Washington Initiative #1029: Homecare Workers

AIR DATE: Wednesday, October 1st 2008
What training should be required to be a homecare worker?

I often wonder what might happen if one my parents became incapable of taking care of themselves. Would I -- could I -- stay home and provide care for them? In Oregon the answer would probably be yes. At least that is what Beverly Mackey did when her daughter became gravely ill with a kidney disease. When her daughter could no longer take care of herself, Mackey registered with the state to be a homecare worker. The process took about six weeks. Now, six years later, her daughter has had a kidney transplant and is doing much better. Mackey, meanwhile, continues as a homecare worker for other people in need of comfort. She cooks their meals, takes them to the store, cleans their bathrooms, and rubs cream into their dry skin. And the state pays her to do it (and gives her medical benefits).

In Oregon you have to pass a criminal background check to register with the state as a homecare worker, but there isn't any mandatory training. There are plenty of classes available for people to attend (and you even get paid to go!).

In Washington homecare workers deal with a different system. And a change to that system is on the ballot in Washington this fall. Supporters of Initiative #1029 want the number of hours of training for home care workers to increase from 34 to 75 hours. They also want to require federal criminal background checks (there are currently state checks) for all homecare workers. The opposition argues that the Initiative will cut jobs and deplete the pool of qualified workers.

Are you homecare worker? What training did you receive? How much did you need? How prepared did you feel to care for your patient? Do you receive homecare services? What background or education do you want your providers to have? Whether in Oregon or Washington, what do you think of Initiative #1029?

Photo credit: MonkeyC.Net / Flickr / Creative Commons

Tagged as: 2008 election · initiative 1029 · medicine · washington

Requiring criminal background checks is not an outlandish demand before granting state certification to people who will be dispatched into the homes of the elderly or infirm. It allows the state to know fully who they are licensing. Otherwise, the agency faces the risk of bad headlines and loss of public support if things go wrong in a sympathetic victim's home. A few bad apples spoil the cart? And which victim wouldn't be sympathetic?

The problem arises when the agency demands homecare workers to be conviction free. While the ongoing, neverending criminal crackdown rages on, state legislatures race one another to prove themselves the toughest on crime. By increasing the number of crimes on the books, the amounts of fines payable upon conviction, and the funding given to police agencies, the number of untrained* people who live conviction-free dwindles. (*I presume that more highly skilled folks with other options open to them are taking them.)

The elderly and infirm are a segment of society that demands vigilant state support and defense. Yet commonsense must dictate whether a person who has been convicted for minor crimes that present no reasonable risk to the patient be allowed to work in another's home. If someone is willing to do work that I wouldn't be willing to do, then perhaps Washington shouldn't be too quick to eliminate those who aren't squeaky-clean.
Will Perkinson —
I agree that caregivers shouldn't have to be "squeaky clean" in order to perform a job that only few are willing to do. However, I believe that caregivers should be psychologically analyzed, along with a criminal background check to clears them from any prior drug addiction/abuse before liscensed to perform these intense physical and emotional duties. I also believe that these positions should be well compensated in order to draw out more qualified individuals.

After three grueling, frustrating years of taking care of my 28 year old brother who suffered from a stroke onset by chemo-therapy. He became eligible for in long-term in home care. The first caregiver wasn't abusive, but neglected to take care of my brother. We would show up to the house that he was staying at unexpected, and find him laying in bed in his own feces at 3 in the afternoon. To think that an insurance company would even consider recomending these people is absured.

mydaughterisbeautiful —
Sorry, I didn't mean insurance company, I meant the agency that recommends care givers.
mydaughterisbeautiful —
Beverly Mackey and Mary Wood are great examples of why Oregon's program works so well -- both for those in need of care and those who provide it. The program ought to be expanded and supported. Every dollar we devote to training and supporting home health care is a dollar very well spent -- and actually saves dollars more by reducing the need for expensive institutionalization.
Mt. Tabor Maven —
How does this issue apply to assisted living and foster care homes? As an EMS provider, I have seen a huge increase in the number of facilities providing services to the elderly and disabled that are not considered "skilled care" as a nursing home is. Some of these facilities are run well with caring skilled employees. Some are not. While the employees seem well intended, the skills they sometime possess do not meet the needs of the patient. I would suggest that this type of service has become "big business". The cost of theses services are relatively high, from $2500 to $5000 per month in group settings. Individual care is much more expensive. We arranged for 24 hour in home care for my great aunt in her last months and it was over $11,000 a month. We went through several services before we found a provider that had both had the skills and the compassion to do the job. It should be noted that the actual provider made about $10.00 per hour. Fortunately, she could afford the cost of spending her last days at home. I feel it would be prudent for government to examine this industry as it currently has very limited oversight.
Andy Louden —
People we hire to come into our homes and care for our family members need to be trustworthy, know what to do, and how to do it safely. When people need long-term care, they are incredibly vulnerable. In my personal experience, we hired caregivers through an agency to care for my mother in her home. The agency was highly recommended, but toward the end of her life when her needs became more complicated, they sent us completely unqualified and untrained people. We were sent caregivers who had never worked in homes before. One woman was transferred from housecleaning to care for my mother. I had to train them how to transfer my mother from her wheelchair to her bed, how to give her meds, etc. These were basic skills that all professional caregivers should have. When we voiced our concerns, the agency pulled the caregivers that had developed close relationships with my mother and sent us a parade of inexperienced, unskilled caregivers. We eventually fired the agency and were able to care for her ourselves, with the help of a highly skilled and loving private caregiver.
bnelson —
As a hospital discharge planner, I work with families who aren't prepared to provide care for their loved ones. If they're hiring home care workers, they want an individual or agency who has the best training to help their loved ones remain as independent as possible. Many of the care needs of the patients I discharge are so specialized that without proper training, home care workers will do more harm than help. They need training!
emmettdigger —
The question is and always has been, "Why are Home Care Workers necessary ?" Home Care Workers are necessary because we have structured our lives in such a fashion that family members are seldom and/or generally unavailabe to provide basic care for their members who need care and assistance. Despite a generally negative attitude toward and about government we turn to government to solve some of our most personal needs and problems. Passing a criminal background check and participation in 35-75 hours of training does not ensure ethical and caring behaviors or the ability or willingness to apply such training to the care of clients. Such checks only reduce the probability of unethical behavior. Training only increases the probability that the necessary skills to care for a client will actually take place. Every day their are family menmbers who behave unethically toward immediate family members and who exhibit uncaring behaviors in their care of family members.

