H.R. 8541 — Long-Term Care Workforce Support Act

This section authorizes the Secretary of Health and Human Services to award a competitive grant to an eligible partnership of at least three specified entities to establish a national technical assistance center for direct care professional workforce creation, training, education, recruitment, retention, and advancement. The Center must consult with the Secretaries of Labor, Education, and Veterans Affairs, the Administrators of the Administration for Community Living, CMS, and HRSA, and other relevant agency heads. It may develop training curricula recommendations, learning and dissemination strategies, data collection improvements including a proposed Standard Occupational Classification category for direct care professionals as a healthcare support occupation, and career pathways such as apprenticeships, certifications, and specializations. The Secretary must also convene an advisory council including older individuals, people with disabilities, direct care professionals, employers, labor organizations, and state and local agencies to advise the Center.

This section directs the Secretary of Health and Human Services to submit to the appropriate congressional committees, not later than 180 days after enactment, a report assessing the Department’s programs and activities to enhance the direct care professional workforce, including those authorized under titles VII and VIII of the Public Health Service Act. The report must address increasing geriatric nursing faculty and individuals pursuing careers or advanced degrees in geriatric nursing or long-term care, expanding the direct care professional workforce, interagency coordination on related Federal programs, and recommendations for best practices.

This section revises Section 865 of the Public Health Service Act to update terminology throughout the comprehensive geriatric education provisions by replacing references to “the elderly” and “the elderly population” with “older individuals.” It also modifies the grant purpose in subsection (b)(2) to address the health care needs of older individuals, changes the subsection (d) heading from “Eligible Entity” to “Definitions,” and adds a definition for “older individual” with the meaning given in section 102 of the Older Americans Act of 1965. In addition, this section reauthorizes the program for fiscal years 2026 through 2030.

This section directs the Secretary of Labor, in coordination with the Secretary of Health and Human Services, to submit a report within 180 days after enactment to the appropriate congressional committees that (1) identifies the extent of vacancies for direct care professionals at state and local levels; (2) reviews existing apprenticeship programs in the direct care professional workforce; (3) provides recommendations on apprenticeship program design, including funding opportunities, potential sponsors, and a national competency-based occupational framework; and (4) identifies coordination opportunities with state and local entities, including state educational agencies, local educational agencies, career and technical education programs, institutions of higher education, state Medicaid agencies, and labor management organizations, to establish programs and incorporate associate and bachelor’s degrees.

This section establishes a rural health workforce grant program under part D of title VII of the Public Health Service Act. The Secretary of Health and Human Services, acting through the Administrator of the Health Resources and Services Administration and in consultation with the Secretary of Education, must award competitive grants to eligible consortia to develop career exploration programs aligned with career and technical education programs of study that expose elementary and secondary school students in underserved rural communities to health care professions, including direct care professionals, and provide related hands-on experiences. Each grant is limited to $250,000 per year for a period of up to 5 years. Eligible entities must consist of a local educational agency plus at least two other specified partners, such as an institution of higher education offering health care credentials, a health care provider, a local workforce board, or a rural health clinic, and may be required to provide at least 50 percent in non-Federal matching funds. The Secretary must give priority to consortia that align with a State or local Perkins Career and Technical Education plan, include a high-need local educational agency or minority-serving institution, or demonstrate a plan to sustain the program after the grant period. Grant funds must be used for program planning, age-appropriate education and promotion activities, and long-term participant tracking.

This section directs the Secretary of Health and Human Services, in coordination with the Director of the National Institute for Occupational Safety and Health, the Assistant Secretary for Mental Health and Substance Use, and the Administrator of the Health Resources and Services Administration, to develop a research-based assessment tool for direct care professional well-being within 1 year of enactment and to collect and publicly release aggregated, de-identified data using the tool at least biennially thereafter. The tool must consist of an anonymous, validated survey that assesses workplace policies and culture, physical environment and safety, circumstances outside of work, and physical and mental health status, and must be developed with input from direct care professionals, older individuals, people with disabilities, and family members. This section also requires the Secretary to make the tool publicly available for voluntary use by employers and researchers, submit biennial reports to Congress with recommendations, and minimize burden and protect confidentiality in data collection. This section authorizes appropriations of $6,000,000 for each of fiscal years 2026 through 2031.

