Direct Creation, Advancement, and Retention of Employment Opportunity Act or the Direct CARE Opportunity Act
This bill directs the Department of Labor to award grants to eligible entities to develop and carry out projects to recruit, retain, or provide advancement opportunities to direct care workers. The term direct care worker includes home health aides, psychiatric aides, nursing assistants, and personal care aides who assist seniors and persons with disabilities in their homes.
After the completion of each project assisted with a grant, the Government Accountability Office must study and report to Congress on (1) an assessment of how the project assisted in the recruitment, retention, or advancement of direct care workers; and (2) recommendations for appropriate legislative or administrative actions.
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.
                                 <all>
Direct CARE Opportunity Act
To award grants for the recruitment, retention, and advancement of direct care workers.
Direct CARE Opportunity Act
Direct Creation, Advancement, and Retention of Employment Opportunity Act
Rep. Scott, Robert C. "Bobby"