,,ii #aafth ,,congress #ast ,session ,s4 #beba ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,september #ai1 #bjai,mr4 ,kaine 7for himself and ,ms4 ,hassan7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to award grants for the recruitment1 retention1 and advancement of direct care workers4 #a4 ,short title ,this ,act may be cited as the ,direct ,creation1 ,advancement1 and ,retention of ,employment ,opportunity ,act or the ,direct ,,care ,opportunity ,act4 #b4 ,findings ,congress finds the following3 7#a7 ,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 extent4 ,the ,bureau of the ,census projects that by #bjfj the population of individuals age #fe or older will double from #di1bjj1jjj in #bjaf to #id1gjj1jjj4 ,according to the ,centers for ,disease ,control and ,prevention1 #a in #d 7or #fj1jjj1jjj7 adults in the ,united ,states are living with a disability4 7#b7 ,the assistance of direct care workers allows older individuals and individuals with disabilities to live with dignity and safety1 and to exercise their right to live independently in their own homes and communities1 in keeping with what is most appropriate for their needs and preferences4 ,older individuals and individuals with disabilities may also participate in the direct care workforce1 further supporting their ability to live independently4 7#c7 ,according to ,,phi1 direct care workers provide most of the paid1 hands-on care for older individuals and individuals with disabilities4 7#d7 ,according to ,,phi1 #d1ejj1jjj direct care workers provide care across home and community-based settings1 nursing facilities1 assisted living facilities1 group homes1 intermediate care facilities1 and hospitals to care for the growing population of older individuals and individuals with disabilities4 7#e7 ,,phi projects that by #bjbd1 #e1bjj1jjj direct care workers will be needed across all care settings to care for the growing population of older individuals and individuals with disabilities4 7#f7 ,many direct care workers lack access to a career pathway or advanced training opportunities4 ,this limits their ability to build competency and expertise in their field that1 when gained1 may lead to an increase in their earning capacity4 ,according to ,,phi1 more than half of home care workers have completed no formal education beyond high school1 making high-quality1 transferable training essential to success on the job4 7#g7 ,as of #bjae1 the median wage for direct care workers is approximately #aa an hour2 wages and earnings for home care workers are even lower in rural areas4 ,because of low wages1 variable work hours1 and the inability to access workplace-based benefits1 #ai percent of home care workers live below the ,federal poverty level as compared to #i percent of the general ,united ,states workforce4 ,nearly half of direct care workers rely on some form of public assistance to support themselves and their families4 7#h7 ,according to ,,phi1 approximately #i in #aj direct care workers are women1 more than half are women of color1 and one quarter of direct care workers are immigrants4 7#i7 ,the direct care workforce is plagued with high turnover1 low job satisfaction1 and workforce shortages4 ,these conditions can contribute to reduced quality of care and threaten the availability of supports for older individuals and individuals with disabilities4 7#aj7 ,because of the nature of the work1 direct care workers suffer from disproportionately high rates of injury4 ,in #bjaf1 the injury rate for nursing assistants was #ccg per #aj1jjj as compared to #ajj per #aj1jjj for other occupations4 7#aa7 ,training has been shown to reduce worker turnover1 reduce rates of injury1 and lead to increased job satisfaction4 7#ab7 ,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 #bast century1 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 needs4 #c4 ,definitions ,in this ,act3 7#a7 ,apprenticeship program ,the term apprenticeship program means an apprenticeship program registered under the ,act of ,august #af1 #aicg 7commonly known as the ,national ,apprenticeship ,act2 #ej ,stat4 #ffd1 chapter #ffc2 #bi ,u4,s4,c4 #ej et seq474 7#b7 ,direct care worker ,the term direct care worker has the meaning given the term in section #gii;,b of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #biep74 7#c7 ,eligible entity ,the term eligible entity means-- 7,a7 a ,state2 7,b7 a nonprofit organization1 a labor organization1 or an entity with shared labor-management oversight-- 7i7 with an established record of recruiting or providing training to direct care workers2 or 7ii7 that establishes a training program in consultation with an organization with an established record of providing training to direct care workers2 7,c7 a local board2 7,d7 a nonprofit entity carrying out an apprenticeship program2 7,e7 an ,indian tribe or tribal organization2 or 7,f7 a consortium of entities listed in subparagraph 7,a71 7,b71 7,c71 7,d71 or 7,e7 that may also include an institution of higher education4 7#d7 ,employ2 employer ,the terms employ and employer have the meanings given the terms in section #c of the ,fair ,labor ,standards ,act 7#bi ,u4,s4,c4 #bjc et seq474 7#e7 ,indian tribe2 tribal organization ,the terms ,indian tribe and tribal organization have the meanings given such terms in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd74 