This section establishes the National Direct Care Professional Training Standards Commission within 1 year after the date of enactment of this Act to advise the Secretary of Health and Human Services on developing national direct care professional training standards and supporting States in implementing such standards. The standards must be competency-based, industry-recognized, and portable across settings and States. The Commission consists of representatives from 17 specified stakeholder groups, including organizations representing older individuals, people with disabilities, direct care professionals, State Medicaid and aging agencies, labor organizations, and entities serving underserved communities. The Commission must conduct a study of training matters, develop recommendations, and submit a report with findings and legislative or administrative proposals to the Secretary and the appropriate congressional committees within 3 years after enactment. Non-federal members receive compensation at the daily equivalent of level IV of the Executive Schedule plus travel expenses.

This section establishes grant programs administered by the Secretary of Health and Human Services to promote mental health and resiliency among direct care professionals. It authorizes grants, contracts, or cooperative agreements to states, labor organizations, nonprofits with relevant experience, and Indian Tribes or Tribal organizations to implement evidence-based programs addressing suicide awareness, prevention, peer support, and access to mental health care or referrals, with priority given to rural areas and areas where direct care vacancies exceed 30 percent of positions. It further authorizes training grants to institutions of higher education, state and local governments, and other entities to incorporate strategies for addressing mental and substance use disorders into direct care professional preparation, continuing education, and professional development programs. Grants are awarded for 3-year terms, and the section authorizes appropriations of $20,000,000 for each of fiscal years 2026 through 2030.

This section directs the Secretary of Health and Human Services to identify evidence-based or evidence-informed best practices for preventing suicide and improving mental health and resiliency among direct care professionals and for training them in strategies to promote their mental health, and to disseminate those best practices to the appropriate congressional committees, not later than 2 years after the date of enactment of this Act.

This section establishes a national evidence-based or evidence-informed education and awareness initiative by the Secretary of Health and Human Services, in consultation with relevant stakeholders including medical professional associations, to prevent suicide, mental health conditions, and substance use disorders among direct care professionals by encouraging them to seek support and care, identifying associated risk factors, teaching appropriate responses, and addressing stigma. Not later than 2 years after enactment, the Secretary must report to the appropriate congressional committees on the initiative’s activities and outcomes, including quantitative and qualitative metrics.

This section establishes a state entitlement grant program under section 2041 of the Social Security Act to recruit and retain direct care professionals serving individuals age 60 or older or with disabilities in eligible settings. States receive annual allotments equal to their share of the national population of such individuals (as measured by the most recent American Community Survey), subject to a 0.25 percent minimum and annual adjustments to fully allocate available funds; after FY2030, allotments are further limited to between 90 and 110 percent of the prior year’s amount. The Secretary makes separate grants to Indian tribes and tribal organizations using a formula that reserves a portion of total funds for this purpose. Grantees must use funds for wage subsidies, student loan repayment or tuition assistance, child care support, and transportation assistance for eligible workers, and may use funds for emergency reserves, in-kind supports, barrier-removal assistance related to criminal records, employer paid leave, or other retention services. Grantees may reserve up to 10 percent of funds for administration, technical assistance, outreach, and supply-building activities, must avoid supplanting existing state or tribal expenditures, and must obligate funds within two years or return them for reallotment.

This section establishes a nonrefundable tax credit of $5,000 for taxable years beginning after December 31, 2024, for individuals who, at any time during the year, provide compensated services in a long-term care setting as a practitioner under section 1842(b)(18)(C) of the Social Security Act, a certified nursing assistant, a licensed practical nurse or registered professional nurse, a home health aide, a personal or home care aide, or a direct care professional.

This section establishes a national technical assistance center, to be operated by the Secretary of Health and Human Services in consultation with the Secretary of Labor and the Administrator of the Centers for Medicare & Medicaid Services, to address inequities and disparities facing the direct care professional workforce and to ensure long-term care settings meet the demographic, cultural, and linguistic needs of the communities they serve and employ. The section authorizes appropriations of $10,000,000 for each of fiscal years 2026 through 2030 and requires the Secretary to report to the appropriate congressional committees on the center’s activities and outcomes not later than 2 years after the date of enactment.

