WASHINGTON STATE REGISTER

WSR 01-23-074

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Adult Services Administration)

[ Filed November 20, 2001, 3:52 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 00-23-049.

Title of Rule: New WAC 388-112-0180 through 388-112-0375, Residential long-term care services -- Training; and amending WAC 388-78A-050 and 388-78A-060, boarding homes.

Purpose: To implement SSB 6502 (chapter 121, Laws of 2000) on training for adult family homes and boarding homes; combine training requirements for these settings into one WAC.

Statutory Authority for Adoption: RCW 18.20.090, 70.128.040, 74.39A.050, and 34.05.020.

Statute Being Implemented: Chapter 121, Laws of 2000.

Summary: Implements requirements for licensed boarding home administrators and caregivers to have continuing education, moves all training requirements for these two settings into one training WAC, and implement processes for approval of alternative curricula and instructors.

Reasons Supporting Proposal: Implementing statutes referenced above.

Name of Agency Personnel Responsible for Drafting: Dotti Wilke, P.O. Box 45600, Olympia, WA 98504-5600, (360) 725-2539; Implementation and Enforcement: Marta Acedo, P.O. Box 45600, Olympia, WA 98504-5600, (360) 725-2549.

Name of Proponent: Department of Social and Health Services, governmental.

Rule is not necessitated by federal law, federal or state court decision.

Explanation of Rule, its Purpose, and Anticipated Effects: This rule implements RCWs on training for adult family homes and boarding homes, and consolidates the current training rules for those settings into one place. The rules also set the processes for approval of instructors and alternative curricula for certain trainings. New requirements in the RCW include requirements for licensed boarding homes for administrators, or their designees, and caregivers to have continuing education.

Proposal Changes the Following Existing Rules: This proposal moves existing rules into one new rule.

A small business economic impact statement has been prepared under chapter 19.85 RCW.

Small Business Economic Impact Statement
SUMMARY OF PROPOSED RULES: The Department of Social and Health Services' Aging and Adult Services Administration (AASA) is proposing to create a new chapter, chapter 388-112 WAC, Home and community long-term care services -- Training. The new chapter contains the training rules for:

&sqbul; Adult family homes, and

&sqbul; Boarding homes.

The new chapter 388-112 WAC consolidates training rules by including rules moved from:

&sqbul; Chapter 388-76 WAC, Adult family homes;

&sqbul; Chapter 388-78A WAC, Boarding homes; and

&sqbul; Chapter 388-110 WAC, Contracted residential services.

The chapter also contains new rules implementing changes mandated by the following RCWs:

&sqbul; Chapter 18.20 RCW, Boarding homes, and

&sqbul; Chapter 70.128 RCW, Adult family homes.

The purpose of this chapter is to:

&sqbul; Define minimum training requirements;

&sqbul; Define the types of training;

&sqbul; Clarify curriculum requirements and instructor requirements; and

&sqbul; Establish department procedures for approval of curricula and instructors.

The statutory authority for these chapters includes RCW 18.20.270 Boarding homes and 70.128.230 Adult family homes.

The major proposed changes are:

&sqbul; Incorporating a new requirement for orientation training for new staff in both settings, as required in chapters 18.20 and 70.128 RCW.

&sqbul; Incorporating new training requirements for licensed boarding homes that do not contract with DSHS, including orientation, basic training, special needs (specialty) training, and continuing education, as required in RCW 18.20.270.

&sqbul; Creating an approval system for alternative curricula for basic and specialty training, as required by RCW 18.20.270 Boarding homes and 70.128.230 Adult family homes.

&sqbul; Creating an approval system for trainers as required by the RCWs.

Background of the proposed rule: In 1995, as part of long-term care reform, the legislature allocated funds for training during the following year. Providers and caregivers who were trained included:

&sqbul; Caregivers in boarding homes that contract with DSHS; and

&sqbul; All licensed adult family home providers and caregivers.

In 1997, two task forces were created under the auspices of the legislature, to review caregiver training:

&sqbul; The Joint Executive-Legislative Long Term Care Task Force's subcommittee on training. This task force reported to the legislature in December 1998 and January 2000.

&sqbul; The training task force, which DSHS, the Department of Health, and the Nursing Care Quality Assurance Commission created, under legislative directives, to review caregiver training. This task force reported to the legislature in December 1998.

