For years, training standards for personal care aides in Washington posed several challenges that affected consumers and workers alike. In 2012, advocates responded by successfully passing a ballot initiative that created a new training system for these aides—expanding learning objectives, increasing training hours, and introducing certification requirements. In just a few years, Washington raised the bar nationwide for training and certification. This report is part of a three-part series focusing on states that have led the way in developing personal care aide training standards. Specifically, we ask: what was the need for improved training standards in Washington State? How did long-term care leaders address that need? And how did the broader long-term care community react to proposed training standards?