I.  Long-Term Care Workers.
 
A long-term care worker is any person who provides paid, hands-on personal care services for the elderly or persons with disabilities, including individual providers of home care services, direct care workers employed by home care agencies, providers of home care services to people with developmental disabilities, direct care workers in assisted-living facilities and adult family homes, and respite care providers.
 
A.  Background Checks.
 
All long-term care workers must be screened through state and federal background checks to verify that they do not have a history that would disqualify them from working with vulnerable persons.  The background checks include a check against the National Sex Offender Registry and fingerprint checks through the Washington State Patrol and the Federal Bureau of Investigation (FBI).
 
B.  Training Standards.
 
Most long-term care workers must meet minimum training requirements within 120 days of their hiring date.  The training must be at least 75 hours in length, at least five of which must be completed before the worker may provide care.
 
C.  Home Care Aide Certification.
 
Most long- term care workers must become certified as home care aides within 200 days of being hired.  To become certified as a home care aide, a long-term care worker must complete 75 hours of training, pass a certification examination, and pass state and federal background checks.
 
II.  Long-Term Care Facilities.
 
The Department of Social and Health Services (DSHS) licenses four primary types of residential long-term care settings:  nursing homes (sometimes referred to as skilled nursing facilities); assisted living facilities; adult family homes; and enhanced services facilities.  These facilities are subject to a variety of requirements, including requirements relating to staffing, training, and inspections.
 
III.  Nurse Delegation.
 
A registered nurse may delegate certain tasks within the nurse's scope of practice.  When delegating a task, the nurse must determine the competency of the individual to perform the tasks, evaluate the appropriateness of the delegation, and supervise the actions of the person performing the delegated task.  Registered nurses may only delegate the administration of medications in enumerated circumstances, including in home health or hospice agencies or in community-based care settings.  When delegating insulin injections, the registered nurse must supervise and evaluate the person performing the delegated task weekly during the first four weeks and at least every 90 days thereafter.
 
IV.  Nursing Assistants.
 
A nursing assistant is a person who assists in the delivery of nursing and nursing-related activities to patients in a health care facility.  Nursing assistants work under the direction and supervision of registered nurses or licensed practical nurses. 
 
A nursing assistant working in a nursing home must either be certified through an approved training program within four months of the date of employment or complete alternative training and a competency evaluation prior to employment.  A nursing assistant must be allowed to take the competency evaluation if he or she is a home care aide or a medical assistant and successfully completed 24 hours of training approved by the Nursing Care Quality Assurance Commission. 

I.  Long-Term Care Workers.
 
A.  Background Checks.
 
The DSHS may require a Washington State Patrol or FBI background check at any time.  The DSHS must adopt rules regarding long-term care workers employed on a conditional basis pending the completion of a background check.  A long-term care worker who has not been disqualified by the state background check may continue to work and have unsupervised access to vulnerable adults pending completion of the FBI fingerprint check. 
 
The requirement that the DSHS check a long-term care worker against the National Sex Offender Registry is eliminated.
 
The changes to background check requirements are intended to apply retroactively to February 29, 2020.
 
B.  Training Standards.
 
If a pandemic, natural disaster, or other declared state of emergency impacts the ability of long-term care workers to complete required training, the DSHS may adopt rules allowing the workers additional time to complete the training.  This requirement applies retroactively to February 29, 2020, to include the period of the state of emergency created by the COVID-19 outbreak.
 
C.  Home Care Aides.
 
The Department of Health (DOH) may adopt rules determining under which circumstances a long-term care worker may have more than one hire date, restarting the worker's 200 day period to be certified as a home care aide.
 
If a pandemic, natural disaster, or other declared state of emergency impacts the ability of long-term care workers to become certified as home care aides, the DOH may adopt rules allowing the workers additional time to become certified.  This requirement applies retroactively to February 29, 2020, to include the period of the state of emergency created by the COVID-19 outbreak.
 
 
II.  Long-Term Care Facilities.
 
Certain regulatory requirements are altered during a pandemic, natural disaster, or other declared state of emergency:

• Inspection Periods:  If the pandemic, disaster, or emergency prevents the DSHS from completing required inspections of long-term care facilities, the DSHS must adopt rules to reestablish inspection timelines based on the length of time since the last inspection, compliance history, immediate health or safety concerns, and federal Centers for Medicare and Medicaid Services requirements.
• Staffing Standards:  If the pandemic, disaster, or emergency prevents a nursing home from complying with minimum staffing standards, the DSHS may adopt rules to grant exceptions, waive penalties, and suspend oversight requirements.  The exceptions, waivers, and suspensions do not apply to the requirement that the nursing home have staff on duty 24 hours daily in sufficient numbers and qualifications to carry out its legal responsibilities.   
• Training Requirements:  If an event such as a pandemic or natural disaster creates a state of emergency that makes specialty training unavailable, the DSHS may adopt rules allowing an adult family home or assisted living facility where the staff have not completed specialty training to admit or care for a resident with special needs relating to mental illness, dementia, or a developmental disability.  The rules must include information on how to complete the training once it is available. 

 
The altered regulatory requirements apply retroactively to February 29, 2020, to include the period of the state of emergency created by the COVID-19 outbreak.
 
III.  Nurse Delegation.
 
A registered nurse may delegate glucose monitoring and testing to a registered or certified nursing assistant or a certified home care aide.
 
The specified frequency with which a registered nurse must supervise and evaluate a person to whom the nurse has delegated insulin injections is eliminated.  Instead, the supervision and evaluation is governed by requirements and determinations by the Nursing Care Quality Assurance Commission (NCQAC). 
 
The requirements relating to nurse delegation apply retroactively to February 29, 2020, to include the period of the state of emergency created by the COVID-19 outbreak.
 
IV.  Nursing Assistants.
 
A nursing assistant who has not completed alternative training and a competency evaluation prior to employment, must complete approved training and a competency evaluation within a period of time determined in rule by the NCQAC, instead of within four months after the date of employment. 
 
The amount of alternative training a nursing assistant must complete is changed from 24 hours to at least 24 hours. 
 
The requirements relating to nursing assistants apply retroactively to February 29, 2020, to include the period of the state of emergency created by the COVID-19 outbreak.
 
V.  Rulemaking.
 
In any instance where the bill grants rule making authority to the DSHS or the DOH, the agencies may adopt the rules as emergency rules and may make the rules retroactively effective.