Several Inland Northwest agencies in the long-term care industry are concerned about potentially negative and lasting effects of new training rules for home-care aides.

Last fall, Washington state voters approved Initiative 1163, which upped the number of required training hours, added criminal background checks, and created state-certification requirements for that group of care providers.

The new rules went into effect Jan. 7, and home-care agencies here say they are now seeing early signs of what could be permanent hurdles to people looking to enter the home-care industry.

Home-care aides typically provide assistance with daily-living tasks and often provide companionship to seniors who are still able to live at their home, but might need help with light housework, meal preparation, or need to be driven to medical appointments.

Donna Goodwin, chief clinical officer with Liberty Lake-based Family Home Care & Hospice, which has three offices in the Inland Northwest and employs an estimated 450 people, is one of those concerned about the new law's impacts.

Goodwin says she believes the more stringent rules for training home-care aides not only will cost agencies like hers more money—and ultimately consumers and the state—but also don't take into account the more specific needs of many of the clients that such agencies serve.

"The training requirements aren't tailored to meet the vast needs of patients," Goodwin says. "It's important to emphasize the variation in the type of services that in-home agencies can provide, from someone who needs help with everything, or as little as light housekeeping, picking up prescriptions, or driving clients to the doctor's office."

Because the law requires new home-care aides to finish training within 120 days of being hired, and pass a state certification test within 150 days of being hired, Goodwin estimates that agencies like hers might annually bear between $15,000 and $20,000 in additional costs to train such employees. Starting pay for home-care aides is around $10 an hour, she says.

"One thing I want to emphasize is that we're very pro-education at Family Home Care," Goodwin says. "We believe that the solution is not a 100-page rule on training, but supervision and on-the-job training. That is key to make sure you have quality care out there. This is entry-level care—limited personal care—and we want people to be safe, but this might have been overshooting it a bit."

Goodwin says that if a home-care aide was actively employed by an agency in 2011, that person was grandfathered into the system and doesn't have to take the additional hours of training.

She says the increased training hour provision of the measure does apply, though, to home-care workers who weren't working in the industry last year, but still had some prior experience in that field.

"Even if someone has 15 years of experience, they have to do those extra hours" if they weren't working in the field last year, she says.

She says that home-care aides often perform similar duties to those performed by certified nursing assistants, or CNAs. However, because of the more in-depth training that CNAs must receive to become certified, they can work in a variety of long-term care settings, such as skilled-nursing facilities, retirement homes, and hospitals.

Home-care aides, on the other hand, usually work in one of two settings—in the home of a senior and employed by a home-care agency, or in an adult family home, which is a smaller-sized facility that houses no more than six residents who may need around-the-clock assistance and supervision.

The state training requirement for a CNA is 85 hours, and Goodwin says that because of the expanded care responsibilities those workers are allowed because of their training, Family Home Care tries to hire mostly CNAs versus home-care aides. CNAs typically start out making several more dollars an hour than home-care aides, depending on the type of facility they're employed at.

"We are working hard to hire people that we won't have to incur the cost of training, but we're not sure how long that will last," Goodwin says. "It might happen that we run out of CNAs and then we have to train home-care aides, and that is when the big cost will come in."

Goodwin says that I-1163's language is similar to the wording of Initiative 1029, which was approved by voters in 2008, but that wasn't set to go into effect until January 2014.

Both initiatives proposed to increase the number of state-required training hours for home-care aides from 34 hours to 75 hours, and also sought to add criminal background checks for such workers, along with adding a certification examination.

Michael Godek, president of Spokane Valley-based Senior Helpers, an in-home care agency that employs both home-care aides and CNAs, says that while I-1029 passed in 2008, it was an unfunded mandate and the changes in it later were thrown out.

Godek says the more recently passed measure, I-1163, was sponsored by the Service Employees International Union, based in Washington, D.C., which he believes will be administering some of the new training courses for home-care aides in Washington state.