Recommendations from both task forces were key in establishing new training requirements created by legislation in the 2000 session. This same legislation created the Community Long Term Care Education and Training Steering Committee to advise the department on the development of rules to implement the new law. (See RCW 74.39A.190.)

Goals for the proposed rules:

&sqbul; Increase the number of caregivers who will be trained;

&sqbul; Ensure that all caregivers have an orientation when they begin to work with residents; and

&sqbul; Allow more boarding homes and adult family homes to teach their own staff and use their own curricula.

Training improves caregiving skills and the quality of care delivered to more than 7,000 adults receiving care through these programs.

SMALL BUSINESS ECONOMIC IMPACT STATEMENT: Chapter 19.85 RCW, the Regulatory Fairness Act, requires that the economic impact of proposed regulations be analyzed in relation to small businesses. This statute outlines information that must be included in a small business economic impact statement (SBEIS). Preparation of an SBEIS is required when a proposed rule has the potential of placing a disproportionate economic impact on small businesses.

Aging and Adult Services Administration has analyzed the proposed amendments to their rules and has determined that small businesses will be impacted by these changes, with some costs considered "more than minor."

INDUSTRY ANALYSIS: Aging and Adult Services Administration is responsible for boarding home and adult family home licensing. As part of licensing, this state agency keeps current internal databases that identify all licensed facilities and agencies. Since internal industry information can be obtained at a more accurate level than is required by chapter 19.85 RCW, it is unnecessary to conduct an industry analysis using the four-digit standard industrial classification (SIC) codes.

INVOLVEMENT OF SMALL BUSINESSES: The data used in this analysis was gathered from several sources:

&sqbul; The statewide organizations that represent the 2084 adult family homes, and 513 boarding homes affected by these proposed rules.

&sqbul; The residential care services and management services divisions of the Aging and Adult Services Administration.

The organizations that contributed current data on wages, benefits, and cost estimates for the businesses they represent, most of which are small businesses, include: Washington State Residential Care Council (AFH), the Adult Family Home Association (AFH), Washington Health Care Association (BH), Washington Association of Housing and Services for the Aging (BH), and Northwest Assisted Living Facilities Association (BH).

This proposed chapter has been developed with the advice of the training steering committee, which has been meeting monthly for fifteen months to consider and recommend the rules to implement these laws. Represented in this committee are small business members from the statewide provider organizations mentioned above.

In addition, four public forums were held during the summer in (Bellevue, Lacey, Spokane, and Yakima) to discuss the rule development and take public comment on the proposed rules as recommended by the steering committee. Approximately 2,000 interested parties were invited; seventy-seven people attended and commented. Small businesses were represented at these forums, as well.

AASA staff have also regularly attended meetings with adult family home and boarding home providers for the past year to update them on the rule development and take their comments and suggestions. To reach those who could not attend meetings, the proposed rules as recommended by the steering committee have been posted on the AASA Internet web site, with contact person information for anyone wishing to comment or make suggestions on the rule. All the input from these various groups and meetings has helped shape the development of this rule.

COST OF COMPLIANCE: Costs related to record keeping: Each business must keep on file copies of certificates showing successful completion of required trainings for each of their employees. The only new record-keeping requirement for boarding homes that contract with DSHS and adult family homes is orientation. The new requirements for boarding homes that do not contract with DSHS include orientation, basic training, and continuing education. Boarding homes that contract with DSHS already meet these requirements under contracting rules, so they will incur no additional costs. Training costs are included in the DSHS rates paid to both boarding homes and adult family homes. Keeping these certificates on file will result in a minor cost to the business.

Costs related to professional services: In estimating costs, AASA has chosen to assume that staff are trained on-site for orientation, and sent off-site for other trainings, with the intent that these are probably the highest cost scenarios. However, if a boarding home or adult family home chooses to contract with a trainer to come in and provide training in their own facility, this will result in costs for the professional services of a trainer. This training strategy, however, eliminates the costs of paying tuition and paying for travel time to and from training, for each trainee.

Estimated training costs: Expected costs include:

&sqbul; The trainer's wages and benefits (if an on-staff trainer is used, as for orientation);

&sqbul; The trainee's wages and benefits; and

&sqbul; Costs for training materials (if training is on site) or for tuition, if off-site.

