YES on Initiative 1029: I-1029 Fact Checker on 1029 and LTC Training

I-1029 Factchecker

Myths and Facts About Long-Term Care Worker Training

Long-Term Care Worker Training Workgroup Recommendations

MYTH: Critics charge that the Long-Term Care Worker Training Workgroup established by the Legislature in 2007 did not recommend 75 hours of training, with an implicit suggestion that the Workgroup recommended a lower number. Some go further and suggest that the Workgroup recommended a 35 hour training standard.
FACT: This is an intentionally misleading claim. As the report clearly states, a majority of Workgroup members recommended an 85-hour training and certification standard A minority of members recommended a range between 45 and 90 hours with only one member recommending no change to the current standard. Many of the backers of I-1029 pushed for an 85 hour standard during the 2008 legislative session, and agreed to a compromise of 75 hours in order to reduce the cost. 75 hours is consistent with the federal standard for direct care workers in nursing homes (CNAs).
For more information on the Workgroup's recommendations: www.governor.wa.gov/ltcf/workgroup.htm

Impact of Improved Training On Workforce Supply

MYTH: Critics charge that increasing training will reduce the supply of workers.
FACT: While critics provide no evidence of this claim, there are numerous studies by respected long-term care workforce experts that suggest just the opposite - that improved training will improve both recruitment and retention of caregivers. For example:
In the recent report "Retooling for an Aging America," the Institute of Medicine wrote: "Direct-care workers are the primary providers of paid hands-on care and emotional support for older adults, yet the requirements for their training and testing are minimal. Furthermore, even though patient care has become much more complex... very little is done to ensure the competence of personal care aides. The committee concluded that current federal training minimums are inadequate to prepare direct care workers and that the content of the training lacks sufficient geriatric-specific content."

One national review of literature on the impact of training on recruitment and retention found that, in general, higher levels of training for direct-care workers helped employers both find and keep employees, especially in home care agencies (see Workforce Strategies #3, Paraprofessional Healthcare Institute, January 2005)

When nurse aides reported that training prepared them well for their jobs, intent to leave and actual workforce turnover were lower (see "Job Satisfaction of Nurse Aides in Nursing Homes: Intent to Leave and Turnover, The Gerontologist 47, 2007)

In Pennsylvania's home health agencies, more staff training was found to be associated with lower reported recruitment and retention problems (see Pennsylvania's Frontline Workers in Long Term Care, report to Philadelphia Geriatric Center)

Relationship Between Training and Quality of Care

MYTH: Critics suggest there's no evidence that improved training leads to improved quality care.
FACT: These critics are ignoring a substantial body of evidence that suggests that improved training does increase quality care - though much of the research has been done in nursing homes, not home care. For example:
A 2000 Institute of Medicine report found "some agreement among experts... that there is a relationship between the level and type of training and the quality of care that nursing assistants provide." The report also noted that improved training and job quality decreases turnover, which impacts both quality of care and quality of life for residents."

In one study comparing quality of care in nursing homes before and after establishing national CNA training standards in 1987, quality of care improved after the law's training mandate went into effect (see Bernard Gross: Quality of Care Defined, PA Department of Education, 1995)

A 2001 survey of nursing facility administrators, nursing directors, nursing assistants, social workers, family members, and surveyors found that "training, orientation, or education" was tied for first place as a means of improving quality of care. (see "Redefining Quality and Excellence in the Nursing Home Culture," Journal of Gerontological Nursing, 2001)

Impact of Training Legislation on Union Membership or Union Finances

MYTH: Critics charge that I-1029 will require long-term care workers to join a union, increase union membership, or provide financial gains to a labor union.
FACT: None of this is true. Nothing in I-1029 requires, encourages, or facilitates long-term care workers joining a union. I-1029 simply establishes a new standard for training, certification, and criminal background checks that will apply to all home and community-based long-term care workers, regardless of whether they're in a union or not.

Initiative backers refused to compromise at the legislature

MYTH: Critics charge that the backers of I-1029 refused to compromise down from their initial position on training standards.
FACT: Advocates for better training worked to problem solve with legislators, stakeholders, and the Governor's Office to address legitimate concerns and build consensus among stakeholders. Based on this collaborative process, SEIU Healthcare 775NW, for example, moved from an initial 150-hour training and certification proposal to a less costly and more flexible 75-hour training and certification proposal reflected in the Governor's 75 hour striking amendment.
SEIU Healthcare 775NW started this process in the Spring of 2006 when the union sought to bargain with the state over training standards for individual provider home care workers. The state, however, refused to talk about the issue at all. In January 2007 SEIU backed legislation consistent with the findings of the Paraprofessional Healthcare Institute which had been commissioned to analyze the current training program and develop a blueprint for a 21st Century training system. That proposal was for 150 hours of required training for all home and community based caregivers. Midway through the 2007 session, SEIU and other advocates floated a compromise of an 85 hour standard, consistent with the standard for nursing home workers in Washington State. At the end of the session, supporters agreed to a compromise that established a workgroup of legislators and stakeholders to develop a new training standard.
A majority of workgroup participants supported an 85 hour standard for all caregivers. However, legislators introduced legislation that had 85 hours of training - but most of it could be satisfied through unstructured and unsupervised on the job training. We viewed this as a starting point for discussions. However, rather than engage in serious efforts to compromise, legislators gutted the bill entirely to create a 35 hour training standard - only 1 hour more than the current standard.
At the end of the session, advocates supported a significant compromise proposal by Governor Gregoire that would have established a 75 hour training standard, addressed concerns raised by family and intermittent caregivers, and reduced the cost of the measure. In the end, however, legislators passed nothing.

The initiative will cost $100 million

MYTH: Despite clear evidence to the contrary, critics continue to suggest that the initiative would cost Washington State $100 million a biennium.
FACT: While a fiscal note on I-1029 hasn't been completed, OFM's fiscal note of virtually identical legislation during the 2008 session estimated the cost at just over $23 Million GF-S through the 2009-11 biennium.