Home health care workers licensed by the state of Washington currently receive 34 hours of training. A measure on the Nov. 4 ballot seeks, among other things, to increase training requirements to 75 hours.
Unjustified costs, inflexible training, negative workforce effects and union control are three reasons a significant portion of the home health care industry in Southwest Washington opposes Initiative 1029.
“I don’t know of a single business owner who supports it,” said Greg Pang, executive director of Community Home Health and Hospice, which has offices in Longview and Vancouver.
But an official statement from the 23-member Washington Home Care Coalition says that “some individual member agencies support or remain neutral on the issue.”
Return on investment
The state pays to train Medicaid caregivers.
According to the Washington State Office of Financial Management’s Fiscal Impact Statement for I-1029, “estimated costs are $651,000 for fiscal year 2009 and $29.7 million for 2009 through 2011.”
For non-Medicaid caregivers, however, the initiative’s cost would be borne by home health care agencies, to the tune of about $700 per employee, as estimated by Craig Hanley, general manager of Vancouver’s Synergy HomeCare franchise.
Proponents of I-1029, which is sponsored by the Service Employees International Union, say that increased training will increase the quality of care, increase the number of people able to stay at home and save the health care system money, since home health care is less expensive than care in an institutional setting.
“I support I-1029 because of quality of care,” said Tim Probst, CEO of the Washington Workforce Association, a statewide nonpartisan economic organization. “Plus, it will drive down costs of health care in general.”
Au contraire, say opponents.
Hanley said increased training costs will be passed directly to the consumer. He estimated I-1029 would boost the cost of home care from today’s $18 to $22 per hour to as much as $26 per hour.
The high level of turnover in the home health care industry – 21 percent to 28 percent, according to the Visiting Nurse Association of America – is one reason business owners like Hanley are reluctant to spend hundreds of dollars on what they see as unnecessary training.
“Agencies will pay for the training then the employee might go to work for someone else and the agency doesn’t get anything,” Hanley said.
And the initiative has no effect on independent, unlicensed home health care providers, he said. Therefore, only state-licensed providers will bear the cost of implementing I-1029 and will be at a competitive disadvantage.
“Some agencies will go out of business and it might push others to Oregon,” Hanley said.
Is more training necessary?
“The intent of more training is laudable, up to a certain point,” Hanley said. “But 70 to 75 hours of training is ridiculous.”
One of the major objections to the training proposed by I-1029 is its inflexibility. The 75 hours of training is the same, whether it is for someone who provides non-medical assistance such as cooking or cleaning, or someone who provides medical care.
Annie Gunderson, home care supervisor for Hazel Dell-based Athena Home Care Services, Inc., said most home health agencies – for-profit and nonprofit – provide client-specific training.
“We train and orient our caregivers to our company policies and procedures and to the unique needs of each client they work with,” Gunderson said. “Furthermore, we monitor them closely to make sure it is a good match and both parties are happy.”
“Ultimately,” she concluded, “providing quality care to our vulnerable citizens depends on caregiver support and supervision, not just classroom training hours.”
Plus, training proposed by I-1029 initially will be nonaccredited and won’t transfer to any community college programs, although the initiative’s sponsor claims accreditation is a goal.
Jesse Rios, program manager at Vancouver-based Relationship/Care Northwest, said existing workforce investment programs will suffer if I-1029 passes because only the specific training classes proposed by I-1029 will satisfy the 75-hour requirement.
Local home health care providers also claim I-1029 will shrink the available field of home health care workers, especially part-time workers who provide basic services such as cooking and cleaning.
“Many of our caregivers are part-time workers,” Gunderson said. “Requiring such extensive training would make it nearly impossible for part-time workers to succeed in this industry.”
The YES on Initiative 1029 website counters these objections, but cites no statistics about availability of home health care workers – only that training is associated with reduced turnover. The website is an “in-kind contribution” of SEIU, according to a spokesperson.
But a 2003 study titled “Home Health Workforce Retention: A Study of Factors Associated with Increased Job Satisfaction,” found that “having educational and promotional opportunities” ranked last among the seven factors identified by the authors.
Following the money
Many home health care businesses are also concerned about the direct tie between I-1029 and the Service Employees International Union Local 775.
SEIU 775 sponsored the measure and paid for signature collection. And the “small print” of I-1029 specifies that the SEIU is the only allowed provider of the 75 hours of training, despite the existence of “numerous certified health care educators who have done a fine job of teaching caregivers,” Gunderson said.
In fact, the language of the initiative is somewhat vague on who will provide the training. The union will provide the training to its
own members – at the taxpayer’s expense. But for non-union providers, it will depend on who the Department of Health and Social Services chooses.
Certainly the framework exists for the SEIU to be the trainer du jour. The text of the initiative refers to a “training partnership” as defined in the Revised Code of Washington, which references an “exclusive bargaining representative” designated by the governor.
“The SEIU wants the training dollars for its organization, along with 75 hours of face time with every caregiver in the state,” Gunderson said. “Seventy-five hours with a captive audience would be very beneficial to union recruiting.”
Hanley estimates the union will make $60 million providing the training.
“I-1029 is bad for business, bad for the consumer, but good for the union,” he said.
Home health care: a burgeoning industry
More than 30 agencies and companies provide home health care in Clark County, with more in Cowlitz County. Here are some indicators of how much this sector will grow:
• Americans age 65 and older make up 13 percent of the total United States population
• Washington saw 200 adult family homes open in 2007, bringing the total to 3,700
• Home health care industry revenues will grow 15 percent annually through 2010, according to a 2005 report by investment banking firm Cochran, Caronia & Co.
• The Centers for Medicare and Medicaid Services reports that national expenditures on home health care were $41.3 billion in 2001 and are projected to reach more than $90 billion by 2014.
• In 1963, 1,100 home care providers were in operation. In 2001, the National Association for Home Care counted more than 20,000 home care service providers with a total of 658,110 employees providing services to 7.6 million people – a 1,718 percent increase.
• Census data indicates that annual revenue for home health care services grew from $27,524 million in 1999 to $47,007 million in 2006 and experienced an average 9.8 percent increase each year since 2000.