[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 2521 Introduced in Senate (IS)]

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116th CONGRESS
  1st Session
                                S. 2521

  To award grants for the recruitment, retention, and advancement of 
                          direct care workers.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           September 19, 2019

 Mr. Kaine (for himself and Ms. Hassan) introduced the following bill; 
     which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 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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