This section defines terms used throughout the subtitle, including the Administrator of the Wage and Hour Division, community partners such as state labor departments, attorneys general, law enforcement agencies, consulates, employee advocates, academic institutions, and municipal agencies, community partnerships between such partners and the Department of Labor, covered employees as direct care professionals in long-term care settings, covered employers, eligible entities such as nonprofits, employers, business associations, and institutions of higher education, the Secretary of Labor, strategic enforcement targeting noncompliant industries, and wage and hour laws and violations enforced by the Wage and Hour Division.

This section establishes the Direct Care Professional Workforce Wage Theft Prevention and Wage Recovery Grant Program. The Secretary, acting through the Administrator, awards competitive grants to eligible entities for up to three years to support activities that prevent and reduce wage and hour violations and assist covered employees in recovering back pay. Permissible uses of funds include outreach and training for covered employees and employers, joint worksite visits and investigations with the Department of Labor’s Wage and Hour Division, assistance with claim filing, compliance monitoring, and technology-based reporting systems. In selecting recipients, the Secretary must give priority to entities serving the long-term care industry or geographic areas at highest risk of noncompliance and those with demonstrated experience preventing violations or recovering unpaid wages; the Secretary must also consider community support and existing partnerships. Grant recipients must enter into a memorandum of understanding with the Secretary within 60 days and update it annually, and must develop procedures for performance reporting.

This section establishes definitions for terms used in the subtitle, incorporating the meanings of "enterprise," "enterprise engaged in commerce or in the production of goods for commerce," "person," and "regular rate" from the Fair Labor Standards Act of 1938. It also defines "child" (an individual under 18 years of age, including biological, foster, adopted, step, or other specified relationships), "covered entity" (any person or agency providing compensation to direct care professionals), "Medicaid HCBS-eligible older individual" (an individual 60 years of age or older enrolled in specified Medicaid services such as home health care, personal care, PACE, home and community-based services under section 1915, case management, rehabilitative services, or others designated by the Secretary of Health and Human Services), "on-call shift," "parent," "shared living arrangement" (involving no more than 2 individuals with disabilities or Medicaid HCBS-eligible older individuals, with specified payment and consumer-driven matching requirements), and "spouse."

This section requires each covered entity to provide a signed, dated written agreement to every covered direct care professional compensated for long-term care services for at least 8 hours per week. The agreement must be provided in a language fully understood by both parties no later than 5 calendar days after hire and must include the entity’s contact information, work location, job responsibilities and schedule, regular and overtime pay rates, pay day, meal and rest breaks, time-off policies, a good-faith estimate of expected weekly hours with at least 72 hours’ advance notice of scheduled shifts (except in specified circumstances), reporting-time pay, policies on health insurance, transportation, equipment, severance, safety and emergencies, termination notice, and, for live-in arrangements, rules governing entry into living spaces and immediate-removal procedures.

This section establishes fair scheduling practices for covered direct care professionals who provide long-term care services. It requires covered entities to provide notice of scheduled work hours through a written agreement specifying the time of day and days of the week or through a good faith estimate schedule. The section mandates that covered entities communicate any changes to scheduled work hours, including on-call shifts, in writing at least 72 hours before the professional is scheduled to begin work. It also requires reporting time pay at the professional’s regular rate for any canceled or reduced hours after arrival at work, or at half the regular rate for cancellations made less than 72 hours in advance, unless the entity qualifies for an exception by obtaining consent for alternative equivalent hours within a 7-day period. Covered direct care professionals gain the right to decline additional hours outside their agreed schedule or good faith estimate, which requires prior written consent that may be provided electronically. The requirements do not apply during natural disasters, presidentially or gubernatorially declared emergencies, severe weather, medical emergencies, public health quarantines, or when a professional voluntarily requests a schedule change, and they are inapplicable to shared living arrangements. This section takes effect 2 years after the date of enactment.

