Home Care Aide Rules need to change

Funds spent for long term care initiatives

SEIU 775 Pushed for and Paid for each of these initiatives – Caregiving is still in crisis. Things need to change.

Several concerning issues regarding this case:

  1.  The Administrative Hearing Coordinator did not know the laws/rules of the HCA training.  He insisted several times that there was only one training course that the applicants could take – that of the Training Partnership (SEIU 775)
  2. The Administrative Hearing Coordinator insisted that there were not problems with others completing the training and getting their certification.  He treated this applicant as if she was a failure for not completing the SEIU 775 training.

HCA applications and certificates

Data for these charts was from the Credentialing Manager, Health Systems Quality Assurance, Washington State Department of Health

completed certification

The facts were provided to the Administrative Law Judge (ALJ) by the appellant.  While the ALJ had to abide by the Washington Administrative Code, she did fully understand the frustration and barriers for both the caregivers and those needing that care.

So, in the end, this was a very expensive and long drawn out ordeal that was frustrating but also clarified the problems with these rules.  Now we need people to help get the rules changed so that our community members in need of caregivers and those who want to provide this care can both get what they need.

Longterm care initiatives Washington state

SEIU 775 Pushed for and Paid for each of these initiatives clearly outspending the coalitions (or 501 (c)(3)) that were against each of these initiatives – Caregiving is still in crisis. Things need to change.

The Department sent the appellant the Planned Action Notice which outlined she had not completed the required Basic Training to be an individual provider.  The Appellant has continued working as an individual provider after January 25, 2018, and has not been paid by the Department.

Text from “Initial Order” signed by the Administrative Law Judge on July 23 2018 below:

The undisputed evidence established the Appellant has not completed the 70 hours of Basic Training to be an Individual Provider.

The Appellant explained she had difficulty finishing the Basic Training due to being locked out of the system at some point.  The Appellant expressed frustration about all the barriers in place to becoming an individual provider.  The Appellant also expressed frustration at not being informed about other possible ways to complete the Basic Training.

An administrative law judge may not find a Department regulation in the Washington Administrative Code invalid or unenforceable.  The authority of an administrative law judge (ALJ) and a review Judge is limited to those powers granted by statute or rule.  An ALJ and review judge do not have any inherent or common law powers.  (WAC 182-526-0216).  The Appellant made compelling arguments about the need for providers and how the process to become certified is frustrating because there are so many barriers.  The undersigned administrative law judge does not have the authority to grant the Appellant any relief or an exception to the certification process based on the need for providers in the community.  The undersigned administrative law judge also does not have the authority to implement basic policy changes to the certification process or great exceptions to the Basic Training requirement.

The Appellant has not completed the 70 hours of Basic Training within the 120 days of providing paid in-home care as an individual provider as required by WAC 388-71-0875.

Since the Appellant has not completed the required 70 hours of Basic Training, the Department was required to deny her payment as an individual provider pursuant to the Washington Administrative Code regulations.   There are not exceptions to completing the required Basic Training within the time frame outlined in the Washington Administrative Code.

Follow up:  the Appellant completed training through a DSHS approved  course

May 18, 2018 – sent application for HCA to Department of Health

July 25, 2018 – Completed the 75 hours of Basic Training

August 15, 2018 – DOH Credentialing scheduled caregiver for HCA test

September 7, 2018 – Caregiver took scheduled test – passed with 97%

September 19,. 2018 – DOH updated from PENDING to ACTIVE – FINALLY SHE CAN BE PAID TO PROVIDE CARE – even after she completed the training – the bureaucratic process to almost 2 months to complete – this was time that the caregiver had no control over yet she was not able to be paid. 

This caregiver is now providing daily care to two disabled university students.  

