Background: Home care is a nonmedical service provided to individuals needing assistance with various tasks such as toileting, bathing, dressing, and meal preparation to remain living in their own home. Clients may receive home care from an individual provider or from an employee of a home care agency. Individual providers (IPs) providing Medicaid funded home care services are jointly employed by the state and client. The legislature passed a law in 2018, that requires the Department of Social and Health Services (DSHS) to contract with a Consumer Directed Employer (CDE) to act as the legal employer for IPs by July 1, 2021. Under the CDE, the client is the managing employer and has the primary right to select, dismiss, assign hours and supervise the work of their IP.

Federal law and the Washington Law Against Discrimination (WLAD) prohibit discrimination in employment based on race, creed, color, national origin, sex, marital status, age, disability, retaliation, sexual orientation, gender identity, honorably discharged veteran or military status, or use of a trained dog guide or service animal by a person with a disability. WLAD is administered by the Washington State Human Rights Commission (HRC). The HRC investigates complaints alleging unfair practices in violation of the WLAD. If the HRC finds there is reasonable cause to believe discrimination has occurred, it must first try to eliminate the unfair practice via conference and conciliation. If the parties do not reach an agreement, the HRC must refer the matter to an administrative judge for a determination. In 2019, the Legislature passed a law requiring employers of certain isolated workers to adopt a sexual harassment policy, provide mandatory sexual harassment training, provide a list of resources to employees, and provide a panic button to each isolated worker. The law does not include home care workers.

Summary of Bill (First Substitute): Policy. Home care agencies and the CDE must adopt and maintain a comprehensive written policy about how they will address instances of discrimination abusive conduct, and challenging behavior by July 1, 2021. Abusive conduct includes workplace aggression, workplace violence, aggravated workplace violence, physical sexual aggression, rape, attempted rape, sexual contact, sexual harassment, workplace verbal aggression, or inappropriate sexual behavior. Discrimination includes existing prohibited practices and discriminatory harassment, but does not include a client refusing to hire or terminate an employee based on gender preferences. Challenging behavior is behavior by a service recipient that is caused by or related to a disability that might be experienced by the employee as offensive or presenting a safety risk. The policy must:

define discrimination, harassment, abusive conduct, and challenging behavior;
describe the types of discrimination and abusive conduct covered by the policy;
identify multiple people to whom an employee may report discrimination, abusive conduct, and challenging behavior;
include permission and a process allowing workers to leave situations where they feel their safety is at immediate risk;
include prohibition against retaliation and describe how the employer will protect employees against retaliatory behavior;
provide resources for a worker to utilize; and
include any additional recommendations from the training work group convened by DSHS.

The employer must review and update the policy annually, and ensure that all employees are aware of the policy. The policy must be disseminated to each employee at the beginning of employment, annually, and when substantive updates occur, posted in prominent locations at the place of business, and available in English and the top three languages spoken most by long-term care workers in the state.

Prevention Plan. Beginning July 1, 2021, home care agencies and the CDE must implement a plan to prevent and protect employees from abusive conduct, assist employees working in environments with challenging behavior, and work to resolve issues impacting the provision of personal care.

A workplace safety committee consisting of employee-elected individuals, employer-selected individuals, and at least one service recipient representative, must develop and monitor the plan. A labor management committee established by a collective bargaining agreement that receives formal input from representatives of service recipients who wish to participate in the committee's deliberations is sufficient to fulfill the requirement for a workplace safety committee. The plan should be reviewed and updated as necessary, at least every three years, and must be adjusted based on the work place safety and employer's annual review of incidents of discrimination and abusive conduct in the home care setting.

The plan must include processes for intervening and assisting employees affected by challenging behaviors and abusive conduct, engaging appropriate members of the care team when allegations of discrimination, abusive conduct, or challenging behaviors occur and engaging the service recipient in problem resolution.

In developing the plan, the employer must consider any guidelines on violence in the workplace or in health care settings issued by the Department of Health (DOH), DSHS, L&I, the federal Occupational Safety and Health Administration, and the training work group convened by DSHS.

Informing Workers. Prior to assigning an employee to a service recipient and throughout the duration of service, home care agencies and the CDE must inform employees of instances of discrimination and abusive conduct occurring in, or around the service recipient's home care setting, if those incidents are documented by the employer or DSHS. Prior to assigning an employee to a service recipient, home care agencies and the CDE must inform employees of a service recipient's challenging behavior that is documented in the service recipient's care plan, by the employer, or by DSHS and communicated to the employer. Home care agencies and the CDE may not terminate, reduce pay, or not offer future assignments to an employee for requesting reassignment due to alleged discrimination, abusive conduct, or challenging behavior.

