Does Your Caregiver Have 75 Hours of Training, Analysis of Washington State Initiative 1163

Molly Schlanker, 12/27/2011

Washington voters passed Initiative 1163 this month, requiring 75-hours of training and FBI background-checks for all professional caregivers.  These new measures for senior caregivers seem like good ideas, but the governor of the state and many senior care professionals were advocating against this measure. Caregiverlist researched this issue to find out why.

One union, SEIU (Service Employees International Union), spent more than $1 million dollars to promote passage of this new requirement for 75-hours of caregiver training.  This union's membership includes caregivers paid through Medicaid programs.  Medicaid is the state and federal health care program for low-income seniors and the disabled.  The state of Washington estimates it will cost as much as $80 million to implement this new training program and the FBI background-check requirements.  The same initiative was passed in 2008 but was never implemented because there were no state funds to pay for it.  Caregiver training and background checks are currently required before a caregiver can be staffed (the training is much less than 75-hours and state police background-checks are currently required).

Right now, Medicaid pays for nursing home care for as long as a Medicaid recipient may need it, in every state in the U.S.A.  But Medicaid does not pay for senior caregiving services in the home in every state.  As the senior population grows and states battle with budget challenges, new programs will be needed to address how to provide cost-effective quality care.  Is 75-hours of caregiver training for home caregivers one answer?  What if a senior caregiver has many years of experience - would the same 75-hours of training be required?  What if senior home care agencies already provide adequate training through on-going seminars and online caregiver training programs?  Does Washington's 75-hour training program meet the appropriate training needs for all caregivers? 

Caregiverlist reached out to Julianne Ferguson, who has worked as a senior care professional in Washington for more than 20 years, to learn more about why this new training and background check requirement was presented for a vote and passed.

You can review Washington State Initiative 1163 here. 

Quick Read:  Go to the Caregiverlist Analysis at the end of this article.

Caregiverlist Q  & A with Julianne Ferguson, Administrator, Advanced Health Care and Board Member of the Washington Private Duty Association and National Private Duty Association (senior home care is referred to as “private-duty care” in the senior care industry).

Caregiverlist:  Initiative 1163 was passed by Washington state's residents yesterday.  Before we discuss the specifics of this initiative, we wanted to note that this election was Washington's first all-mail general election. What are you hearing about the voter turnout?  Did the all-mail ballots during an off-year election cause people to be more informed or less informed, do you think?  

Julianne Ferguson:  Voter turnout was predictably low.  Most of the state has used mail-in ballots for years and in most counties there were no    options.  This was the first election where every county had only mail in ballots.  I’m am not aware of discussion or concerns regarding people being more or less informed because of the type of balloting available.

Caregiverlist:  Initiative 1163 introduced the same measures from an initiative that was passed in 2008, with the requirement of 75-hours of training and FBI background checks for home care workers.  How many years have you been a senior home care professional in Washington?  Do you recall what incident or events lead to the introduction of the first initiative in 2008?

Julianne Ferguson:  I have worked in home care for more than 20 years, and have been with Advanced Health Care more than 15 years.  The introduction of Initiative 1029 in 2008 was the direct result of a workgroup established by the governor in 2007 called “The Long Term Care Worker Training Workgroup”.  While we (private duty senior home care agencies) requested and were not granted a seat at the table, we did attend each meeting and spoke whenever public comment was allowed.  The workgroup was heavily weighed by SEIU supporters and the final outcome was not close to being unanimous.

Caregiverlist:  Licensed senior home care agencies must conduct background checks on employees already.  This initiative includes "FBI background checks".  What does that mean exactly and how are these background checks different from the ones that are already being conducted by home care agencies?

Julianne Ferguson:  Current law in Washington State requires agencies to perform State Patrol background checks, much like the requirement of schools, hospitals, etc.  This process searches records throughout the state, but not throughout the nation.  The FBI background checks presumably are more extensive.  

Caregiverlist:  Senior home care agencies already provide caregiver training.  How many hours of caregiver training does Washington state currently require for licensed senior home care agencies to provide?

Julianne Ferguson:  Washington State “home care” and “home health” agencies are licensed by the Department of Health. (Note: home care refers to private-duty caregiving services and home health refers to “skilled” care services by Registered Nurses, Speech Therapists, Occupational Therapists, Physical Therapists and Certified Nursing Aides, with Medicare providing for payment for the skilled home health services).   {WAC 246-335-065 Personnel, contractor, and volunteer policies and WAC 246-335-095 Supervision of home health care}.  See entire regulations here:

Current law requires caregivers to be trained and oriented to their client prior to their first shift.  It does not specify the number of hours required.  Keep in mind, home care licensed agencies provide only “non-medical home care”, consisting of such tasks as preparing meals, housekeeping, laundry, linen change, transportation to medical appointments or shopping, companionship, etc. 

Caregiverlist:  The new requirement will be for 75 hours of training.  The main reason the 2008 initiative was not implemented was due to costs. Could you explain for us:

1)   Who created the 75-hour home care worker training program?

 Julianne Ferguson:  The 75-hour home-care aide curriculum was written by the Washington State Department of Social and Health Services (DSHS), based primarily on the existing training program called “Revised Fundamentals of Care” usually referred to as “RFOC”; testing and certifying is the responsibility of Washington State Department of Health (DOH). 

2)   Who would be qualified to teach this new training (would only certain schools be authorized to provide the training, as Certified Nursing Aide schools are now)?