This section establishes a right for covered direct care professionals to obtain temporary changes to scheduled work hours due to a personal event. For each calendar year, covered entities must grant either at least 2 such requests covering up to 1 business day each or 1 request covering up to 2 business days; personal events include serving as a caregiver for a family member or equivalent, attending legal proceedings related to SNAP or TANF benefits, or circumstances qualifying for safe time, family, medical, or sick leave.

This section prohibits covered entities from monitoring or recording direct care professionals while using restroom or bathing facilities, in private living quarters, or during dressing, undressing, or changing of clothes. It further restricts interference with or monitoring of private communications except when preapproved by an individual’s person-centered planning team, when the entity reasonably believes such communications interfere with duties or violate the person-centered plan, or when establishing reasonable work-related restrictions; it also bars taking possession of documents or personal effects. This section defines private communications as any telephone or internet-based exchanges, including text messages, social media, email, and calls, with an entity or individual other than the covered entity.

This section requires covered entities to provide direct care professionals an uninterrupted meal break of at least 30 minutes after more than 5 hours of work and a paid rest break of at least 10 uninterrupted minutes during the first 3 hours of every 4 hours of scheduled work. The covered entity must pay the direct care professional at the regular rate for both breaks unless the professional is fully relieved of duty and permitted to leave the worksite during the meal break. The section permits on-duty meal or rest breaks only when relieving the professional of all duties would compromise the health or safety of the individual receiving care, and only pursuant to a voluntary, revocable written agreement that is not a condition of employment and does not waive stronger collective bargaining or state or local protections. The requirements do not apply to shared living arrangements.

This section prohibits interference with, restraint of, or denial of rights provided under this subtitle to direct care professionals, including discharge, discrimination, or retaliation for exercising such rights or engaging in concerted activities for collective bargaining. It further prohibits covered entities from taking adverse employment actions against direct care professionals for opposing unlawful practices, asserting claims, requesting schedule or agreement changes, or participating in related proceedings, and specifies that certain immigration-related actions—such as reporting citizenship status, requesting excess documents, misusing E-Verify, or filing false reports—constitute discrimination unless undertaken at the express direction of the Federal Government. The section also establishes a presumption of retaliation if a discharge or adverse action occurs within 90 days of a direct care professional asserting a right or assisting another in doing so, which may be rebutted only by clear and convincing evidence of a permissible reason.

This section provides enforcement authority to ensure compliance with the subtitle by covered entities and direct care professionals. It grants the Secretary investigative and subpoena authority under sections 9 and 11 of the Fair Labor Standards Act of 1938, requires covered entities to keep and preserve compliance records (with submissions generally limited to once per 12-month period absent reasonable cause or an ongoing charge), authorizes aggrieved direct care professionals to bring civil actions for lost wages or compensation, actual monetary losses, liquidated damages, interest, equitable relief such as reinstatement, and reasonable attorney and expert fees, and establishes specific liability of one hour of pay (up to two hours per workday) for meal and rest break violations under section 316 and $5,000 for written agreement violations under section 312. The section further directs the Secretary to receive and investigate complaints in the manner provided under sections 6, 7, and 15(a)(3) of the Fair Labor Standards Act, assess civil penalties of not more than $15,000 for a first violation and $25,000 for any subsequent violation, provide for administrative review by an administrative law judge, and bring civil actions to recover amounts owed on behalf of aggrieved direct care professionals.

This section preserves existing employment benefits and rights for direct care professionals by providing that nothing in this subtitle supersedes collective bargaining agreements, diminishes obligations under contracts or plans offering greater rights or benefits, or discourages adoption of such agreements or plans. It further requires compliance with other Federal, State, or local laws (including reasonable accommodation requirements for work schedules), prevents preemption of comparable or superior State or local laws, and prohibits waiver of rights or remedies under this subtitle through any agreement or as a condition of employment.