See Tables 1 and 2 below for estimated costs for each type of provider.

To fairly consider costs of compliance, AASA has elected to look at costs per trainee. This is because there is no reliable data on the number of employees that will be required to have this training, or the rate of turnover, both of which affect total training costs.

In each setting, the most costly wage scenarios were used for cost estimates. These include:

&sqbul; For orientation, using a registered nurse as the orientation trainer, and assuming a one-on-one training, rather than in a group;

&sqbul; For basic training, assuming the facility will pay tuition rather than providing training at the facility.

&sqbul; For continuing education, assuming the facility will pay tuition rather than providing training at the facility.

Circumstances that may be used to mitigate these costs are noted in the section on mitigating expenses, which follows the cost estimates.

Specialty training has not been included in this analysis, because the boarding home rules specifying who has to take this training are not yet developed. The Residential Care Services Division of AASA is in the process of developing these rules with the input of stakeholder workgroups.

Costs of Compliance for Boarding Homes:

&sqbul; Orientation is a new requirement for all boarding homes. It is always provided at the facility, by facility staff.

&sqbul; Basic training is a new requirement for boarding homes that do not contract with DSHS. It may be provided by the facility or staff may be sent to another educator for training.

&sqbul; Continuing education is a new requirement for boarding homes that do not contract with DSHS. It includes ten hours of training on caregiving issues, per calendar year. The requirement begins the second year after the basic training is completed. It may be provided by the facility, or staff may be sent to another educator for training.

Table 1 Boarding Homes

Training Personnel & other costs Wages Benefits & Taxes Total per hour Hours Tuition
(if applies)
Total Cost

Orientation Trainer (RN) $24.24 $6.14 $30.38 2 N/A $60.76

Trainee $9.15 $2.32 $11.475
43.86
2 N/A $22.94

Materials $10.00

Total per trainee $93.70

Basic Trainee $9.15 $2.32 $11.47 28 $129.00 $450.16

Total per trainee, first year $543.86

Continuing Education

Trainee $9.15 $2.32 $11.47 10 $50.00 $164.70

CE total per trainee per year $164.70

Costs of Compliance for Adult Family Homes: Orientation is a new requirement for all adult family homes. It is always provided at the facility, by facility staff.

Table 2 Adult Family Homes

Orientation	Personnel, other costs	Wages	Benefits & Taxes	Total per hour	Hours	Tuition	Total Cost
	Trainer (RN)	$24.24	$6.14	$30.38	2.00		$60.76
	Trainee	$9.15	$2.32	$11.47	2.00	$0.00	$22.94
	Materials						$10.00

	Total						$93.70

Disproportionate Economic Impact Analysis: When there are more than minor costs to small businesses as a result of proposed rule changes, the Regulatory Fairness Act requires an analysis to be done, comparing these costs between small businesses and 10% of the largest businesses.

All for-profit adult family homes are by nature small businesses; an adult family home can serve a maximum of six residents at a time, and so has a small number of employees. No data is available on the actual numbers of employees in boarding homes, but many or most boarding homes are small businesses with fewer than fifty employees. While the per-trainee costs do not differ between small and large businesses, the costs may be a higher proportion of overall costs for a small business. AASA elected to focus on mitigating expenses regardless of results of comparing large and small businesses; therefore AASA considered this type of comparative analysis unnecessary. Therefore, AASA proposes several measures that will mitigate the impact of costs for small businesses.

Mitigating Expenses: Aging and Adult Services Administration has included the following to help mitigate training costs for small businesses:

&sqbul; Orientation training costs can be significantly reduced if the person doing the orientation is not an RN (high wage rate), for instance, if an LPN does the orientation, the median hourly wage is estimated to be $15.72, and a social worker's median hourly wage is $18.74 (compared to an RN at $24.24). for instance, an RN's median hourly wage is estimated to be $24.24. If an LPN does the orientation, the hourly wage drops to $15.72; if a social worker does the orientation, the hourly wage is $18.74. Both are qualified to do this training. The organization has a choice of who to use in conducting the orientation training.

&sqbul; Orientation training costs are further reduced if the facility orients more than one person at a time. This can be done any time the facility hires several new caregivers and has them start working at the same time.