This situation was unusual in that the caregiver and her baby moved back into her parents home during this time.  Having the family support and “free” babysitting enabled her to continue providing care free of charge since most of her living costs were covered by her own self-employment and parents.  Without this support, she would have had to quit and become another one of those who applied to become an HCA but was unable to complete the SEIU 775 demands.  Caregiver provided care for 8 months without being paid.  Also the state had not paid her for the 2 weeks in January that she was locked out of the system.

Caregiver was not able to be paid by DSHS until September 19, 2018.  The rules state that the caregiver needs to complete the training and certification test.  Email from Case manager:

Planned Action Notice (PAN) that was sent to SG on 01/08/2018 informing her she would not be paid as of 01/25/2018. In the PAN, the WACs pertaining to the action are listed. WAC 388-71-0540 stipulation 14 indicates a provider cannot be paid if they do not successfully complete the certification requirements as described in WAC 388-71-0975.  SG was actually required to complete her HCA certification within 150 days of first starting to provide care.

The dates for completion of training and the HCA certification are based on when SG was first authorized to start providing care. SG was first authorized to start providing care on 09/28/2017.

I (and others) have been misled

For several years I was under the impression that the Intermediate Care Facility (ICF/ID) and Residential Habilitation Center (RHC) where my son lived was also a healthcare facility.  We were led to believe that the medical and nursing providers had oversight by the Department of Health which also provided oversight to what was referred to as “the healthcare clinic.”

The ICF/ID and RHCs are NOT healthcare facilities.  There is no professional peer review or oversight by the Department of Health.  I have learned this lesson after years of frustration trying to get appropriate medical and nursing care for my son who was a resident of the RHC.

While these facilities in Washington State employ Physicians, Nurses, Physical, Occupational and Speech Therapists to provide care to the residents, there is no state oversight of this care to ensure it meets the community standard of care that everyone should be entitled to.  The residents and their families/guardians are led to believe that appropriate medical and nursing care is provided but in some cases, I believe this is not happening.

This is a systems problem that no one seems to be able to address.  The Department of Health has no oversight, the Department of Social and Health Services does not look at healthcare standards, the Long Term Care Ombudsman does not oversee anything having to to with the Intermediate Care Facility or RHC, Disability Rights Washington (the Protection and Advocacy Agency) has not addressed this problem.

I fully support the idea of an intermediate care facility and a campus community that can provide full service health and behavioral care but the system in place in our state does not meet this standard.  It is shameful that the agency which oversees the RHC cannot see that there are major problems ensuring the healthcare for the residents is provided for.

It appears to me that our state is not meeting the Federal Regulations  and the so-called “investigations” that have been done have been a waste of time and energy.    This is so frustrating  – when they can not even see the problem, there is no opportunity to fix it.  The whole system is in denial and it is only hurting the very people who are supposed to be helped.

The investigator I spoke with today made it very clear by her repeated statement of “the RHC is not a healthcare facility” and by the regulations she had there were no deficiencies to cite.

I read the Code of Federal Regulations differently though – Below is the exact text from the Code of Federal Regulations  – am I reading this incorrectly?

  • 440.150   Intermediate care facility (ICF/IID) services.

(a) “ICF/IID services” means those items and services furnished in an intermediate care facility for Individuals with Intellectual Disabilities if the following conditions are met:

(1) The facility fully meets the requirements for a State license to provide services that are above the level of room and board;

(2) The primary purpose of the ICF/IID is to furnish health or rehabilitative services to persons with Intellectual Disability or persons with related conditions;

(3) The ICF/IID meets the standards specified in subpart I of part 483 of this chapter.

(4) The beneficiary with Intellectual Disability for whom payment is requested is receiving active treatment, as specified in §483.440 of this chapter.

(5) The ICF/IID has been certified to meet the requirements of subpart C of part 442 of this chapter, as evidenced by a valid agreement between the Medicaid agency and the facility for furnishing ICF/IID services and making payments for these services under the plan

So, my questions are is our state our of compliance by the ICF/ID or RHC not being a healthcare facility?

If so, how is this remedied?