512px-Flag_map_of_Washington.svgIn November 2011, the voters of Washington State passed Initiative 1163 mandating new training, testing, background checks, and continuing education requirements for “long-term care workers,” which includes home care aides. Most eldercare professionals including those working for home care agencies, adult family homes, assisted living, and skilled nursing facilities were against the initiative as were virtually all the newspapers and other media outlets in the state. In favor were I-1163’s prime sponsors and financial backers, a large public employee labor union. The “Yes” side outspent the “No” side by a 10 to 1 margin and the initiative passed by an overwhelming majority.

How has I-1163 fared two years later? Has it done what its backers claimed would happen which was to raise the standard for long-term care workers and create a new career path for them, while increasing the quality of care for families? Or has the initiative raised the cost of home care for our most vulnerable older citizens while costing the state millions, shown no discernable benefit for our seniors, and driven qualified home care aides into the “grey market”?

It’s hard to tell the statewide effect as there have been no comprehensive studies done yet on the effects of I-1163 on the costs of providing care, the burden on caregivers and providers for training and certification, if caregivers have been driven into the grey market, and how much, if any, has care actually improved. The initiative also affected many different types of providers each with different circumstances.

But here’s how 1163 has affected at least one type of provider – home care agencies which are not Medicaid providers and provide in-home, non-medical care for tens of thousands of Washington State elderly residents:

  • The new home care aide training has provided basic training for caregivers. However, as home care providers argued, it is a poor substitute for the more widely available and useful Certified Nursing Assistant (CNA) program. In fact, a new state program “bridge” HCA to CNA has proved extremely popular as caregivers realize the limitations of the home care aide certification.
  • Problems with the new background check system continue to exist although the state continues to make progress. Rural areas of Washington State are still experiencing unavailability in certain areas, inconsistency in office hours, and delays in processing. A benefit has been that the few agencies that were performing only limited Washington State background checks are now required to perform national checks.
  • Testing and certification remains an issue although the state has responded positively by extending the time aides have to receive their certification.
  • Continuing education requirements have added costs and administrative regulatory burdens to agencies and their caregiving staff while any benefits are hard to determine.
  • The benefits to families from higher quality care are virtually impossible to measure at this time as state mandated training, testing, and certification of home care aides are but one factor in the quality of care. My guess is that several years down the road the state or other entity will perform a study on the effectiveness of the initiative, and then we’ll see.

Image credit: Wikimedia Commons