Julianne Ferguson:  Individuals desiring to teach may look at the DSHS website to determine if they meet the requirements, and then apply to DSHS for credentialing.  DSHS does not license “training schools”.  If someone wanted to set up new business this would be a separate and different entity.

3)   Does the 75-hour home-care worker training include an exam that would need to be passed at the end for certification, similar to Certified Nursing Aide certification?

Julianne Ferguson:  Yes, there is an exam and certification requirement; this is a Department of Health responsibility.

4)   Would this new training apply to direct-hire home caregivers as well as those working for senior home care agencies?

Julianne Ferguson:  Requirements apply to all non-exempt caregivers.  A non-agency home care provider is not licensed or supervised and would not fall into the definitions requiring training or credentialing.

 5)   How often would a home caregiver worker need to receive the training (only 1 time)?     

Julianne Ferguson:  The training is only required once; although continuing education is a yearly requirement.  Certification is also an annual requirement.

Caregiverlist:  The initiative is written to require the state of Washington to pay for the training, right? Would the home caregiver workers also be paid an hourly wage for the 75-hours of training?  If so, who pays these wages and what would the hourly rate be?

Julianne Ferguson:  The state of Washington is required to pay ONLY for Medicaid-funded caregivers – primarily SEIU members.  My understanding is that most of these caregivers will also be paid an hourly wage for attending the training.  I expect the state of Washington would pay the wages; I do not know what the hourly rate would be.  Non-Medicaid caregivers, i.e., all caregivers working in the private sector for private pay agencies have no funding source for their training.  They would have to pay for the training themselves, receive assistance from their employer, and ultimately have the costs passed to the private pay client.  Please note – the Office of Financial Management (OFM) tells us that only 1 in 10 Washington State seniors qualify for Medicaid.  This means that most seniors would pay for their own home caregiver training!

Caregiverlist:  Medicaid home care workers in Washington state are all SEIU members, right?  Are workers for senior home care agencies also SEIU members?

Julianne Ferguson:  I believe most Medicaid home care workers in Washington State are SEIU members.  More than 40,000 home care providers are listed as “Independent Providers or IP’s”, and work with Medicaid clients.  All Independent Providers (non-agency workers) are SEIU members.  I am not aware of any non-Medicaid home care agencies that are members of the SEIU.

Caregiverlist:  When this initiative was introduced, how was it proposed that it would be funded?  How much money are these new requirements estimated to cost?

Julianne Ferguson:  There has never been a funding source for this initiative, or for the previous initiative I-1029.  There are various estimates of cost, depending on whether or not costs of implementing I-1029 is included, and whether or not federal dollars are included.  We estimate the costs at $80 million over the next two years. 

Caregiverlist:   If you were the governor of Washington and could spend this money in any way you chose for the senior care industry, what initiative would you create?  

Julianne Ferguson:  I don’t think I can answer this question.  The money is simply not here.  We have a huge budget crisis and have drastically cut funding to seniors and other programs already.  Funding 1163 will only hurt the people of Washington State, specifically seniors and people with disabilities.

Caregiverlist:  Next steps:  what will happen next with this initiative, do you think?  Will the legislature place it on ice again?

Julianne Ferguson:  I don’t know what will happen next.  Obviously there is a funding issue.  The legislature will have to decide how to fund, or whether to fund.

Caregiverlist Final Analysis:   Washington state Initiative 1163 was fashioned around the desires of one union, not the entire senior care industry (as Ms. Ferguson mentions, the private-duty senior home care agencies were not given a seat at the table).  Quality caregiver training requirements make sense but could be provided in a much more cost-effective way (secure online training with an in-person component would be significantly more cost-effective and could be customized to provide various levels of training, based on the caregiver's experience level. Indepth training on age-related illnesses, for example, could also be offered.  Progressive levels of training for each year could also be implemented with online training).  

  • 9 out of 10 seniors in Washington state do not receive Medicaid benefits and would need to pay for the 75-hours of training for their caregivers out of their own pocket
  • Seniors are losing some Medicaid services and community programs due to state budget cuts which means if the state budget should increase,  it might be best to spend it on reinstating senior services before spending it on caregiver training when caregivers already receive training
  • Medicaid, funded by taxpayers, would foot the bill for paying for the 75-hours of caregiver training
  • Medicaid paid caregivers also happen to be union members and their union spent more than $1 million to pass this initiative requiring 75-hours of paid training which raises a red flag
  • Non-union senior care professionals were not included in creating the training, yet there are more than 200 private duty senior home care agencies in Washington state who are affected by this law  - this raises another red flag
  • Initiative does not offer customized training based on caregiver experience level
  • Initiative does not take advantage of modern online training programs which would be much more cost-effective 
  • There is no money in the state budget to pay for creating the caregiver training, including implementing it and paying the caregiver's wages to attend the 75-hours of training

The fact that anyone would create a government program without including funding raises questions about the quality of everything they are doing.  You could not sustain a private business in this way and should not expect to run a government budget by spending money for a program with no revenue stream to support the cost of the program.  This is why the Seattle Times has already noted that the legislature can kill this intiative with a two-thirds vote and has suggested that they do so. It may also be helpful for the senior care industry to educate Washington's voters about the current training and background checks that are already in place.

(Thank you to Julianne Ferguson of Advanced Health Care, with locations in Tacoma, Olympia and Federal Way, Washington, for helping us navigate this initiative - and for being an advocate for quality senior care).



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