Initiative 1029 increasing requirements to be a long term care provider

This measure would require long-term care workers to be certified as home care aides based on an examination, with exceptions; increase training and criminal background check requirements; and establish disciplinary standards and procedures.

Another initiative for which I have experience. However, I’m not nearly so sure about my choice in this case.

On behalf of my mom, I hired and had experience with seven different caregivers during the last four months of her life. In addition, I had a fair amount of contact with hospice workers who would be covered under the act. The initiative will also cover nursing home and care facility workers, and I didn’t have that experience with mom.

No one wants to put their loved ones in a nursing home or care facility only to have the facility cut corners, make ends meet, or increase profits by hiring unqualified help that’s cheaper than needed to do a job properly. But people also don’t want to pay a lot of money for this care.

The same problem exists for the situation mom was in. We wanted qualified people, but my mom also didn’t want to spend a lot of money. At the current going rates, she could actually afford a year+ of full time care, but she’s frugal. Other folks may not have the nest egg mom had, and so cost is a huge issue.

The problem is fairly simple economics. If you limit supply (by imposing a minimum level of quality), prices will rise.

It doesn’t take a lot of training to be able to do the job needed to care for my mother. Not minimally at least. By imposing legal minimums I suspect more folks will just go outside legal providers and use unlicensed providers. I couldn’t find a penalty in the law that would have applied to my family. They all seem to apply to businesses. Three of our seven caregivers were people we hired and put on our own payroll and paid taxes for and everything. Three were self-employed, and I believe they could be penalized, though I’m not sure how they could be caught if they avoided the requirements. But I digress a little. If I can’t afford to hire people who have the minimum legal qualifications through a licensed agency or similar, I would absolutely have to hire unlicensed workers directly. For people who need caregivers, there is little other option. We can’t just go without. Someone has to bathe mom, or brush her teeth, or wipe her bum, or move her so she doesn’t get a bedsore. Under the initiative, legally that could only be a licensed person, or a very close family member. Few families will have enough close family members to provide 24 hour care. They can pony up the extra money for licensed, but if you ain’t got it (and it’s expensive even for unlicensed folks currently) or you got a little but have to make it last, a lot of people will just hire unlicensed folks.

How bad was the caregiving we got? Not awful, but I hated the experience. I would have preferred to pay more and get better care (mom was “frugal” though). Physically, we had few issues. One caregiver was ditzy and mixed mom’s food wrong. And a couple were pretty locked in to their belief that pain medication was the right thing for all terminal patients. Nothing big. The real problem we experienced was that the caregivers all had personal issues that affected their readiness to work. Nothing that would come up in the required background check. Sick days that were called in 1/2 hour after their shift started. Mental health days because the work is stressful. People taking other jobs without telling us and not working for us, last minute. People overestimating how much they could handle. I think with the increased pay that would occur with the increased requirements, some of these issues would go away, because better adjusted people would be attracted by the higher pay.

So, is the initiative worth it? I’m inclined to say no. We could have paid more anyway and gotten higher quality. There’s nothing preventing people from hiring people right now who have 75 hours of training. Sucks for the people who can’t afford it and don’t get assistance (or enough assistance). They will be stuck with lower quality care. But I think that would be the case regardless.

I do like some aspects. I like the idea of a minimal license requiring a background check that could be revoked on misconduct.

I think most of the goals could be accomplished without pricing everyone out. Add an endorsement(s) on that license for additional training. Generous subsidies for people who hire trained folks. Rather than forbid people from working without training, make it worth their while to get it. It would cost a lot, but it would have a lot better chance of succeeding.

A couple of big negatives with the proposed initiative aside from economics. Legally, I wouldn’t be able to care for a family member unless they were a biological, step, or adopted parent or child. I could not care for a brother. My step-father might not legally qualify, since I was never adopted. Perhaps since he cared for me before I turned 18 he qualifies, but if mom re-married after I was an adult, would he be my legal step-father? What about cousins? I couldn’t care for my grandparents legally without yearly training and licensing. The definition of family is pretty narrow.

So I think I will vote NO on this initiative. I think it will only have limited success as currently structured. But I don’t have a crystal ball and I don’t think it will hurt much either if passed. Some folks will just go the unlicensed route. Basically, the government would have to fork out some dough to accomplish the goals, and this doesn’t do it that way.

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