Home care training back on ballot

Initiative 1163 should give most Washington voters a sense of déjà vu this week when they open their ballots for the Nov. 8 election.

More than 72 percent of them approved a nearly identical measure in 2008, just before the global economy tanked. Under that measure, Initiative 1029, home care aides were required to get 75 hours of training, pass competency exams and be certified by the state.

But cash-strapped state lawmakers voted twice to postpone the law – in 2009 and again this year – delaying the higher standards for home care aides until 2014.

This year, the Service Employees International Union-Healthcare 775 Northwest contributed nearly all of the $1.66 million raised for the campaign to put the standards back in place next January. Opponents have raised just $112,165, with $72,000 coming from the Washington State Residential Care Council of Adult Family Homes, based in Olympia, according to filings with the state Public Disclosure Commission.

The state Labor Council is backing the measure; business groups, such as the Association of Washington Business, and both Democratic Gov. Chris Gregoire and Republican Attorney General Rob McKenna oppose it on grounds there is no money to pay for it.

COSTS A MAJOR OBJECTION

Opponents say the state cannot afford to pay its share of increased training when it is facing a new budget gap of up to $2 billion. The governor’s budget office says costs would be about $32 million over the next two years, with nearly $18 million paid by the state and the rest by federal funds or new fees.

“It’s just the wrong time; it’s the wrong vehicle,’’ said Cindi Laws, executive director of the WSRCC and the chairwoman of the opposition campaign. She said that without a tax increase to pay for the training, the state would have to cut other care for seniors and disabled adults to pay for it.

But Sandeep Kaushik, a political consultant with the I-1163 campaign, says the costs are not significant. He argues that a revenue source would have turned the campaign into a tax fight, taking the focus off the care needs of seniors.

Kaushik said that I-1163, by providing more safety and skilled care for the elderly and disabled adults, would help them live on their own or in less-costly boarding homes or adult family homes.

“It’s frankly better for the state, because it saves the state millions of dollars in what would be higher costs in nursing homes,’’ Kaushik said.

Brendan Williams, a former Democratic state lawmaker from Olympia and one-time director of the state nursing home association, said taxpayers risk bigger payouts for negligent care if training is not improved for state-paid Medicaid clients.

Even if voters approve the measure, lawmakers could suspend the training requirements yet again if they can muster a two-thirds vote.

Rep. Tami Green, a Lakewood Democrat, nurse and former board member of SEIU, supports the measure but also believes the Democratic-majority Legislature would have to postpone I-1163 if it passes – at least until economic times get better. Still, she thinks its passage would send an important message.

“I think it’s important to keep that conversation going and understand it’s a priority,” Green said.

INCREASED HOURS

In a nutshell, I-1163 would double the training requirements for about 50,000 independent in-home and residential caregivers, most of whom are paid by the state under Medicaid, which serves low-income adults. The measure would require competency tests for aides and certification by the Department of Health.

Workers now get about 34 hours and must obtain 10 hours of continuing education training each year. I-1163 would boost the training to 75 hours initially and to 12 hours a year in refresher courses.

I-1163 also would impose higher training requirements for individual providers who care for their own elderly or disabled adult children. And the higher training requirement – but not certification – would be required for other caregivers such as those in adult family homes and boarding homes starting in 2016, according to an analysis by the state budget office.

Lorrie Mahar, office chief for the training and quality unit at the Department of Social and Health Services’ Aging and Disability Services Administration, said the longer training is more detailed and includes in-depth lessons specific to the care needs of a student’s clients – say, those who work with people who have dementia, developmental disabilities or mental illness.

Under contracts SEIU has negotiated with the state for about 40,000 individual providers who care for Medicaid clients, the cost of training is paid by the state, including time students spend in class.

That practice will continue whether I-1163 passes or fails. But under I-1163, the training costs would be higher because of the longer hours of training and more time workers were off their regular duties.

I-1163 opponents take issue with the training subsidy itself. Laws said the state doesn’t pay for training or time spent training for non-Medicaid caregivers in adult-family homes, and she doesn’t think the state should pay for anyone’s.

But Mahar of DSHS said the state does pay extra to adult family and boarding homes to help defray their share of training costs, too.

FBI CHECKS

The initiative also requires more thorough background checks for people new to the long-term care field. This includes a federal FBI check and fingerprinting for all long-term care workers for the elderly and disabled who are hired after Jan. 1, 2012.

Washington already does state-level background checks for long-term care workers it oversees, and it checks names against abuse registries.

DSHS does not do fingerprint checks as a rule, but it does require a fingerprint and FBI criminal-history check for paid caregivers who have lived in the state for less than three years in a row.

Neither side in the I-1163 campaign is able to say how Washington’s training standards compare nationally. There is no national repository of training standards for home care workers, and the federal government gives states the power to set standards, according to the federal Centers for Medicare and Medicaid Services.

But a 2006 report by the inspector general for the U.S. Department of Health and Human Services found 50 states require background checks, and 46 require training. The training hours ranged from two hours to 120 – and median was 28 hours.

Under I-1163, Washington would become one of the few states to certify or credential personal and home care aides, which is “pretty uncommon at this point,” said Steven Edelstein of the New York-based nonprofit PHI, which promotes better long-term care through increased training.

Brad Shannon: 360-753-1688

bshannon@theolympian.com

www.theolympian.com/politicsblog

This story was originally published October 23, 2011 12:00 AM.