7#f7 ,institution of higher education ,the term institution of higher education has the meaning given the term in section #aja of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja74 7#g7 ,secretary ,the term ,secretary means the ,secretary of ,labor1 except as otherwise specified in this ,act4 7#h7 ,state ,the term ,state has the meaning given the term in section #c of the ,carl ,d4 ,perkins ,career and ,technical ,education ,act of #bjjf 7#bj ,u4,s4,c4 #bcjb74 7#i7 ,workforce ,innovation and ,opportunity ,act terms ,the terms career pathway1 career planning1 in-demand industry sector or occupation1 individual with a barrier to employment1 individual with a disability1 local board1 older individual1 one-stop center1 on-the-job training1 recognized postsecondary credential1 region1 ,state board1 and supportive services have the meanings given such terms in section #c of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cajb74 7#aj7 ,work-based learning ,the term work-based learning has the meaning given the term in section #c of the ,carl ,d4 ,perkins ,career and ,technical ,education ,act of #bjjf 7#bj ,u4,s4,c4 #bcjb74 #d4 ,authority to award grants2 duration 7a7 ,authority ,to award grants ,not later than #ab months after the date of enactment of this ,act1 the ,secretary1 in consultation with the ,secretary of ,health and ,human ,services1 shall award grants-- 7#a7 to not fewer than #ae eligible entities to develop and carry out projects for purposes of recruiting1 retaining1 or providing advancement opportunities to direct care workers2 and 7#b7 #e of which shall be awarded for projects that focus on providing such advancement opportunities4 7b7 ,treatment of continuation activities ,an eligible entity that carries out activities for purposes of recruiting1 retaining1 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 activities1 and shall be treated as an eligible entity carrying out a project described in subsection 7a77#a74 7c7 ,duration 7#a7 ,grant period ,a grant under this ,act shall be for not less than #e years4 7#b7 ,length of project ,a project assisted with a grant awarded under this ,act shall be carried out for not less than #c years4 #e4 ,project plans2 consultation 7a7 ,project plans 7#a7 ,in general ,to receive a grant under this ,act1 an eligible entity shall submit to the ,secretary a project plan for each project to be developed and carried out 7or for activities to be continued7 with the grant at such time and in such manner as the ,secretary may determine1 and which shall contain the information described in paragraph 7#b74 7#b7 ,contents ,a project plan submitted by an eligible entity under paragraph 7#a7 shall include a description of each of the following3 7,a7 ,current or projected job openings for1 or relevant labor market information related to1 direct care workers in the ,state or region to be served by the project1 and the geographic scope of the workforce to be served by the project4 7,b7 ,specific efforts and strategies that the project will undertake to reduce barriers to recruitment1 retention1 or advancement of direct care workers1 including an assurance that such efforts will include-- 7i7 an assessment of the wages or other compensation or benefits necessary to recruit and retain direct care workers2 and 7ii7 a description of the project's projected wages and other compensation or benefits for direct care workers at the ,state or local level1 including a comparison of such projected wages to regional and national wages4 7,c7 ,in the case of a project offering an education and training program1 a description of such program 7including any curricula1 models1 and standards used under the program1 and any associated recognized postsecondary credentials for which the program provides preparation1 as applicable71 which shall include an assurance that such program will provide-- 7i7 an apprenticeship program1 work-based learning1 or on-the-job training opportunities2 7ii7 supervision or mentoring2 and 7iii7 a progressively increasing1 clearly defined schedule of wages to be paid to the direct care worker that-- 7,i7 is consistent with skill gains or attainment of a recognized postsecondary credential2 and 7,,ii7 ensures the entry wage is not less than the greater of-- 7aa7 the minimum wage required under section #f7;a7 of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bjf7;a772 or 7bb7 the applicable wage required by other applicable ,federal or ,state law1 or a collective bargaining agreement4 7,d7 ,if applicable1 any other innovative models or processes the eligible entity will implement to support the retention of direct care workers4 7,e7 ,the supportive services and benefits to be provided to direct care workers to support the retention of employment of direct care workers4 7,f7 ,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 project4 7,g7 ,how the eligible entity will collect and submit to the ,secretary workforce data and outcomes of the project4 7,h7 ,how the project will-- 7i7 provide adequate and safe equipment1 and facilities for training and supervision1 including a safe work environment free from discrimination2 7ii7 provide safety training for direct care workers as part of the education and training program described in subparagraph 7,c71 as applicable2 and 7iii7 provide adequate