Politics & Government

Three years after voters approved higher standard for home care training, audit finds progress is slow

A recent state audit report finds Washington is making progress to screen, train and certify more home care workers under terms of a 2011 citizen initiative. But large numbers of new hires are still dropping out of the business before obtaining certifications.

Overall, progress is being made in the state’s first-in-nation certification program, which two state agencies spent more than $14 million to administer and monitor in the most recent budget year. The number of applicants, according to the audit, grew from 406 in early 2012 to 6,776 in 2013, and the share of applicants who achieved certification doubled — going from 29 percent to 58 percent.

A spot check of 83 adult family homes found 96 percent of workers examined there met requirements of the initiative, many because they were working in the industry prior to passage of the initiative. Initiative 1163 provided exemptions for those already employed.

A January 2013 audit — also prepared by the performance audit staff of state Auditor Troy Kelley — found deeper failings with the I-1163 implementation. The state subsequently identified limited English language skills as one of the caregiver community’s barriers to certification and took steps to ensure training and exam materials were translated into 13 languages, up from six.

“It’s moving in the right direction,” Diane Young, credentialing manager for the Department of Health, said last week. “And the (certification) pass rates for the most part are in line with how other health profession exams fall out. The focus for any efforts to make improvements have been on the translation into other languages — having that translation (language) double-checked.”

Another improvement cited in the second audit was the Legislature’s decision to extend time available for care workers to obtain a certificate from 150 days to 200 days after being hired. Non-English speakers were given an extra 60 days.

Even so, the latest audit makes clear the state’s work on I-1163, which affects potentially 50,000 care givers, is not done.

It recommends that the Department of Social and Health Services and DOH continue to collaborate and asks DSHSto address the case of one long-term care worker whom auditors found still working without certification. DSHS also must follow up with caregivers in homes that had employed nine other uncertified workers discovered during the September 2013 spot checks.

Because the audit looked at a small sample of the roughly 10,000 care workers in adult family homes, auditors estimated there could be as many as 340 who don’t have certificates that the law requires.

The audit also cited concerns of program managers who said “they believe that the failure of workers to complete the certification has resulted in a higher turnover rate, which can affect continuity of care for clients.’’

When Washington voters approved Initiative 1163 three years ago, it was part of a push to improve care for the elderly and disabled who wanted to remain in their homes. Voters had approved similar higher standards previously, but lawmakers balked at finding money to implement the rules the first time around.

Under I-1163, care workers are required to get 75 hours of training, up from 28 hours previously required.

Backed by Service Employees International Union 775 Northwest, the initiative also set up a system of testing and certifying home care workers. Some work in adult homes and many more are hired by individual clients in the Medicaid program to provide help with bathing, cleaning, cooking, shopping and other chores. SEIU and the state formed The Training Partnership, which oversees the training for SEIU members, and the state now keeps a register of approved training programs available to the workforce.

John Ficker, executive director for the Washington State Residential Care Council, said the initiative has placed a cost burden on the adult family homes he represents, which cater to between two and six clients. The state’s training reimbursements for owners who cover training for new hires are small considering how many workers quit once they learn how grueling the work can be.

“The cost of training includes the time of the employee (usually between $10-$14 per hour) and tuition, which depending on the trainer can range from around $500 in a larger classroom setting to private arrangements, which can cost up to $125 per hour,” Ficker said. “Also keep in mind that turnover would be conservatively measured at 100 percent annually.”

Ficker said the association, which opposed the initiative, would be interested in working with the training partnership for an easier way to help applicants meet the 75-hour training requirement. An idea he’s heard from staff and his board is using on-the-job training and mentoring programs to achieve a portion of the training requirement.

He said there is a risk of “a labor crisis” for many homes if over time they are unable to get the quality help needed. “As an organization, we’re just in a process of monitoring it,” Ficker said.

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