Initiative would require more training for caregivers

The scenario is not difficult to imagine: someone who is elderly or disabled being harmed by a caregiver, whether intentionally or not.

Will additional training help ensure quality care for the most vulnerable among us? That's what the Service Employees International Union Local 775 says. SEIU is the organization behind Initiative 1029, which more than doubles the training requirements for certain long-term caregivers.

Considering these health-care aides often work without supervision, there is obvious gut-level support for more training. The catch is that the initiative, which has received little publicity so far, carries a big bill.

According to the Office of Financial Management, I-1029 would cost taxpayers nearly $30 million in the first biennium. And that covers only workers — many of them SEIU members — who care for Medicaid patients. Home-care agencies and the operators of boarding homes, adult family homes or assisted-living facilities would pay to train the rest, and those costs may be passed along to their elderly or disabled clients.

The cost has caused even some supporters to balk — hence, this vague statement from the office of Gov. Christine Gregoire, who has been an ally of the SEIU:

"When she signed the petition to get this on the ballot, the state was in a different place and the country was in a different place economically," said Debra Carnes, communications director for the Gregoire campaign. "She can't ignore the budget situation."

In other words, while Gregoire still supports the idea behind the initiative, the timing isn't exactly ideal.

Intense debate

The long-term-care workforce has been a topic of intense debate in Olympia. In 2001, people who provide home-care for Medicaid patients won the right to unionize. In the next few years, the union workers won health-insurance coverage and wage increases. In 2007 the SEIU began pushing for a law that would increase training requirements.

That didn't succeed. However, Gregoire and the Legislature created a task force to figure out what, if any, training changes were needed.

Although there are many categories of long-term caregivers, the task force focused on those who work in adult family homes, boarding homes or assisted-living facilities and those who work in private homes. About 35,000 of these workers are union members. About 20,000 people enter the field each year. (Other types of caregivers, such as people who work in nursing homes, are covered by separate regulations.)

It quickly became clear that consensus would be difficult. There are long-term-care workers who care for dementia patients and those who care for people with paralysis. There are those whose patients have complex medical histories and clients who just need help with meals and dressing. There are those who care only for family members and those who view caregiving as a career.

Each of them wanted something different, and the task force couldn't agree on specifics. In general, they favored a two-tiered system: Basic training, covering issues like infection control and patient rights, would be required for all.

Additional training, and certification, would be offered for those who wanted more. The idea was to create a career ladder, so that certification could count toward becoming, for example, a nursing assistant.

In early 2008, state Rep. Dawn Morrell, D-Puyallup, co-chair of the task force and a nurse herself, sponsored a bill along those general lines: 35 hours of required classroom training, with an optional 50 hours for certification.

The bill went through numerous revisions. In the end the union was not satisfied, and the bill never was brought up for a final vote.

"What [the Legislature] had pretty much was a neutered bill," said Jeff Parsons, campaign manager for Yes on 1029.

"The SEIU was working the door to defeat it," Morrell, generally a union supporter, said. "No one was more disappointed than me."

I-1029 was the direct result of that failure. Nearly all $699,000 in cash and in-kind contributions have come from the SEIU.

Critical, or just costly?

The initiative would require new long-term-care workers, with some exceptions, to undergo 75 hours of training and pass a test. In addition, caregivers would be required to pass a nationwide FBI background check.

Supporters say more training would help professionalize a workforce in a field that doesn't always get respect.

"It gives them an opportunity to say, 'I am a professional,' " Parsons said.

He added that the union wants community colleges to allow the new training hours to count as credits toward becoming, for example, a certified nursing aide.

Supporters say that the initiative will attract more workers to the field and entice them to stay in their jobs longer.

"Training really is critical for home-care workers, in part because they have to act very independently," said Nancy Dapper, executive director of the Alzheimer's Association for Western and Central Washington.

She points out that Washington's system is somewhat unique because people who are ailing have more opportunities to stay in their own homes, or in homelike settings, rather than going into nursing homes. The result of that progressive ideal, however, is that some community caregivers perform services on par with those performed in nursing homes, even though they get half as much training.

"We have to catch the training system up to work with that," Dapper said.

Opponents, like Deb Murphy, CEO of Aging Services of Washington, said the initiative may seem like "motherhood and apple pie," but it wouldn't improve quality of care even as it increases costs.

While training hours would be doubled over the current requirement, the new curriculum would cover largely the same topics, Murphy said. And unlike Morrell's bill, which gave caregivers an option of receiving further training in specialty areas, Murphy says that certain topics, like dementia care, will be included regardless.

"You shouldn't have to sit through training, and taxpayers shouldn't pay for training, that is irrelevant to the person being cared for," Murphy said.

"The bottom line is we don't need this. It's not going to improve the quality. It's going to cost taxpayers and private-paying people millions of dollars," she said.

Families worried

Some opponents worry about the union's control. The state pays to train workers who care for Medicaid patients — that's where the $30 million tax bill comes in. Many of these caregivers are union members.

Last year, the state agreed to fund a trust, co-managed by the union, to run union workers' training. The more hours of training required, the more money goes into this fund, Murphy pointed out. She sees I-1029 as a union-recruiting tool, although the union says that wasn't its intent.

The cost of training nonunion caregivers — about 26,000 new workers per biennium — would be borne by operators of adult family homes, boarding homes, care agencies and probably the patients themselves. Employers also would pay the worker his or her wage while attending training, plus the wage of a substitute caregiver while the trainee is in class.

Families who care for disabled loved ones are perhaps the most worried, even though they wouldn't have to complete as many training hours as the others. Many are insulted that, after caring for their disabled children for years, they are being told they need more training.

They say they already have enough trouble finding fill-in care when they need a night off. Often, they'll get trusted friends to do the job. But under the initiative, the trusted friend would need to have amassed many hours of training. How realistic is that?

In fact, many opponents believe requiring this much training would exacerbate the shortage of long-term-care workers by making it more difficult to get into the field.

"One-size-fits-all just doesn't make sense," Morrell said. "This is just too complicated of an issue to be deciding by initiative."

Maureen O'Hagan: 206-464-2562 or mohagan@seattletimes.com