This section directs the Secretary of Labor to issue an interim final standard on workplace violence prevention not later than 1 year after the date of enactment of this Act. The standard requires certain employers in the health care and social service sectors, and employers conducting similar activities, to develop and implement a comprehensive workplace violence prevention plan to protect workers from workplace violence; it must be based at a minimum on the 2015 OSHA Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers. The interim standard takes effect no later than 30 days after issuance (with a possible phase-in for engineering controls), is enforceable like other OSHA standards, and remains in effect until superseded by a final standard. The Secretary must provide 30 days of public notice and comment before issuance and prioritize technical assistance to covered employers for up to 1 year; specified procedural requirements under the Occupational Safety and Health Act, the Administrative Procedure Act, the Paperwork Reduction Act, and Executive Order 12866 do not apply. If the interim standard is not issued within 1 year, the requirements of section 323 take effect and are enforceable until superseded. Not later than 2 years after enactment, the Secretary must issue a proposed final standard, and not later than 42 months after enactment, the Secretary must issue a final standard that provides no less protection than approved state plans and is enforceable like other OSHA standards.

This section establishes definitions for the terms covered facility, covered services, covered employer, and covered employee to determine the scope of standards promulgated under section 321. Covered facilities include hospitals and outpatient clinics, residential treatment and long-term care facilities, nonresidential treatment settings, correctional and detention medical clinics, community care and mental health settings, psychiatric and substance use disorder treatment centers, freestanding emergency centers, assisted living facilities, and certain federal facilities, but exclude standalone offices of physicians, dentists, or other practitioners. Covered services include home health care, hospice, social work, emergency services and transport, and certain federal services, but exclude child day care. Covered employers and employees encompass contractors, subcontractors, temporary firms, and leasing entities that employ individuals to work in or provide such facilities and services, with exclusions for individuals privately employing caregivers in their own residences or through self-directed Medicaid waivers.

This section establishes minimum requirements for each workplace violence prevention standard issued under section 321. It directs covered employers to develop, implement, and maintain a written workplace violence prevention plan no later than 6 months after promulgation of the interim final standard (or 18 months after enactment in cases under section 321(a)(5)), with meaningful participation by direct care professionals, other employees, and their representatives. Each plan must be tailored to facility- or service-specific hazards, including patient-specific and environmental risk factors, incorporate patient-centered and trauma-informed practices, and contain procedures for identifying responsible individuals, conducting risk assessments informed by prior incidents, applying hierarchy-of-controls hazard prevention measures (such as alarms, staffing protocols, and flagging systems), reporting and post-incident investigations, emergency response for mass casualties or weapons, training and communication, coordination with other employers, and annual evaluations. The section further requires employers to investigate and document workplace violence incidents, risks, or hazards as soon as practicable with employee input and to provide annual training and education to covered employees exposed to such hazards.

This section establishes rules of construction for the subtitle notwithstanding section 18 of the Occupational Safety and Health Act of 1970. It (1) preserves the Secretary's authority under any other provision of law; (2) provides that rights, privileges, or remedies for covered employees are in addition to those available under federal or state law or collective bargaining agreements; (3) permits health care workers, social service workers, and other personnel to report violent incidents to law enforcement; and (4) maintains existing federal, state, or local protections related to domestic violence, stalking, dating violence, and sexual assault.

This section defines terms used throughout the subtitle, including alarm, dangerous weapon, engineering controls (such as weapon detectors, enclosed workstations, and closed-circuit monitoring), environmental risk factors, patient-specific risk factors, Secretary of Labor, threat of violence, four categories of workplace violence (type 1 through type 4), work practice controls (such as staffing assignments and de-escalation training), and workplace violence (including threats or use of force or weapons that may cause injury or trauma).

This section requires hospitals and skilled nursing facilities not otherwise subject to the Occupational Safety and Health Act of 1970 (or an approved state occupational safety and health plan) to comply with the Workplace Violence Prevention Standard promulgated under section 321 of the Long-Term Care Workforce Support Act as a condition of Medicare participation. The amendments apply beginning 1 year after issuance of the interim final standard.

This section defines terms used in the subtitle, including child, covered direct care professional, domestic violence, employee, employer, employment benefits, health care provider, paid sick time, parent, public health emergency, sexual assault, spouse, stalking, and victim services organization.

