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Northwest Voices

Seattle Times letters to the editor

October 8, 2008 at 4:10 PM

Initiative 1029: training for caregivers

Just doesn’t make sense

Maureen O’Hagan’s story on I-1029 [“Initiative would require more training for caregivers,” page one, Oct. 6] was spot on in explaining the problems with the Service Employees International Union’s costly and unnecessary initiative to more than double training requirements for a broad range of caregivers for the elderly and disabled. I would like to elaborate on a couple of points touched on in her article.

First, the $29.7 million estimated cost in the first biennium is only the tip of the iceberg. Among the many costs not included in this number is the cost to taxpayers for the FBI background checks, for which the FBI charges $85.

So with 20,000 new caregivers each year and assuming that employers hire two out of every three applicants, taxpayers can expect to fork over $2.5 million to the FBI each year.

All of these background checks — including those for private agencies, homes and facilities — would be funneled through the Department of Social and Health Services, which means we would need a new bureaucracy there just to process all the paper. DSHS would pay the FBI and could not pass the costs on to the applicants or employers.

The FBI checks can take six to eight weeks, leaving applicants in limbo longer than most would tolerate. This mess would degrade current practice at many agencies that already conduct 50-state background checks through private services that are quick, reasonably priced and far more complete and accurate than the FBI database.

Second, the comments by Nancy Dapper of the Alzheimer’s Association for Western and Central Washington are not accurate. She says that Washington is “somewhat unique because people who are ailing have more opportunity to stay in their own homes” rather than go into nursing homes.

In fact, home-care agencies throughout the country, and in many other countries, are caring for seniors with Alzheimer’s disease and other forms of dementia in their homes in large and growing numbers. There is nothing unique about Washington.

Dapper goes on to say that as a result of the move toward more home-based care, caregivers are increasingly performing services on a par with those performed in nursing homes. This is simply false. Home-care agencies are strictly nonmedical and are not licensed to provide the complex medical services available from skilled nurses in nursing homes.

Alzheimer’s sufferers can receive a wide range of nonmedical care at home, including assistance with activities of daily living such as dressing, bathing and toileting.

Home-care agencies train their caregivers on these services today. Extending the training to include services on a par with those performed in nursing homes would require home-care agencies, and ultimately their clients, to pay for training they would be prohibited from using under their license.

The cost of care would increase with no benefit to the clients — exactly the point made by Deb Murphy of Aging Services of Washington.

— Tom Boughner, Sequim

Let’s consult the money tree

Our seniors’ wisdom and knowledge is the foundation for our families and communities. Should we deny them the compassionate care they deserve?

One of the initiatives on the November ballot is I-1029, the “training initiative” for all long-term care workers. It mandates new requirements for the hiring (FBI background checks), training (75 hours) and certification of a broad range of caregivers. Sounds like a great idea, right? Wrong.

Here’s why:

The reality is I-1029 will harm both seniors and compassionate caregivers receiving and providing care services. Our company hires and trains caregivers to provide nonmedical home care to our greatest generation.

Training costs money, and for seniors who don’t qualify for public assistance, those costs are ultimately passed on to them. The whole idea of nonmedical home care is to provide seniors and their families an affordable alternative to home health care when all they need to stay in their homes is help with household tasks and perhaps some personal care. We already provide targeted training for these nonmedical skills, and we do it efficiently to keep our fees reasonable.

We also provide supervision available to our caregivers 24/7. Should they encounter a situation they need help with, our staff is on-call and available to help. The added training required by I-1029 is not specific to the services we offer. It’s a one-size-fits-all course including skills our caregivers could never use with our clients, such as caring for disabled children.

Our clients’ fees would increase by about 25 percent because of this training.

I-1029 would make home care less available.

Requiring 75 hours of training will create a barrier to thousands of entry-level caregivers who just want to help seniors but don’t want to spend two weeks in a classroom to qualify. If thousands of workers are eliminated from our care-delivery system at a time when the need is rapidly increasing, who will care for our seniors?

The provision for FBI background checks would degrade our current hiring practices. We already do a 50-state background check derived from court records, which are far more complete and accurate than the FBI database. Also, the FBI background check process takes weeks and is much more costly.

I-1029 would hurt all of us as taxpayers. With the nation facing a financial crisis and with the state facing a projected $3.2 billion budget shortfall, I-1029 would create a new state bureaucracy at a cost of at least $30 million in the first two years.

I-1029 would, however, benefit one group: union bosses at the Service Employees International Union.

Their Local 775 sponsored the initiative, and they wrote themselves into the bill by requiring that they do much of the training.

We strongly urge your readers to reject I-1029 by voting “no” this November.

— Kelly Cavenah, Olympia

There’s nothing wrong with more training

Concerning Monday’s story by Maureen O’Hagan, we believe there is more that has been left unsaid.

First, this initiative has strong support and should not be dismissed as just a union effort. The SEIU [Service Employees International Union] may be the financial arm, but there is a long list of supporters. This initiative is good public policy.

Second, the issues addressed by I-1029 are not new.

In 2000 the Washington State Long-term Care Ombudsman Program authored a report on the failures in the community-caregiver system. A key recommendation was to establish a certification mechanism for community-based caregivers — those who work in boarding and adult family homes. That certification was patterned closely after the one that now applies to aides who work in nursing homes and hospitals.

The substance of I-1029 is a compromise that we can support even though it may fall short of the ideal.

It addresses background checks, training and certification in a uniform way that treats Medicaid and private-pay providers the same way.

The curriculum will be relevant to the adult learner and flexible.

It allows providers to offer their own training curriculum as approved by DSHS [Department of Social and Health Services]. Nothing in I-1029 would prevent part of the training hours to be supervised on-the-job training. I-1029 is not one-size-fits-all as opponents argue.

Yes, $30 million is a lot of money, but it is less than one-half of 1 percent of the total Medicaid budget for the state. And, it is cheaper than the millions of dollars in lawsuits that DSHS has paid out for failures in our long-term-care system.

It is interesting that opponents of I-1029 made many of the same arguments in 2000 when the training standards were increased from 22 to 34 hours. They said it was too costly, inflexible and would put them out of business.

They were wrong then and they are wrong now.

I-1029 is a wise investment in the future of Washington’s long-term-care system, and is not one that we can afford to postpone.

–Nancy J. Dapper, Seattle

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