Home Care Aide Certification. A long-term care worker is a 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. The term excludes employees of several types of health care and residential care facilities, as well as care providers not paid by the state or a private agency or facility licensed by the state.
Most long-term care workers must become certified as home care aides within 200 days of being hired by Department of Health (DOH) unless an exemption applies. 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.
Certified Nursing Assistant Certification. DOH issues credentials to nursing assistants at two levels—registered nursing assistants and certified nursing assistants (CNAs). A person may become a registered nursing assistant by submitting an information form to DOH and paying a fee. To become a CNA, a person must complete an approved training program or alternative training program that meets the Nursing Care Quality Assurance Commission's criteria and complete a competency evaluation. The curriculum for CNA training programs, other than an alternative training program, must be competency based and include a minimum of 85 hours total, with at least 35 hours of classroom training and at least 50 hours of clinical training.
State Auditor's Office. The Office of the Washington State Auditor (SAO) holds state and local governments accountable for the use of public resources. The state auditor has the power to examine the financial affairs of all governments in the state, including local governments, schools, state agencies, and institutions of higher education. SAO carries out special investigations and performance audits of state agencies and local governments, and may contract with certified public accountants to audit state agencies and local governments.
Performance Audits of Long-Term In-home Care. The state auditor is required under Initiative 1163, approved by the voters in November 2011, to conduct performance audits of the long-term in-home care program on a biennial basis. In September 2022, SAO published a performance audit report on addressing testing barriers for home care aides. The audit found that prospective home care aides still face a number of barriers to becoming certified including long delays between completing training and taking the test, as well as the number of regional test sites dropped 20 percent since the previous SAO performance audit in 2016.
The audit recommends the Legislature give DOH similar authority and discretion in testing home care aides as the Nursing Commission has for testing CNAs. Other recommendations include ways to address delays between training and testing, the lack of test sites, and gaps in performance and contract management. The audit found that concrete steps such as establishing more test sites and reducing delays between the completion of training and scheduling a certification test would result in a greater number of qualified home care aides available in communities across Washington State.
DOH is required to either prepare, grade, and administer, or determine the nature of and supervise grading and administration of a home care aide certification examination to evaluate whether an applicant possess the skills and knowledge necessary to practice competently. Other specific requirements for testing and certifying home care aides are removed from statute.
DOH, in consultation with Department of Social and Health Services (DSHS) and other relevant participants, must devise a system to reduce delays between training and testing for home care aides that include:
DOH, in consultation with DSHS and other relevant participants, must examine existing challenges related to a lack of testing sites and develop a plan expanding testing sites with a cost estimation included. The plan must consider:
DOH, in consultation with DSHS and other relevant participants, must establish performance-based contracts for vendors who administer the tests that include all key performance measures expected and detailed vendor costs. The key performance measures expected must include a definition of what sufficient access to test sites entail.
A preliminary report on this work from DOH, in consultation with DSHS and other relevant participants, is due to the Governor and appropriate committees of the Legislature no later than December 1, 2023, and a final report is due no later than June 30, 2024.
PRO: The lack of test sites is a big issue and in the past few years, there has been a decrease in test sites. For applicants seeking certification, there is a significant investment in time and having to incur additional expenses to travel for their test. It is discouraging. The longer wait time between when an applicant completes training and testing, can result in lower scores and decreasing chances of passing the test. There are issues trying to navigate the challenges of scheduling the test and since applicants cannot choose their test dates, they receive an email with their test date at least 2 weeks in advance. This is not enough time to change shifts or take the time off needed to travel and take the exam. It would be helpful if applicants can submit for testing when signing up for training. These are common sense recommendations. If enacted, the bill will expedite the process for home care aides to train, test, and receive their certification and also, help to turn around the declining numbers of certified home care workers. There is a concern that if training schools are allowed to test, there should be a vetting policy to assure that they have a valid testing and training process.
OTHER: Home care aides are a critical component to the health care workforce and the home care aide workforce is facing a critical shortage. Complicated testing requirements, timelines, and costs are significant barriers to workers wanting to enter and remain in this field. The bill will make an immediate impact on testing delays by removing the requirement to complete training before registering to take the test. There are critical recommendations that should be implemented such as allowing remote knowledge testing, shortening the window for when people complete training to when they can be tested, and allowing people to choose their test dates. There is a request to extend timelines by 6 months for completing the work and submitting the required reports. For any new testing or training site that is established, there needs to be regulations in place and agency oversight to ensure the sites are meeting the standards and people are receiving the types of training that they need. Also, there are changes in the bill that do not solve the problems facing the workforce and could undermine the quality of the home care system. There should be great care to not make the mistake of removing parts of the state law that provide critical protections for consumers in trying to solve the barriers to testing.