Godek echoes many of the concerns of Family Home Care's Goodwin, and he says he also feels that the increased training requirements eventually will deplete the pool of people who might choose to go into the field of caregiving.

"They have raised the price overall by passing this initiative," Godek says. "It lessens the pool of caregivers, and people are put out of work by doing this. I haven't been able to employ people because even if they have practical experience working in the field, and now they want to work as a caregiver, they don't have the $750 it now costs to become a caregiver."

Jennipher Ama, president of Family First Senior Care, another Spokane-area home-care agency, located at 521 N. Argonne in Spokane Valley, says she's also worried that the new rules, over the long run, are going to reduce the number of people interested in becoming home-care aides.

"The testing is overwhelming. It's actually reducing the number of people who can be caregivers or who choose to look into the field," Ama says. "We have a lot of people going through training now, but we are seeing that the number of potential caregiver applicants has dropped because they aren't willing to do what it takes to get the home-care aide certification."

Right now, she says her agency employs around 60 home-care aides.

To teach its new hires, Family First Senior Care is using an online-based training company that's had its curriculum approved by the state, Ama says. She estimates the cost to train its new home-care aides ranges between $500 and $600 per person.

"We are helping people through it and we are hiring and people are saying, 'Oh wow, you are hiring someone who hasn't been through the training?'" she says. "There is no way we can't add costs to consumers—that is what will need to happen."

Godek says the new law has created somewhat of a catch-22 situation for both home-care agencies needing to hire and caregivers who weren't grandfathered in.

He says that some agencies here plan to take on the training of newly-hired home-care aides, like Family First Senior Care is doing, while others just won't hire people who don't meet the new requirements because of the expense to train them, he says.

"There's a missing piece here because some of these caregivers who work for specific agencies, a large majority of them are transient and maybe they worked for one agency, but their client dies and then they aren't getting any hours," Godek says. "Then they leave and go to a different agency, so it's like a wave in the sea—caregivers come and go, and so I can understand that it's difficult for a caregiving agency that might not want to put money into a caregiver, because if they aren't already trained, they won't get hired."

Not only did I-1163 increase the number of training hours needed to become a certified home-care aide, it also implements new, continuing-education hours that must be completed by such workers each year, says Goodwin. She says agencies now must provide 12 hours of such training annually.

"Normally, that's not difficult for most agencies to meet. However, the state Department of Social and Health Services has said that all continuing-education offerings have to be approved by them, and we have run into snags with them approving things," Goodwin says. "That is a function of this rule that is so unwieldy, because I'm not sure the state agencies were prepared for what it is to entail."

Family First Senior Care's Ama says her agency already had been providing continuing-education courses to its employees, but now is just waiting to see if DSHS approves the material it's using because of the new law.

For long-term care workers looking to take the additional training courses needed to become state-certified home-care aides, CNA Schools NW LLC, a vocational school that opened here a little more than a year ago, soon will begin offering home-care aide training courses, says its president Jim Byrnes.

Byrnes says the online-based curriculum CNA Schools NW will use to train people to become home-care aides already has been approved by DSHS.

He says students will learn the majority of the material on their own time, but also will be required take 16 hours of in-person training broken up into four four-hour segments to learn hands-on skills at the school's facility here, located at 1817 E. Springfield.

The overall course is three weeks long, he says, and it costs $350, compared with $750 for CNA Schools NW's certified nursing assistant program.

Byrnes says the school is encouraging anyone interested in taking the home-care aide training program to think about taking the CNA training sessions instead, because the training required to test to become a CNA is only 10 hours more than for a home-care aide.

While the vocational school's CNA course also costs $400 more than the home-care aide training, Byrnes asserts that because of the expanded employment opportunities for someone who's a CNA, the chances to advance and attain a higher salary also are much better.

Byrnes says that if demand grows for CNA Schools NW's new home-care aide course, the school might consider offering in-person classes.