training for mentors and qualified instructors to ensure compliance with clause 7i7 and1 as applicable1 clause 7ii74 7,i7 ,how the eligible entity will consult on the implementation of the project1 or coordinate the project with1 each of the following entities1 to the extent that each such entity is not a part of the eligible entity3 7i7 ,the ,state agency responsible for administering the ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 7or waiver of the plan71 or the ,state agency with primary responsibility for providing services and supports for individuals with intellectual disabilities and individuals with developmental disabilities1 for the ,state to be served by the project4 7ii7 ,the local board and ,state board for the ,state or for each region to be served by the project4 7iii7 ,a nonprofit organization with demonstrated experience with respect to direct care workers4 7iv7 ,in the case of a project that carries out an education and training program1 a nonprofit organization with demonstrated experience in the development or delivery of curricula or coursework4 7v7 ,a nonprofit organization that fosters the professional development and collective engagement of direct care workers1 including labor organizations4 7vi7 ,a nonprofit organization with expertise in identifying and addressing the care needs of older individuals and individuals with disabilities and their caregivers 7including area agencies on aging1 as defined in section #ajb of the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjjb71 and centers for independent living1 as described in part ,c of title ,,vii of the ,rehabilitation ,act of #aigc 7#bi ,u4,s4,c4 #gif;f et seq474 7vii7 ,a nonprofit ,state provider association that represents providers who employ direct care workers1 where such associations exist4 7viii7 ,an entity that employs direct care workers4 7,j7 ,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 workers4 7,k7 ,how the eligible entity will consult with individuals employed as direct care workers1 representatives of such workers1 individuals assisted by such workers1 and the families of such individuals throughout the project4 7,l7 ,outreach efforts to individuals for participation in such project1 including targeted outreach efforts to-- 7i7 individuals who are recipients of assistance under a ,state program funded under part ,a of title ,,iv of the ,social ,security ,act 7#db ,u4,s4,c4 #fja et seq47 or individuals who are eligible for such assistance2 and 7ii7 individuals with barriers to employment4 7#c7 ,considerations ,in selecting eligible entities to receive a grant under this ,act1 the ,secretary shall-- 7,a7 ensure-- 7i7 equitable geographic and demographic diversity1 including rural and urban areas2 and 7ii7 that selected eligible entities will serve areas where direct care1 or a related occupation1 is an in-demand industry sector or occupation2 and 7,b7 give priority to eligible entities proposing to predominantly serve the individuals described in clauses 7i7 and 7ii7 of paragraph 7#b77,l74 7b7 ,consultation ,the ,secretary shall encourage each eligible entity receiving a grant under this ,act1 in developing and carrying out a project1 to consult with-- 7#a7 institutions of higher education2 7#b7 the ,state ,apprenticeship ,agency recognized under the ,act of ,august #af1 #aicg 7commonly known as the ,national ,apprenticeship ,act2 #ej ,stat4 #ffd1 chapter #ffc2 #bi ,u4,s4,c4 #ej et seq471 for the ,state or region to be served by the eligible entity or1 if no such agency has been recognized in the ,state or region1 the ,office of ,apprenticeship of the ,department of ,labor2 and 7#c7 one-stop centers4 #f4 ,uses of funds2 supplement1 not supplant 7a7 ,uses of funds 7#a7 ,in general ,each eligible entity receiving a grant under this ,act shall use such funds to carry out at least #a project or to continue activities commenced prior to receipt of such grant that-- 7,a7 develop and implement a strategy for the recruitment1 retention1 or advancement of direct care workers1 which includes the activities described in section #e7;a77#b72 and 7,b7 provide compensation to each eligible direct care worker for any training received under the project or activities4 7#b7 ,administrative costs ,each eligible entity receiving a grant under this ,act shall not use more than #e percent of the funds of such grant for costs associated with the administration of activities under this ,act4 7#c7 ,direct support ,each eligible entity receiving a grant under this ,act shall use not less than #e percent of the funds of such grant to provide direct financial assistance1 such as supportive services1 to direct care workers to support the financial needs of such workers to enter1 remain enrolled in1 and complete the project 7or activities7 assisted with such grant4 7b7 ,supplement1 not supplant ,an eligible entity receiving a grant under this ,act shall use such grant only to supplement1 and not supplant1 the amount of funds that1 in the absence of such grant1 would be available to address the recruitment1 retention1 or advancement of direct care workers in the ,state or region served by the eligible entity4 #g4 ,evaluations and reports 7a7 ,reports 7#a7 ,eligible entities 7,a7 ,in general ,each eligible entity receiving a grant under this ,act shall submit to the ,secretary and