Direct CARE Opportunity Act

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- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Direct Creation, Ad- 4 vancement, and Retention of Employment Opportunity 5 Act’’ or the ‘‘Direct CARE Opportunity Act’’. 6 SEC. 2. FINDINGS. 7 Congress finds the following: 8 VerDate Sep 11 2014 23:37 Jun 18, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2999.IH H2999 pbinns on DSKJLVW7X2PROD with BILLS 2 •HR 2999 IH (1) Nearly 20,000,000 adults in the United 1 States require assistance completing self-care and 2 other daily tasks due to physical, cognitive, develop- 3 mental, or behavioral conditions. This number in- 4 cludes about 17,000,000 individuals living in the 5 community, 1,500,000 residing in nursing homes, 6 and nearly 1,000,000 in residential care. The num- 7 ber of people needing this type of assistance is ex- 8 pected to rise as the percentage of the population 9 that is over age 65 increases dramatically in the 10 coming decades. 11 (2) The assistance of direct care workers allows 12 older individuals and individuals with disabilities to 13 live with dignity and safety, and to exercise their 14 right to live independently in their own homes and 15 communities, in keeping with what is most appro- 16 priate for their needs and preferences. Older individ- 17 uals and individuals with disabilities may also par- 18 ticipate in the direct care workforce, further sup- 19 porting their ability to live independently. 20 (3) According to PHI, direct care workers pro- 21 vide most of the paid, hands-on care for older indi- 22 viduals and individuals with disabilities. 23 (4) From 2014 to 2024, home care occupations 24 are projected to add more jobs than any other single 25 VerDate Sep 11 2014 23:37 Jun 18, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2999.IH H2999 pbinns on DSKJLVW7X2PROD with BILLS 3 •HR 2999 IH occupation, with an additional 633,100 new jobs. 1 Home care is also among the top 10 fastest-growing 2 occupations, and with the projected growth in the 3 population over age 65, this may underestimate the 4 number of home care workers that will be needed to 5 provide care for this growing population. 6 (5) Many direct care workers lack access to a 7 career pathway or advanced training opportunities. 8 This limits their ability to build competency and ex- 9 pertise in their field that, when gained, may lead to 10 an increase in their earning capacity. According to 11 PHI, more than half of home care workers have 12 completed no formal education beyond high school, 13 making high-quality, transferable training essential 14 to success on the job. 15 (6) As of 2018, the median wage for direct care 16 workers is $12.27 per hour and wages and earnings 17 for home care workers are even lower in rural areas. 18 Because of low wages, variable work hours, and the 19 inability to access workplace-based benefits, 44 per- 20 cent of such workers live in low-income households, 21 and 15 percent of the workers from such households 22 live below the poverty line. Nearly half of direct care 23 workers rely on some form of public assistance to 24 support themselves and their families. 25 VerDate Sep 11 2014 23:37 Jun 18, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2999.IH H2999 pbinns on DSKJLVW7X2PROD with BILLS 4 •HR 2999 IH (7) According to PHI, the direct care workforce 1 is primarily comprised of low income women and 2 people of color. Approximately 9 in 10 direct care 3 workers are women, more than half are women of 4 color, and one quarter of direct care workers are im- 5 migrants. 6 (8) The direct care workforce is plagued with 7 high turnover, low job satisfaction, and workforce 8 shortages. These conditions can contribute to re- 9 duced quality of care and threaten the availability of 10 supports for older individuals and individuals with 11 disabilities. 12 (9) Because of the nature of the work, direct 13 care workers suffer from disproportionately high 14 rates of injury. In 2016, the injury rate for nursing 15 assistants was 337 per 10,000 as compared to 100 16 per 10,000 for other occupations. 17 (10) Training has been shown to reduce worker 18 turnover, reduce rates of injury, and lead to in- 19 creased job satisfaction. 20 (11) The Institute of Medicine found that to 21 ensure that the United States is prepared to meet 22 the health care needs of older individuals during the 23 21st century, it is essential that the capacity of the 24 direct care workforce be enhanced in both the num- 25 VerDate Sep 11 2014 23:37 Jun 18, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2999.IH H2999 pbinns on DSKJLVW7X2PROD with BILLS 5 •HR 2999 IH ber of workers available and their ability to meet 1 their own health care and quality of life needs. 