Push on for more caregiver training

With a first-aid card and some training about CPR and HIV, you can find yourself a challenging new job, caring for the elderly and infirm, bathing them, feeding them and fielding punches from them.

For this, you can make about $7.50 an hour. At McDonald's, you can make more slinging burgers and fries.

It's a wonder anyone cares for the elderly and infirm at all.

Now, for the third time in the past four years, Kary Hyre, the state's long-term-care ombudsman, is pushing for more training for the caregivers who work in the state's 2,100 adult-family homes and 493 boarding homes.

"The Legislature and the industry both need to step up and say this is an important key profession," said Hyre, who is independent of any government agency. "People who take care of human beings are important people."

Almost 32,000 people, coping with everything from Alzheimer's to schizophrenia, live in the state's adult-family homes and boarding homes.

Hyre's report, like his previous ones, parades their pain and humiliation. Meet the developmentally disabled man left stewing in briefs saturated with urine. Or the elderly woman with dementia, osteoarthritis and Parkinson's disease. Although she was dependent on staff to help her with everything, they failed to notice a pressure sore that developed on her back before it had grown to 3 inches long and burrowed 2 inches deep, to the bone.

One man, only able to walk short distances with a walker, lived for four years in a Vancouver, Wash., adult-family home. He developed 13 pressure sores, including one on his left heel that became black and mushy. His bone became infected. When he landed in the hospital, he was wearing two briefs for incontinence, saturated with urine and feces.

The ombudsman's report, released Wednesday, is the latest volley in a series of pitches at state government to improve care in long-term facilities. Advocates have been asking for more training and more pay for caregivers for years.

A report commissioned by the state Attorney General's Office, also released Wednesday, also pointed out how gaps in the system might be closed. And a state task force on long-term care just released a report it had been working on for two years on beefing up caregiver training.

The Legislature, prompted by the task force, is considering a bill that would increase the training requirements for caregivers. And Gov. Gary Locke has already earmarked about $1.6 million in his budget proposal to improve caregiver training in the next 18 months.

The bill would increase the training for caregivers and also aim to test that training, whether with hands-on work or actual written tests. The bill would also require caregivers to be trained to care for special needs, such as dementia, mental health and developmental disabilities.

Right now, caregivers in adult-family homes and state-funded boarding homes are required to get 22 hours of training - but they can still work unsupervised during the four months they have to complete the training. And people who work at private boarding homes only need first-aid cards and training about HIV and CPR.

"What we tried to do is ensure the caregivers were better trained, hopefully better paid, and had some specialized training, in order to take better care of people," said Democratic Sen. Pat Thibaudeau of Seattle, the chairwoman of the Health and Long-Term Care Committee.

The proposed bill does not include any provision for a pay increase for caregivers.

The bill is scheduled for a hearing at 1:30 p.m. tomorrow in front of the Health and Long-Term Care Committee in the Senate.

"I don't expect this to be controversial, really," said Rep. Eileen Cody, the co-chairwoman of the House Health Care Committee and a member of the long-term-care task force. "We've worked on it so long. All the interest groups have been included. Everyone acknowledges that we need to move forward with training."

Hyre said the bill was a step forward although it didn't do everything needed.

Hyre's report says that caregivers should also go through a minimum-training course, similar to the one required for certified nursing assistants, of roughly 86 hours. They should also be required to be certified in a new category, "certified resident assistant," that would be geared toward people working in adult-family homes and boarding homes.

Of the 9,290 citations issued to boarding homes and adult-family homes in the past two years, more than 50 percent involved poor training or showed a lack of training.

The ombudsman's report also referred to the December series in The Seattle Times, "No Justice for Throwaway People," which highlighted stories of crimes against the elderly and infirm. Like the series, Hyre pointed out that the state was hampered in investigating abuse cases because caregivers failed to recognize abuse and intervene.

For instance, one Tacoma boarding home had at least 15 incidents of aggression between residents and each other or staff. Residents punched, kicked and pushed others.

Staff members never reported these incidents to the Department of Social and Health Services (DSHS), although they are required to. They said they didn't even know the state's complaint hotline number.

Hyre has asked for improvements in staff-training requirements in the last three reports. And what has happened to those recommendations? "Zip," Hyre acknowledged with a sigh.

But those earlier reports included other proposals for changes in adult-family homes and boarding homes, some of which have happened. The state workers responsible for finding new providers of adult-family homes, for instance, are no longer also responsible for policing those same homes, reducing the potential for a conflict of interest.

And after complaints about how the state Department of Health managed boarding homes, jurisdiction was switched temporarily to DSHS. The Legislature might make that switch permanent this year.

Hyre is hopeful that her new report will lead to similar changes.

"After raising it for three reports in a row, and not having any real progress, we thought we just can't let go until it gets fixed," Hyre said.