and training program, a description of such program
(including any curricula, models, and standards used
under the program, and any associated recognized
postsecondary credentials for which the program
provides preparation, as applicable), which shall
include an assurance 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
(III) be free from physical,
sexual, and financial abuse;
(ii) relevant training regarding the
provision of culturally competent services to
recipients of direct care;
(iii) an apprenticeship program, work-based
learning, or on-the-job training opportunities;
(iv) supervision or mentoring; and
(v) for the on-the-job training portion of
the program, a progressively increasing,
clearly defined schedule of wages to be paid to
each such participant that--
(I) is consistent with skill gains
or attainment of a recognized
postsecondary credential received as a
result of participation in or
completion of such program; and
(II) ensures the entry wage is not
less than the greater of--
(aa) the minimum wage
required under section 6(a) of
the Fair Labor Standards Act of
1938 (29 U.S.C. 206(a)); or
(bb) the applicable wage
required by other applicable
Federal or State law, or a
collective bargaining
agreement.
(F) If applicable, any other innovative models or
processes the eligible entity will implement to support
the retention and career advancement of direct care
workers.
(G) The supportive services and benefits to be
provided to project participants to support the
retention and career advancement of employment of
direct care workers.
(H) How the eligible entity will make use of career
planning to support the identification of advancement
opportunities and career pathways for direct care
workers in the State or region to be served by the
project.
(I) How the eligible entity will collect and submit
to the Secretary workforce data and outcomes of the
project.
(J) How the project will provide adequate and safe
equipment, and facilities for training and supervision,
which--
(i) may include the provision of personal
protective equipment and other necessary
equipment to prevent the spread of infectious
disease among workers and recipients of
services; and
(ii) will include--
(I) a safe work environment free
from discrimination; and
(II) adequate training for mentors
and qualified instructors to ensure
compliance with this subparagraph,
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 subsection (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 workers,
representatives of such workers, individuals assisted
by such workers, and the families of such individuals
throughout the project.
(N) Outreach efforts to individuals for
participation 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 Security Act
(42 U.S.C. 601 et seq.) or individuals who are
eligible for such assistance; and
(ii) individuals with barriers to
employment.
(3) Considerations.--In selecting eligible entities to
receive a grant under this Act, the Secretary shall--
(A) ensure--
(i) equitable geographic and demographic
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 sector or
occupation; and
(B) give priority to eligible entities proposing to
predominantly serve the individuals 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 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 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 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 the State agency with primary responsibility for
providing services and supports for individuals with
intellectual disabilities and individuals with
developmental 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 professional
development and collective engagement of direct care
workers, including labor organizations or joint labor-
management organizations;
(G) a nonprofit organization with expertise in
identifying and addressing the care needs of older
individuals and individuals with disabilities and their
caregivers (including area agencies 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 title I of the
Developmental Disabilities Assistance 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 Americans 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 commenced 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 activities described in
section 5(a)(2); and
(B) provide compensation to each project
participant for any training received under the project
or activities.
(2) Administrative costs.--Each eligible entity 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 receiving a grant
under this Act shall use not less than 5 percent of the funds
of such grant to provide direct 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 entity 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
direct care workers in the State or region served by the eligible
entity.
SEC. 7. EVALUATIONS AND REPORTS.
(a) Reports.--
(1) Eligible entities.--
(A) In general.--Each eligible entity receiving 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 outcomes of
the project; and
(ii) not later 6 months after the
completion of such project, a final report on
the progress and outcomes of the project.
(B) Disaggregation.--Each report submitted 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 participants,
including--
(I) the number of such participants
who completed an education and training
program offered by such project,
disaggregated by the type of education
and training completed (including work-
based learning, on-the-job training, an
apprenticeship program, and a
professional development or mentoring
program); and
(II) the number of such
participants who--
(aa) completed an education
and training program offered by
such project; and
(bb) attained employment as
a direct care worker after
participating in such project.
(ii) The number of individuals or families
assisted by project participants.
(iii) Other services, benefits, or supports
(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 impact of such services,
benefits, or supports.
(iv) How the project assessed satisfaction
with respect to--
(I) project participants assisted
by the project;
(II) individuals receiving services
delivered by project participants,
including--
(aa) any impact on the
health or health outcomes of
such individuals; and
(bb) any impact on the
ability 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
accordance with section
116(b)(2)(A)(i)(VI) of the Workforce
Innovation and Opportunity Act (29
U.S.C. 3141(b)(2)(A)(i)(VI)).
(v) The performance of the eligible entity
with respect to the indicators of performance
on unsubsidized employment, median earnings,
credential attainment, measurable skill gains,
and employer satisfaction, as described under
section 116(b)(2)(A)(i) of the Workforce
Innovation and Opportunity Act (29 U.S.C.
3141(b)(2)(A)(i)).
(vi) Any other information with respect 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 reduced 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.--
(A) Annual performance review.--The Secretary shall
annually conduct a performance 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
recruit, 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 Secretary shall prepare and
submit to Congress, and make publicly available, a
report containing--
(i) the progress and outcomes of the
project as identified in the final report
submitted by the eligible entity under
paragraph (1)(A)(ii);
(ii) an analysis of the workforce supply,
current and projected shortages, and
distribution of direct care workers at the
national, regional, and State levels; and
(iii) recommendations for such legislative
or administrative action, as the Secretary
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 assisted in
the recruitment, retention, or advancement 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 Secretary shall provide technical
assistance to eligible entities receiving a grant under this Act, for
purposes of compliance with subsection (a)(1) of this section, on--
(1) the disaggregation requirements of section 116(d)(2)(B)
of the Workforce Innovation and Opportunity 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.
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