Recordkeeping. Home care agencies and the CDE must keep a record of any reported incidents of discrimination or abusive conduct experienced by an employee while providing home care services. The records must be kept for at least five years and made available for inspection by L&I. If the employer makes its records available to the exclusive bargaining representative representing the employer's employees, the exclusive bargaining representative my assess whether the employer is meeting the data collection requirements. L&I must take into consideration this assessment when determining compliance with recordkeeping. The records must include certain information about the incident including:

the employer's name and address;
the date, time, and location of where the incident occurred;
the reporting method;
the person who experienced the act;
a description of the person committing the act and the type of act; and
a description of the actions taken by the employee and employer in response to the act and how the incident was resolved.

Training Work Group. DSHS must convene a stakeholder work group recommending policy changes and best practices for training employers, long-term care workers, and service recipients to keep home care settings free from discrimination and abusive conduct while maintaining the ability for individuals who need services to access these services and maintaining the ability to provide services. The work group must include:

representatives from DSHS, L&I, HRC, home care agencies and the CDE, labor organizations representing employees, disability advocacy organizations, and area agencies on aging;
organizations with at least five years of experience training at least 10,000 long-term care workers;
service recipients;
a family member or guardian of a service recipient;
the self-advocacy community; and
subject matter experts deemed necessary by the work group.

The work group must report its training recommendations to the Legislature by December 1, 2021.

Enforcement. L&I is authorized to investigate home care agencies and the CDE to ensure compliance with the policy, prevention plan, informing workers, retaliation, and recordkeeping requirements. Employers that are found to be non compliant by L&I, must be subjected to citations under the Washington Industrial Safety and Health Act.

EFFECT OF CHANGES MADE BY HEALTH & LONG TERM CARE COMMITTEE (First Substitute):

Modifies the intent section.
Defines challenging behavior and it excludes it from the definitions of abusive conduct, discriminatory harassment, inappropriate sexual behavior, physical sexual aggression, sexual contact, sexual harassment, workplace physical and verbal aggression and workplace violence.
Modifies the effective date, distribution requirements, and minimum content requirements for the covered employers' written policy and prevention plan.
Modifies the instances in which covered employers must inform employees of discrimination, abusive conduct and challenging behavior occurring in the home care setting.
Removes the requirement that the covered employer report certain information about incidents of abusive conduct and discrimination to L&I and that L&I make this information available to the public.
Directs DSHS to convene the stakeholder work group instead of L&I, and modifies the work group members, report due date, and items the work group may consider in developing their training recommendations.
Specifies L&I enforcement duties; removes the civil penalty and instead subjects the covered employer to citation under the Washington Industrial Safety and Health Act.
Adds a severability clause.

Staff Summary of Public Testimony on Original Bill (Health & Long Term Care): The committee recommended a different version of the bill than what was heard. PRO: A tragedy occurred where an individual shot their former caregiver and their new client. This bill is aimed at protecting in-home care workers and equipping them with the tools to prevent violent situations. It will make the care environment safer for the caregiver and the people they care for. Caregivers face harassment and discrimination and are scared to report these instances in fear of retaliation. They are often women and people of color, and isolated. They do not have co-workers they can frequently check-in with. People that come into the client's home, frequently such as neighbors or other family members, are often the ones that are abusing the caregiver. When this happens the caregiver does not have a resource to assist them. The HRC and EEOC complaint process takes time, the DSHS case manager is only responsible for protecting the client, and APS does not have a mechanism for caregivers to report when they have been put in danger. Caregivers that are exposed to abuse, harassment, and discrimination can experience negative health outcomes and may leave the profession. This bill focuses on prevention and offers real solutions. It was crafted with significant input from caregivers, self-advocates, and the aging and disability communities, and we are committed to working with stakeholders to make the care environment safer for everyone.

CON: The bill does not recognize the power dynamics between the caregiver and the client and would negatively impact individuals with disabilities that struggle with communication. Often individuals with disabilities are mistakenly seen as violent when they struggle to communicate their needs. The union should create training on how to better support individuals in crisis that does not include the caregiver abandoning the client. The bill's reporting requirements could violate the client's privacy and the language about the non-malicious and malicious violence is too vague. The bill should be broadened to include all groups involved in the caregiver setting.

OTHER: Safety of the in-home care environment is a critical issue but the focus should be on the safety of the client. There is a power dynamic between the clients and caregivers. The bill will make it hard for individuals with developmental disabilities to receive care, and the proposed solutions proposed do not adequately address the problem. Who is responsible for enforcing the requirements, is there an option to include the training in the existing 70 hour training requirements, and would SB 6169 be a better vehicle to address these concerns? L&I provided stakeholders with language for some clarifications regarding the definitions, and how civil penalty funds could be used and where they would be deposited. The number of people that will need services in their home will double in the next couple of decades, and adequate workforce is needed to address this. There are concerns about the tone of the bill, definitions, potential client abandonment, client privacy, and reporting requirements. DSHS should convene the work group rather than L&I, and it should include advocates and self-advocates receiving DDA services.