I-1029: better training or train wreck?

Trainee Janelle Yates, right, observes as Vancouver adult family home operator Bonnie Bruce helps 97-year-old Zelpha Rose Carpenter take her medication. Bruce opposes a sweeping new training mandate on the November ballot. (Zachary Kaufman/The Columbian)

How much training is enough for those who care for society’s most vulnerable adults? A measure on the November ballot will ask voters to decide.

Initiative 1029, sponsored by the Service Employees International Union, would more than double the training required of most long-term care workers, from 34 hours to 75 hours, beginning in 2010. New workers would have to pass federal criminal background checks and obtain state certification.

The state would pay for the training of state-subsidized caregivers, and pay their salaries while they receive training, at a cost of nearly $30 million in the 2009-11 biennium.

The low-profile measure has provoked acrimonious debate in the long-term care community.

Proponents, including the state Democratic Party and some of the state’s largest labor unions, say it’s unacceptable that most long-term caregivers are required to get so little training. More formal preparation, they say, will result in better care for the elderly and disabled.

“With minimal training, today’s workers are caring for clients who in the past would have received care in nursing home settings,” the SEIU notes in its 2007 “Blue Print for the Future,” a strategy for training and organizing Washington’s long-term care workers.

The union’s case is, at first glance, compelling. “In Washington, hairdressers need 1,000 hours of training and dog masseurs need 350 hours,” wrote Nancy Dapper and Louise­ Ryan, the state’s long-term care ombudsman, in an opinion piece published in the Seattle Post-Intelligencer.

Opponents, organized as the Washington Home Care Coalition, say there’s no evidence that the current training system is inadequate. Instead, they contend that the initiative is the SEIU’s opening gambit in a campaign to train and organize thousands of low-paid workers who care for the elderly and disabled in their homes, assisted living centers and adult family homes.

“They have an ulterior motive,” said Deb Murphy, chief executive officer of Aging Services of Washington, a state association of nonprofit providers dedicated to the needs of older persons, and a spokesman for the campaign to defeat I-1029. That motive, she said, is “to get those training dollars from the state.”

The increased training, and the union’s focus on creating a “career track” for caregivers, would result in a shortage of workers and could swamp families that pay out of pocket for care, Murphy predicted.

“It’s going to drive up the cost of care for people who are on fixed incomes and who are struggling to pay privately,” she said. “It will further squeeze them and increase their costs.”

On-the-job training

Bonnie Bruce wears two hats as an “independent provider” already represented by the SEIU and as the operator of an adult family home in east Vancouver that serves six elderly and disabled women.

It’s a serene and intimate setting, more private home than institution. The sign outside says “Almost Like Home.”

Bruce gives each new caregiver an in-depth orientation to her residents’ needs.
On a recent morning, she introduced Janelle Yates to each woman’s routine, preferences and medical issues, from their dietary preferences to which TV channels they watch.

It was Yates’ first day on the job.

There’s 97-year-old Zelpha Rose Carpenter, who is hard of hearing, eats with her hands and needs lots of liquids to stay hydrated. A photo of Carpenter as a Wave in the U.S. Navy rests on the fireplace mantel. With a little prompting, she can still sing “Take Me Out to the Ball Game” in a loud, quavering voice.

There’s 87-year-old June Bassett, a quiet woman who suffers from dementia. After six weeks at the home, “she’s finally beginning to feel comfortable,” Bruce said. “She has a routine. It’s very important to her not to have her routine interrupted.” After breakfast, she takes her chair near the window and picks up a Reader’s Digest.

And there’s Joan Kennedy, a bright, articulate 75-year-old who suffers from the effects of a brain aneurism. “She has no short-term memory,” Bruce said. “She could walk off and leave a stove on.”

Yates, a pastor’s wife and mother of three, is a certified nursing assistant who has undergone more than 75 hours of training and worked in nursing homes in other states. She took the job, she said, “to get out of the house and get some spending money.” Eventually, she’d like to operate her own adult family home.

Bruce herself has undergone more than 100 hours of training to qualify as a long-term care provider, including specialized courses in working with people who have dementia and mental illness.