I have had personal experience with and contact with dozens of Home Care Workers, Adult Foster Home Providers, and Child Care Workers. On the whole they are a group of deeply caring and dedicated people. I would have tremendous difficulties performing their joys. Each group saves the state thousands of dollars per client and the citizens of Oregon and Washington valuable tax dollars. We reward each of these groups with ongoing abuse by failing to provide adequate pay to them and wonder in amazement why their is such a high percentage of turnover. Clients are not sacks of potatoes who can be passed from one person to another without regard for the client's needs and feelings. Caring for another human being requires compassion, trust, understanding, and commitment/dedication. Clients deserve no less from anyone and everyone. These are the most vunerable members of our family and society.

The woman who is behind the Washington State measure would do well to concern herself with adequate pay and health care first before developing additional requirements for the people who care for the most vulnerable members of our society. Show these groups the money and health care and they will lead the charge for the development of skills far in excess of what she could imagine. The competition and quality of people seeking to enter these careers will be awesome. I have met Mary several times and know her to be a caring and passinate care giver. Oregon is lucky to have her. I was deeply impressed by the other care giver in Lincoln City as well. Another lucky stroke for Oregon.

For the record, I am not a paid care giver and neither do I play one on tv. I have been a social worker for a number of years but have not played one on tv.
MeanMachine2 —
My Grandmother for the last 5 years has insisted on homecare workers. My Grandfather didn't want the homecare workers, but lost the argument, although for the first few years he was involved in most of the household activities, grocery shopping, bill paying etc...

A year ago my Grandfather took a turn for the worse and was unable to take care of those daily things and this summer we lost him.

We found out that the year that he was undergoing serious medical complications the homecare worker was taking thousands of dollars from my grandmother. She told her that the agency didn't pay her so my grandmother wrote her a check to pay for services, on top of that the worker told her that a weeks worth of groceries cost $500, which she was given in cash to take care of the house, plus under-the-table "bonuses" that my overly generous grandmother offered to her to help the homecare workers ailing family.

The homecare worker had a clean background when she entered my grandparent?s home, but that is no longer the case. She was licensed in CA, so she could enter Oregon or Washington and need to re-certify. For people like this, we need background checks! I would stand for any policy that could help alleviate the stress and violations that occurred right under our noses. I would not wish this kind of activity on any other family, ever.
amy-OR —
I have just one comment. All the education and certification in the world is not going to make a good home care provider. Or nurse. Or doctor. No matter what a person's training is, there are a few people out there who make the rest of us look bad. Many years ago when I worked as an LPN in a small hospital in Florida, one of our RNs was arrested right on graveyard shift. She had been stealing narcotics from the medications cart. The good thing that came out of this was that the hospital pharmacy changed its method of dispensing and documenting narcotics.

I'm not saying that I think this initiative is wrong, it's just that I'm not so sure that it will fix the problem. Right now, I am employed as a home care worker. I've been with the same agency for 11 years. I get background checks done every two years and they always came back spotless. That is until last year. The Washington State Patrol has expanded their background checks to include information from all public agencies.

My employer had to terminate me for what showed up and I had no idea what I might have done. I called WSP and they did not have me in their data base. I've never been arrested. It turned out that something happened in 2002 and a complaint was filed against me. Because of a major mistake the State of WA made, I was off work for over 6 months. My termination had been changed to a suspension thanks to my union rep. My good name has been cleared and now I'm back on active status with my employer.

I agree that the system needs to be reworked, but at what cost?
pnwfemale —

I did listen in on that program and I thought it was well done. My heart went out to those dedicated home care providers. I went through something similar in trying to provide home care support for my wife when she was dealing with advanced stage breast cancer and chemo-therapy treatments. The pain medication program was very difficult/frustrating to deal with and I was very grateful to the pharmacists? that assisted me during that time period. I believe there should be back-ground checks and more training for those workers.
marko3 —

To be a home care worker, there should be a thorough backgroud check and plenty of training.  I appreciate the job that home care workers do for the helpless people out there.

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wyld187 —

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