Is Washington Leading on State-Level Training Standards?

PHI recently released issue 19 in its #60CaregiverIssues campaign, a national public education campaign that’s tackling the growing workforce shortage in paid caregivers.

Our latest issue—Training Standards for Personal Care Aides: Spotlight on Washington—examines how home care leaders in Washington State raised the bar on training standards for personal care aides. This case study is the final part of a three-part series on state-level examples for improving training for personal care aides.

In the last 15+ years, Washington State made progress in rebalancing long-term care services for older adults and people with disabilities toward home- and community-based settings. These rebalancing efforts resulted in savings of $2.6 billion from 2000 to 2015. This work has also meant that the population of people with high needs living in the community is much larger today.

Additionally, these trends have increased demand for well-trained personal care aides who can provide home-based support. However, before new training requirements took effect in 2012, home care leaders experienced several challenges with the existing training system. Trainers did not believe they had enough time to achieve the learning objectives required in the state-mandated minimum training hours (28 hours). In addition, training for personal care aides could not apply toward certification as a nursing assistant or home health aide, despite shared competencies across these three “direct care” occupations.

The state created a workgroup in 2007 to recommend how to improve its personal care aide training system. These recommendations informed a statewide ballot initiative, which took effect in 2012. Sweeping changes compelled by the initiative include: increased training hours for most aides from 28 hours to 75 hours, reduced training barriers between direct care occupations, and new condition- and population-specific content included in curricular requirements.

The field’s reaction to these changes has been mixed. While these new training requirements address some problems in the previous training system, they also present a new set of challenges. According to recent state audit reports, forty percent of people who begin training do not achieve certification, which ultimately affects the supply of eligible workers. This result would affect many consumers and family members who rely on these workers. Also, consumers who prefer self-direction also want a more participatory role in training provision and curriculum development. In response, Washington State continues to partner with home care leaders, consumers, and family members to address their concerns.

Read the full case study here.