2 SEC. 3. DEFINITIONS. 3 In this Act: 4 (1) APPRENTICESHIP PROGRAM.—The term 5 ‘‘apprenticeship program’’ means an apprenticeship 6 program registered under the Act of August 16, 7 1937 (commonly known as the ‘‘National Appren- 8 ticeship Act’’; 50 Stat. 664, chapter 663; 29 U.S.C. 9 50 et seq.), including any requirement, standard, or 10 rule promulgated under such Act, as such require- 11 ment, standard, or rule was in effect on January 1, 12 2020. 13 (2) DIRECT CARE WORKER.—The term ‘‘direct 14 care worker’’ has the meaning given the term in sec- 15 tion 799B of the Public Health Service Act (42 16 U.S.C. 295p). 17 (3) ELIGIBLE ENTITY.—The term ‘‘eligible enti- 18 ty’’ means— 19 (A) a State; 20 (B) a nonprofit organization, a labor orga- 21 nization, a joint labor-management organiza- 22 tion, or an employer— 23 VerDate Sep 11 2014 23:37 Jun 18, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2999.IH H2999 pbinns on DSKJLVW7X2PROD with BILLS 6 •HR 2999 IH (i) with an established record of re- 1 cruiting or providing training to direct care 2 workers; or 3 (ii) that establishes a training pro- 4 gram in consultation with an organization 5 with an established record of providing 6 training to direct care workers; 7 (C) a local board; 8 (D) an entity carrying out an apprentice- 9 ship program; 10 (E) an Indian tribe or tribal organization; 11 or 12 (F) a consortium of entities listed in sub- 13 paragraph (A), (B), (C), (D), or (E) that may 14 also include an institution of higher education. 15 (4) EMPLOY; EMPLOYER.—The terms ‘‘employ’’ 16 and ‘‘employer’’ have the meanings given the terms 17 in section 3 of the Fair Labor Standards Act (29 18 U.S.C. 203 et seq.). 19 (5) INDIAN TRIBE; TRIBAL ORGANIZATION.— 20 The terms ‘‘Indian tribe’’ and ‘‘tribal organization’’ 21 have the meanings given such terms in section 4 of 22 the Indian Self-Determination and Education Assist- 23 ance Act (25 U.S.C. 5304). 24 VerDate Sep 11 2014 23:37 Jun 18, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2999.IH H2999 pbinns on DSKJLVW7X2PROD with BILLS 7 •HR 2999 IH (6) INSTITUTION OF HIGHER EDUCATION.—The 1 term ‘‘institution of higher education’’ has the 2 meaning given the term in section 101 of the Higher 3 Education Act of 1965 (20 U.S.C. 1001). 4 (7) PROJECT PARTICIPANT.—The term ‘‘project 5 participant’’ means an individual participating in a 6 project assisted with a grant under this Act, includ- 7 ing a direct care worker or an individual training to 8 be such a worker. 9 (8) SECRETARY.—The term ‘‘Secretary’’ means 10 the Secretary of Labor, except as otherwise specified 11 in this Act. 12 (9) STATE.—The term ‘‘State’’ has the mean- 13 ing given the term in section 3 of the Carl D. Per- 14 kins Career and Technical Education Act of 2006 15 (20 U.S.C. 2302). 16 (10) SUPPORTIVE SERVICES.—The term ‘‘sup- 17 portive services’’ means services such as transpor- 18 tation, child care, dependent care, housing, and 19 needs-related payments, that are necessary to enable 20 an individual to participate in a project assisted with 21 a grant under this Act. 22 (11) WORKFORCE INNOVATION AND OPPOR- 23 TUNITY ACT TERMS.—The terms ‘‘career pathway’’, 24 ‘‘career planning’’, ‘‘in-demand industry sector or 25 VerDate Sep 11 2014 23:37 Jun 18, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2999.IH H2999 pbinns on DSKJLVW7X2PROD with BILLS 8 •HR 2999 IH occupation’’, ‘‘individual with a barrier to employ- 1 ment’’, ‘‘individual with a disability’’, ‘‘local board’’, 2 ‘‘older individual’’, ‘‘one-stop center’’, ‘‘on-the-job 3 training’’, ‘‘recognized postsecondary credential’’, 4 ‘‘region’’, and ‘‘State board’’ have the meanings 5 given such terms in section 3 of the Workforce Inno- 6 vation and Opportunity Act (29 U.S.C. 3102). 7 (12) WORK-BASED LEARNING.—The term 8 ‘‘work-based learning’’ has the meaning given the 9 term in section 3 of the Carl D. Perkins Career and 10 Technical Education Act of 2006 (20 U.S.C. 2302). 11 SEC. 4. AUTHORITY TO AWARD GRANTS; DURATION. 12 (a) AUTHORITY TO AWARD GRANTS.— 13 (1) IN GENERAL.—Not later than 12 months 14 after the date of enactment of this Act, the Sec- 15 retary, in consultation with the Secretary of Health 16 and Human Services, shall award grants to eligible 17 entities to develop and carry out projects for pur- 18 poses of recruiting, retaining, or providing advance- 19 ment opportunities to direct care workers. 20 (2) PROJECTS FOR ADVANCEMENT OPPORTUNI- 21 TIES.