the ,secretary of ,health and ,human ,services1 with respect to each project assisted with such grant-- 7i7 for each year of the grant period1 an annual report on the progress and outcomes of the project2 and 7ii7 not later #f months after the completion of such project1 a final report on the progress and outcomes of the project4 7,b7 ,disaggregation ,each report submitted under paragraph 7,a7 shall-- 7i7 include the information described in subparagraph 7,c72 and 7ii7 disaggregate such information in the manner described in subparagraph 7,d74 7,c7 ,contents ,each report submitted under subparagraph 7,a7 shall include each of the following3 7i7 ,the number of individuals served by the project1 including-- 7,i7 the number of individuals recruited to be employed as a direct care worker2 and 7,,ii7 the number of individuals who attained employment as a direct care worker4 7ii7 ,the number of individuals or families assisted by direct care workers4 7iii7 ,the number of direct care workers who participated in and completed-- 7,i7 work-based learning2 7,,ii7 on-the-job training2 7,,iii7 an apprenticeship program2 or 7,,iv7 a professional development or mentoring program4 7iv7 ,other services1 benefits1 or supports 7other than the services1 benefits1 or supports described in clause 7iii77 provided to assist in the recruitment1 retention1 or advancement of direct care workers1 the number of individuals who accessed such services1 benefits1 or supports1 and the impact of such services1 benefits1 or supports4 7v7 ,how the project assessed satisfaction with respect to-- 7,i7 direct care workers assisted by the project2 7,,ii7 individuals receiving services delivered by such workers1 including any impact on the health or health outcomes of such individuals2 and 7,,iii7 employers of such workers1 as determined in accordance with section #aaf7;b77#b77;,a77i77,,vi7 of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cada7;b77#b77;,a77i77,,vi774 7vi7 ,the performance of the eligible entity with respect to the indicators of performance on unsubsidized employment1 median earnings1 credential attainment1 measurable skill gains1 and employer satisfaction1 as described under section #aaf7;b77#b77;,a77i7 of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cada7;b77#b77;,a77i774 7vii7 ,any other information with respect to outcomes of the project4 7,d7 ,disaggregation ,the information described under subparagraph 7,c7 shall be disaggregated by race1 ethnicity1 sex1 and age in accordance with section #aaf7;d77#b77;,b7 of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cada7;d77#b771 by each population listed in section #c7bd7 of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cajb7bd771 and by the individuals described in clauses 7i7 and 7ii7 of section #e7;a77#b77,l74 7#b7 ,secretaries 7,a7 ,annual performance review ,the ,secretary1 in consultation with the ,secretary of ,health and ,human ,services1 shall annually conduct a performance review of each project carried out by an eligible entity receiving a grant under this ,act1 including-- 7i7 the performance of the project with respect to the indicators of performance described in paragraph 7#a77;,c77vi71 and disaggregated in the manner described in paragraph 7#a77;,d72 and 7ii7 the efficacy of the project plan submitted under section #e7;a7-- 7,i7 for recruiting1 retaining1 or providing advancement opportunities for direct care workers2 and 7,,ii7 on the methods used to recruit1 retain1 or provide advancement opportunities to direct care workers4 7,b7 ,report to ,congress ,not later than #a year after the completion of each project assisted with a grant under this ,act1 the ,secretary1 in consultation with the ,secretary of ,health and ,human ,services1 shall prepare and submit to ,congress1 and make publicly available1 a report containing-- 7i7 the progress and outcomes of the project as identified in the final report submitted by the eligible entity under paragraph 7#a77;,a77ii72 7ii7 an analysis of the workforce supply1 current and projected shortages1 and distribution of direct care workers at the national1 regional1 and ,state levels2 and 7iii7 recommendations for such legislative or administrative action1 as the ,secretary determines appropriate4 7#c7 ,,gao report ,not later than #a year after the completion of each project assisted with a grant under this ,act1 the ,comptroller ,general of the ,united ,states shall conduct a study and submit to ,congress a report including-- 7,a7 an assessment of how the project assisted in the recruitment1 retention1 or advancement of direct care workers2 and 7,b7 recommendations for such legislative or administrative actions1 as the ,comptroller ,general determines appropriate4 7b7 ,technical assistance ,not later than #ae months after the date of enactment of this ,act1 the ,secretary shall provide technical assistance to eligible entities receiving a grant under this ,act1 for purposes of compliance with subsection 7a77#a7 of this section1 on-- 7#a7 the disaggregation requirements of section #aaf7;d77#b77;,b7 of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cada7;d77#b772 and 7#b7 the data collection requirements of section #aaf7;b77#b77;,a77i7 of such ,act 7#bi ,u4,s4,c4 #cada7;b77#b77;,a77i774 #h4 ,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 #bjba through #bjbe4