This section requires employers to provide each covered direct care professional with not less than 1 hour of earned paid sick time for every 30 hours worked, up to a maximum of 56 hours in a year unless the employer sets a higher limit. Exempt employees are deemed to work 40 hours per week (or their normal workweek if shorter) for accrual purposes. Covered direct care professionals begin earning paid sick time upon commencement of employment and may use it beginning on the 60th calendar day, except that additional paid sick time may be used immediately during a public health emergency. The section permits carryover of earned time from year to year, allows employers with equivalent existing paid leave policies to forgo additional accrual, requires reinstatement of previously earned time if the professional is rehired within 12 months, and prohibits requiring the professional to find a replacement as a condition of use. Paid sick time may be used for the professional’s own physical or mental illness, injury, medical condition, or preventive care; workplace closures or exposure risks during a public health emergency; or caring for a child, parent, spouse, domestic partner, or equivalent family member whose school or place of care is closed due to a public health emergency.

This section requires each employer to notify covered direct care professionals of paid sick time available under this subtitle, including information on filing actions, notice requirements for foreseeable leave, and protections against rights violations, and to post and maintain a notice with excerpts or summaries of the pertinent provisions in conspicuous workplace locations or employee handbooks. Employers who willfully violate the posting requirements are subject to a civil fine of up to $100 per offense.

This section prohibits employers from interfering with, restraining, or denying the exercise of rights to paid sick time under this subtitle, including by discharging or discriminating against individuals for taking such leave, using it as a negative factor in employment decisions, or counting it under no-fault attendance policies. It also bars discrimination against individuals who oppose unlawful practices or participate in proceedings related to these rights, and clarifies that the prohibited activities are not narrower in scope than those under section 105 of the Family and Medical Leave Act of 1993.

This section provides the Secretary of Labor with investigative and enforcement authority modeled on the Fair Labor Standards Act of 1938 to ensure compliance with the requirements of this subtitle for covered direct care professionals. It authorizes the Secretary to investigate employers, require recordkeeping, and issue subpoenas, while limiting required record submissions to once per 12-month period absent reasonable cause or an ongoing charge. The section also establishes a private right of action allowing covered direct care professionals or similarly situated individuals to sue employers in federal or state court for violations of section 334, recovering lost wages or benefits, interest, liquidated damages, and equitable relief such as reinstatement, plus attorney’s fees and costs. It further authorizes the Secretary to receive and investigate complaints in the manner used for FLSA minimum wage and overtime violations, to bring civil actions to recover damages, and to seek injunctions restraining violations or withholding of compensation, with unclaimed recoveries deposited in the Treasury after three years. Actions must generally be brought within two years of the last alleged violation, or three years for willful violations.

This section authorizes the Secretary to conduct a public awareness campaign to educate and inform the public of the requirements for paid sick time under this subtitle and authorizes appropriations of $20,000,000 to carry out the campaign.

This section preserves any contract, collective bargaining agreement, or employment benefit program or plan that provides greater paid sick leave or other leave rights to covered direct care professionals than the rights established under this subtitle, and prohibits any such agreement from diminishing those established rights.

This section provides that nothing in the subtitle shall be construed to discourage employers from adopting or retaining leave policies more generous than those required under the subtitle, or from entering into contracts, collective bargaining agreements, or benefit plans that provide greater rights or benefits to covered direct care professionals.

This section directs the Secretary to prescribe regulations necessary to carry out this subtitle within 180 days after the date of enactment, while requiring immediate compliance with the rights and responsibilities specified in the subtitle upon enactment, regardless of whether regulations have been issued.

This section deems any public health emergency declared before the date of enactment of this Act, and remaining in effect on that date, to have been declared on the date of enactment, for purposes of this subtitle (including section 332(c)).

This section requires the Commissioner of the Bureau of Labor Statistics to collect data on the amount of paid and unpaid sick time available to covered direct care professionals by occupation and type of employment establishment, as well as estimates of average sick time used, and to report the data annually to the Comptroller General of the United States. This section also directs the Comptroller General to conduct a study evaluating implementation of this subtitle, including access to paid sick time, awareness of rights under this Act, and employer compliance experiences, disaggregated by race, ethnicity, gender, disability, occupation, and other characteristics determined by the Secretary, and to submit a report on the study to the Senate Committee on Health, Education, Labor, and Pensions, the Senate Special Committee on Aging, and the House Committee on Education and Workforce not later than 5 years after the date of enactment of this Act.