Because four of Bruce’s six clients are covered by Medicaid, the state requires her to have this training. She requires her workers to undergo 34 hours of state-mandated training at their own expense, then reimburses them if they stay with her.

One size fits all?

Bruce supports adequate and appropriate training, but she says I-1029 assumes that everyone who provides care to the elderly and disabled needs the same level of training.

Some part-time workers are stay-at-home moms who have no interest in a career, she said. Some perform simple custodial tasks that don’t require extensive training. And some provide respite care for exhausted families who care for an elderly parent or a developmentally disabled child, fulfilling a tradition of helping out when families are stretched too tight.

Jeff Parsons, chairman of Yes on 1029, says the initiative was carefully written to exempt those who work less than 20 hours a month and those who provide only comfort care. Plus, everyone who works as a caregiver before January 2010 is grandfathered under the old training standard.

The SEIU says increased pay and benefits will attract more qualified caregivers to the field. It has the numbers to show that unionization has improved working conditions for individual providers who are paid by the state to care for Medicaid clients.

Under their collective bargaining agreement, their starting wage is now $10.03 per hour, up 30 percent since they voted for union representation in 2001. Their new contracts guarantee them health, dental, vision and pharmacy benefits as well as paid vacations.

In contrast, Bonnie Bruce will pay Janelle Yates $9 an hour to start, with no benefits and no paid vacation.

“We are small businesses,” Bruce said. “We really couldn’t pay for the things unions would require. For some of our Medicaid patients, we get maybe $50 a day. “

Pushing an agenda

In 2007, a work group appointed by Gov. Chris Gregoire convened to study training requirements for long-term care workers and make recommendations. The group failed to reach consensus. A majority recommended 85 hours of training, but the group agreed only that the current 34-hour standard, less than half that required of nursing home employees, was insufficient.

Armed with the working group’s report, SEIU Local 775 tried to win a beefed-up training requirement from the 2008 Legislature. In the session’s final hours, Gregoire personally lobbied for a bill requiring 75 hours of training, but House Speaker Frank Chopp, D-Seattle, refused to bring any training bill to a vote.

The union then raised and spent $450,000 to gather 300,000 signatures and get I-1029 on the ballot.

SEIU makes no secret of the fact that its eventual goal is to organize all long-term caregivers. It points out that baby boomers soon will be retiring in droves, and says supporting them in home or community-based environments when they can no longer manage on their own will be less expensive, and more humane, than consigning them to nursing homes.

Care-giving is a growing job market, and SEIU is determined to tap it.

“The more than 10,000 paid family caregivers in Washington are an example of a work force with huge potential that is untapped by the current approach to caregiver training,” the union writes in its Blue Print for the Future.

The union has developed a training curriculum that it would offer to its own unionized caregivers at taxpayer expense if I-1029 passes. The state Department of Health could choose to contract with SEIU or some other party to train other workers, or could provide the training itself.

Critics say providing uniform training to tens of thousands of new caregivers would give the SEIU an edge in organizing this fast-growing labor force.

Parsons of Yes on 1029 says the initiative by itself would not lead to that result.

“Obviously the union’s goal is to unionize folks,” he said. But he added, “You can’t find language in the initiative that would allow the SEIU to unionize the entire long-term care industry.”

Bruce admits that her reimbursement rates for some residents have increased under the SEIU collective bargaining agreement. “I understand the power of unions,” she said.

Still, she questions the union’s commitment to training. “I am a member of SEIU, but I have not been offered by the union one hour of caregiver training,” she said.
Vancouver care provider Hope Reffett says there’s no need for the state to pay for training.

Training for certified nursing assistants is widely available through community colleges at a nominal cost, she said, and specialized training is offered by such organizations as the Alzheimer’s Association and the University of Washington’s Northwest Geriatric Training Center.

Ultimately, if I-1029 passes and caregivers are organized, families will pay the price, she predicted.

“We’re either going to have to raise our rates or some of these homes are going to have to close down. Family members will have to take their parents back. Then, they’ll have to take the training too.”

Kathie Durbin can be reached at kathie.durbin@columbian.com or 360-735-4523.