—Not less than 30 percent of projects assisted 22 with grants under this Act for a fiscal year shall be 23 projects to provide advancement opportunities to di- 24 rect care workers. 25 VerDate Sep 11 2014 23:37 Jun 18, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2999.IH H2999 pbinns on DSKJLVW7X2PROD with BILLS 9 •HR 2999 IH (b) TREATMENT OF CONTINUATION ACTIVITIES.— 1 An eligible entity that carries out activities for purposes 2 of recruiting, retaining, or providing advancement oppor- 3 tunities to direct care workers prior to receipt of a grant 4 under this Act may use such grant to continue carrying 5 out such activities, and shall be treated as an eligible enti- 6 ty carrying out a project described in subsection (a)(1). 7 (c) DURATION.—A grant under this Act shall be for 8 not less than 5 years. 9 SEC. 5. PROJECT PLANS; CONSULTATION. 10 (a) PROJECT PLANS.— 11 (1) IN GENERAL.—To receive a grant under 12 this Act, an eligible entity shall submit to the Sec- 13 retary a project plan for each project to be developed 14 and carried out (or for activities to be continued) 15 with the grant at such time and in such manner as 16 the Secretary may determine, and which shall con- 17 tain the information described in paragraph (2). 18 (2) CONTENTS.—A project plan submitted by 19 an eligible entity under paragraph (1) shall include 20 a description of each of the following: 21 (A) Demographic information regarding 22 the population in the State or relevant geo- 23 graphic area, including a description of the pop- 24 ulations likely to need long-term care services, 25 VerDate Sep 11 2014 23:37 Jun 18, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2999.IH H2999 pbinns on DSKJLVW7X2PROD with BILLS 10 •HR 2999 IH such as people with significant disabilities and 1 the aging population. 2 (B) Projections of unmet need for direct 3 care services based on enrollment waiting lists 4 under home and community-based waivers 5 under section 1115 of the Social Security Act 6 (42 U.S.C. 1315) or section 1915(c) of such 7 Act (42 U.S.C. 1396n(c)) and other relevant 8 data to the extent practicable and feasible. 9 (C) Current or projected job openings for, 10 or relevant labor market information related to, 11 direct care workers in the State or region to be 12 served by the project, and the geographic scope 13 of the workforce to be served by the project. 14 (D) Specific efforts and strategies that the 15 project will undertake to reduce barriers to re- 16 cruitment, retention, or advancement of direct 17 care workers, including an assurance that such 18 efforts and strategies will— 19 (i) be undertaken in consultation with 20 the individuals served by the entities de- 21 scribed in subsection (b); and 22 (ii) include— 23 (I) an assessment of the wages or 24 other compensation or benefits nec- 25 VerDate Sep 11 2014 23:37 Jun 18, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2999.IH H2999 pbinns on DSKJLVW7X2PROD with BILLS 11 •HR 2999 IH essary to recruit and retain direct 1 care workers; and 2 (II) a description of the project’s 3 projected wages and other compensa- 4 tion or benefits for direct care work- 5 ers at the State or local level, includ- 6 ing a comparison of such projected 7 wages to regional and national wages. 8 (E) In the case of a project offering an 9 education and training program, a description 10 of such program (including any curricula, mod- 11 els, and standards used under the program, and 12 any associated recognized postsecondary creden- 13 tials for which the program provides prepara- 14 tion, as applicable), which shall include an as- 15 surance that such program will provide to each 16 project participant in such program— 17 (i) relevant training regarding the 18 rights of recipients of direct care services, 19 including their rights to— 20 (I) receive services in the most 21 integrated setting; 22 (II) exercise self-determination; 23 and 24 VerDate Sep 11 2014 23:37 Jun 18, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H2999.IH H2999 pbinns on DSKJLVW7X2PROD with BILLS 12 •HR 2999 IH (III) be free from physical, sex- 1 ual, and financial abuse; 2 (ii) relevant training regarding the 3 provision of culturally competent services 4 to recipients of direct care; 5 (iii) an apprenticeship program, work- 6 based learning, or on-the-job training op- 7 portunities; 8 (iv) supervision or mentoring; and 9 (v) for the on-the-job training portion 10 of the program, a progressively increasing, 11 clearly defined schedule of wages to be 12 paid to each such participant that— 13 (I) is consistent with skill gains 14 or attainment of a recognized postsec- [Text truncated for display. 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