February 24, 2015

Scott Bird, Office Chief of Consumer Affairs

DSHS, Residential Care Services

Melissa Axtell, ALF Complaint Investigator

DSHS, Residential Care Services

WAC 388-112-0005

"Long-term care worker" includes all persons providing paid, personal care

services for the elderly or persons with disabilities, including individual

providers of home care services, direct care employees of home care

agencies, providers of home care services to persons with developmental

disabilities under Title 71A RCW, all direct care workers in state-licensed

assisted living facilities, adult family homes, respite care providers,

community residential service providers, and any other direct care staff

providing home or community-based services to the elderly or persons

with functional disabilities or developmental disabilities.

Background and History:

Legislation in 2000 broadened ALF training requirements for direct care workers.

Initiative 1029 in 2008 – Passed with a YES vote of 72.53%

• Increased mandatory training hours for LTCWs from 35 to 75

• Home care aide certification for certain LTCWs

• State and federal background checks for LTCWs, including fingerprint

screening

• Set to take effect in 2010

Amended by lawmakers twice in 2009 and 2011 to delay implementation until

2014.

Initiative 1163 - Placed on the ballot in November 2011

“This measure would repeal and reenact background checks, training, and

certain other requirements for long-term care workers and providers; and

address financial accountability and administrative expenses of the long-term

in-home care services program.

Should this measure be enacted into law?”

YES = 65.02%

Impact on ALFs

• Increased training requirements

• Home care aide certification requirement

• 12 hours of continuing education each year

• Specific time frame identified in the initiative wording – implement on

January 7, 2012

What changed with Initiative 1163?

Before: Pass state background check before hire

After: Pass state background check before hire AND a federal background

check within 120 days of hire

Before: Complete 28 hours of training within 120 days of hire

After: Complete 75 hours of training within 120 days of hire

Before: No exam requirement

After: Pass written/oral exam and skills exam

Before: No certificate or licensure

After: Become certified as a home care aide within 150 days of hire

Before: 10 hours of continuing education annually

After: 12 hours of continuing education annually

WAC 388-78A-2474 Training and home care aide certification requirements

(1) The assisted living facility must ensure staff persons hired before

January 7, 2012 meet training requirements in effect on the date hired,

including requirements in chapter 388-112 WAC.

(2) The assisted living facility must ensure all assisted

living facility administrators, or their designees, and

caregivers hired on or after January 7, 2012 meet the

long-term care worker training requirements of chapter

388-112 WAC, including but not limited to:

(a) Orientation and safety;

(b) Basic;

(4) The assisted living facility must ensure all persons

listed in subsection (2) of this section, obtain the home-

care aide certification.

Exemptions:

• Registered Nurse

• Licensed Practical Nurse

• Nursing Assistant – Certified (NAC)

• In an approved NAC training program

• Special education training with endorsement by OSPI

• LTCW who worked between 1/1/11 and 1/6/12 and completed training

requirements in effect at the time

NOT Exempt:

• Nursing Assistant – Registered (NAR)

Home Care Aide:

• 2 hours of LTCW orientation training

o Introductory information about the care setting and job

o WAC 388-112-0016 describes content

o Not the same as facility orientation

o Before providing care to residents

o Department-approved curriculum and instructor

o Curriculum available from DSHS

o No test

• 3 hours of LTCW safety training

o Introductory information on safety practices

o WAC 388-112-0019 describes content

o Before providing care to residents

o Department-approved curriculum and instructor

o Curriculum available from DSHS

o No test

Home Care Aide (continued):

• 70 hours of LTCW basic training

o Core basic plus population-specific basic

o Amount allotted to core v. population is not specified by law

o WAC 388-112-0045, -0053, -0055, -0066 describe content

o 120 days from date of hire

o Specialty training hours can be used toward the population-

specific component of the 70 hours if taken within 120 days

of hire

o Department-approved curriculum and instructor

o No curriculum available from DSHS

Home Care Aide (continued):

Instructors for Orientation, Safety, and Basic:

o Teach own staff with own instructors

o Send staff to DSHS-approved instructor in community

o Combination of both

• HCA credential requires examination

o Oral or written

o Skills

Home Care Aide (continued):

Must become certified as a Home Care Aide within 200 days of hire

• WAC 388-112-0106 originally said 150 days

• 2012 audit showed only 29% of HCA applicants obtained certificate

• Substitute HB 1629 in 2013

o Extended time to 200 days

o Additional 60 days for limited English-proficiency (260 days total)

2014 audit showed 59% of HCA applicants obtained certificate

• Opt for NAC training – 10 hours more, wider job opportunities

• Change mind about working in field

• Failed background checks

Entities involved with HCS Certification Process

• Department of Health processes application, verifies training

requirements met, and issues credential

• DSHS authorizes trainers for the 75 hours (orientation, safety,

basic)

o Home and Community Services not Residential Care

Services

• Prometric administers the exams

Three most common ways to qualify as a front-line caregiver :

• Grandfathered in under old training requirements

o Fundamentals of Caregiving

o Attestation showing worked between 1/1/11 and 1/6/12

• NAC

• HCA

Note: The grandfather exemption is lost if the person

does not work as LTCW for 3 full years.

Continuing Education:

• 12 hours annually based on birthdate

• Applies to all LTCWs except RNs and LPNs

o Substitute HB 1629 removed LTCW CE requirement for RNs

and LPNs

• Department approval required, CE certificates coded

(WAC 388-112-0320)

Background Checks:

• Added requirement for federal fingerprint background check

• Pertinent WACs under 388-78A include:

- 2461 -2467

- 2462 -2468

- 2464 -24681

- 24641 -2469

- 24642 -2470

- 2465 -24701

- 2466 -2471

• No unsupervised access by staff without name and DOB background check.

