[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4397 Introduced in House (IH)]
<DOC>
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
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) Millions of older individuals and individuals with
disabilities in the United States require assistance with
activities of daily living to live independently 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 disability.
(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) According to PHI, 4,500,000 direct care workers provide
care across home and community-based settings, nursing
facilities, assisted living facilities, 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 direct care
workers will be needed across all care settings to care for the
growing population of older individuals 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 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.
(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 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 workers are immigrants.
(9) 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.
(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 increased 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 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.).
(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,
or an entity with shared labor-management oversight--
(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) a nonprofit 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) Secretary.--The term ``Secretary'' means the Secretary
of Labor, except as otherwise specified in this Act.
(8) 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).
(9) 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'', ``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 Secretary, in consultation with the
Secretary of Health and Human Services, shall award grants--
(1) to not fewer than 15 eligible entities to develop and
carry out projects for purposes of recruiting, retaining, or
providing advancement opportunities to direct care workers; and
(2) 5 of which shall be awarded for projects that focus on
providing such advancement opportunities.
(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.--
(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.--
(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) 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
recruitment, 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
(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.
(C) 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--
(i) an apprenticeship program, work-based
learning, or on-the-job training opportunities;
(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
postsecondary credential; 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.
(D) If applicable, any other innovative models or
processes the eligible entity will implement 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 pathways for direct care
workers in the State or region to be served by the
project.
(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 equipment,
and facilities for training and supervision,
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 subparagraph (C),
as applicable; and
(iii) provide adequate training for mentors
and qualified instructors to ensure compliance
with clause (i) and, as applicable, 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 the State
agency with primary responsibility for
providing services and supports for individuals
with intellectual disabilities and individuals
with developmental disabilities, 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 direct
care workers.
(iv) 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.
(v) A nonprofit organization that fosters
the professional development and collective
engagement of direct care workers, including
labor organizations.
(vi) 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.)).
(vii) A nonprofit State provider
association that represents providers who
employ direct care workers, where such
associations exist.
(viii) An entity that employs direct care
workers.
(J) An assurance that any benefit or service
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 workers,
representatives of such workers, individuals assisted
by such workers, and the families of such individuals
throughout the project.
(L) 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 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)(L).
(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 region, 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 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 eligible direct
care worker 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 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 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 individuals served by the
project, including--
(I) the number of individuals
recruited 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 families
assisted by direct care workers.
(iii) The number of direct care workers 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 supports
(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 impact of such
services, benefits, or supports.
(v) How the project assessed satisfaction
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 section
116(b)(2)(A)(i)(VI) of the Workforce
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 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)).
(vii) Any other information with respect to
outcomes of the project.
(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 Secretary of Health and Human
Services, 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, in consultation
with the Secretary of Health and Human Services, 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 15 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 such sums as may be
necessary to carry out this Act for each of fiscal years 2021 through
2025.
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