• Name/DOB background check required

o All staff

o Volunteers

o Students

o Contractors who may have unsupervised access to residents

• National fingerprint background check required

o Administrator

o All caregivers

WAC 388-78A-2020 "Caregiver" means anyone providing direct

personal care to another person including, but not limited to: Cuing,

reminding or supervision of residents, on behalf of an assisted living

facility, except volunteers who are directly supervised.

• Administrator/caregiver can work for 120 days after hire as long as

fingerprint background check results are pending

• Privacy issues related to fingerprint background check due to federal overlay

o Special notice must be signed by employee/applicant

o Detailed results can only be provided to the employee/applicant

o One facility cannot share the results with another facility

• Name/DOB background check must be repeated every two years

• National fingerprint background check valid indefinitely

• Facility systems important

o Ensure employee schedules fingerprint appointment

o Ensure employee goes to fingerprint appointment

o BCCU will not notify facility about no-show or failure to schedule

o Updates to system from MorphoTrust occur every night

No record of criminal convictions, pending charges or negative actions.

A. A criminal conviction or pending criminal charge;

OR

B. A negative action.

A. A criminal conviction or pending criminal charge that is on the Department

Secretary’s List of Crimes and Negative Actions;

OR

B. A negative action that is on the Department Secretary’s List of Crimes and

Negative Actions;

OR

C. Has an unknown conviction, pending charge or other action that requires more

information from the applicant.

• Read the results thoroughly and follow the instructions

SOURCE OF CRIMES/NEGATIVE ACTIONS REPORTED:

Source: Washington State Courts. Washington State Courts search results

are attached.

Source: WSP. RAP (Record of Arrests and Prosecutions) sheet is attached.

Source: Department of Health (DOH). DOH has made a decision about the person

named above. Go to “Provider/Credential Search.” Follow the directions to find the

DOH decision. You must decide if your program rules require you to use the DOH

decision for this background check. Call DOH at (360) 236-4700 if you have

questions about the decision or if you think the decision is wrong.

Source: DSHS. It has been reported the above-named individual has a

substantiated FINDING of abuse and/or neglect of a child. Additional information

about this action may be obtained by contacting Children’s Administration at 1-800-

562-5624, Monday through Friday, from 8:00am to 5:00pm.

Source: Fingerprint check. Fingerprint-Based Background Check Conducted.

• Use WAC 388-113 to determine whether staff have a

disqualifying crime and/or negative action

Automatically Disqualifying Convictions:

A pending charge is also

disqualifying:

WAC 388-113-0020(3) When

the department determines

that a conviction or pending

charge in federal court or in

any other court, including

state court is equivalent to a

Washington state crime that is

disqualifying under this

section, the equivalent

conviction or pending charge

is also disqualifying.

WAC 388-78A-2470 Disqualifying negative actions:

• APS finding of abuse, neglect, or financial exploitation prior to October 2003

• CPS finding of abuse or neglect of a child prior to October 1998

• Contract or license denied, terminated, revoked, or suspended due to a/n/fe

of child or vulnerable adult

• Registered sex offender

• Certain restraining orders, other actions for similar issues

Administrators hired after 1/7/12 are subject to the new

training requirements:

• WAC 388-78A-2474-2

• Exceptions

o Licensed nursing home administrator

(WAC 388-112-0106)

o Other categories exempt from LTCW training

(RN, LPN, NAC, etc.)

Timelines matter with training and certification:

WAC 246-980-050-1b & -2 How long does a nonexempt long-term care worker

have to complete the home care aide training and certification requirements?

(1)(b) A long-term care worker who has not completed the training within one

hundred twenty calendar days is no longer eligible to provide care until

certification as a home care aide has been granted.

(2) Certification: A long-term care worker who has not been

issued a home care aide certification within two hundred

calendar days of the date of hire must stop providing care

until the certification has been granted.

• No follow-up when fingerprint identified as source

• Red flag: NAC training certificate from one or two years earlier, but

no NAC credential

o Exam failure

o Lack of follow through related to paperwork or application fees

o Call DOH to inquire

Sometimes result will be interim pending fingerprints, yet identify

the fingerprint background check as a source.

• Person had fingerprints done in the past, permanently

attached to their background check profile

Regulatory references:

WAC 388-78A ALF regulations

WAC 388-112 Training regulations

WAC 388-113 Disqualifying crimes and negative actions

WAC 246-980 Home care aide rules

RESOURCES:

Prometric Home Care Aide Information

https://www.prometric.com/en-us/clients/WADOH/Pages/landing.aspx

ALF Provider Page

https://www.dshs.wa.gov/altsa/residential-care-services/information-assisted-living-facility-professionals

Find a Trainer

https://fortress.wa.gov/dshs/adsaapps/Professional/training/training.aspx

How to Become a Trainer

https://www.dshs.wa.gov/altsa/hcs/training/afh-alf

BCCU

https://www.dshs.wa.gov/altsa/residential-care-services/background-check

BCCU Listserv Signup

https://www.dshs.wa.gov/fsa/background-check-central-unit/bccu-listserv

Fingerprint Background Check Instructions for ALFs

https://www.dshs.wa.gov/altsa/training/training-requirements-classes-fingerprint-background-checks-assisted-living-facility-alf

DOH Provider Credential Search

https://fortress.wa.gov/doh/providercredentialsearch/SearchCriteria.aspx

DOH Customer Service

360-236-4700

This presentation brought to you by the

Department of Social and Health Services,

Residential Care Services.

For more information, please contact

Scott Bird (360) 725-2494

- Or –

Melissa Axtell (509) 323-7307.

Thank you for your participation.