&sqbul; Individuals who have already been oriented at another facility can have a much briefer orientation at a new facility, which is a savings for the second business. The orientation can be shorter because basic information on the required topics will be consistent across facilities. The facility will be able to spend less time on basic information, and focus primarily on information specific to the facility.

&sqbul; Basic training costs may be mitigated if the training is done on-site. The rules allow for facilities to train their own staff if the instructor(s) meet minimum qualifications. This means the facility does not have to pay tuition for each student, nor pay for travel time and expenses to the training.

&sqbul; Individuals who take basic, specialty training, or continuing education will not be required to take it again if hired at another business where training is required, which is a savings for the second business.

&sqbul; Boarding homes with a new requirement for basic training for caregivers will have up to one hundred twenty days following the effective date of the rule to meet the requirement.

&sqbul; The continuing education requirement does not start until January of the second year after an employee takes the basic training.

&sqbul; Continuing education costs may be mitigated by holding this training at the facility rather than sending staff to an educator, paying for each student's tuition and travel. No pre-approval of trainer or instructor is required.

Additional cost savings:

&sqbul; The orientation reduces the time it takes new employees to begin to provide quality care to residents, which translates into higher satisfaction for the clients, and better word-of-mouth publicity for the agency, which may increase income.

&sqbul; Well-trained employees generally have higher job satisfaction and this leads to a lower turnover rate, significantly reducing overall costs. Turnover rates have been estimated as 50% or higher per year, for caregivers. Village Green, a Washington state boarding home, determined that monthly turnover for caregivers dropped from 21% to under 5% after implementing a thorough orientation program.

CONCLUSION: Aging and Adult Services Administration has given careful consideration to the impact of proposed rules in chapter 388-112 WAC, Home and community long-term care services -- Training, on small businesses. In accordance with the Regulatory Fairness Act, chapter 19.85 RCW, Aging and Adult Services Administration has analyzed impacts on small businesses and proposed ways to mitigate those costs associated with implementing the training requirements in these rules. Training staff adequately to care for adult residents is a benefit to both the resident and the provider.

A copy of the statement may be obtained by writing to Tresa Harambasic, Aging and Adult Services Administration, P.O. Box 45600, Olympia, WA 98504-5600, phone (360) 725-2548, fax (360) 725-2646.

RCW 34.05.328 applies to this rule adoption. A cost-benefit analysis has been prepared concerning these proposed rules, and may be obtained by contacting Tresa Harambasic, Aging and Adult Services Administration, P.O. Box 45600, Olympia, WA 98504-5600, phone (360) 725-2548, fax (360) 725-2646.

Hearing Location: Office Building-2 Auditorium, DSHS Headquarters, 1115 Washington, 14th and Jefferson, Olympia, WA 98504, on January 8, 2002, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by January 4, 2002, phone (360) 664-6094, TTY (360) 664-6178, e-mail fernaax@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, by 5:00 p.m., January 8, 2002.

Date of Intended Adoption: Not earlier than January 9, 2002.

November 14, 2001

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

Reviser's note: The material contained in this filing exceeded the page-count limitations of WAC 1-21-040 for appearance in this issue of the Register. It will appear in the 01-24 issue of the Register.

&sqbul;	Chapter 388-76 WAC, Adult family homes;
&sqbul;	Chapter 388-78A WAC, Boarding homes; and
&sqbul;	Chapter 388-110 WAC, Contracted residential services.

&sqbul;	Chapter 18.20 RCW, Boarding homes, and
&sqbul;	Chapter 70.128 RCW, Adult family homes.

&sqbul;	Define minimum training requirements;
&sqbul;	Define the types of training;
&sqbul;	Clarify curriculum requirements and instructor requirements; and
&sqbul;	Establish department procedures for approval of curricula and instructors.

&sqbul;	Incorporating a new requirement for orientation training for new staff in both settings, as required in chapters 18.20 and 70.128 RCW.
&sqbul;	Incorporating new training requirements for licensed boarding homes that do not contract with DSHS, including orientation, basic training, special needs (specialty) training, and continuing education, as required in RCW 18.20.270.
&sqbul;	Creating an approval system for alternative curricula for basic and specialty training, as required by RCW 18.20.270 Boarding homes and 70.128.230 Adult family homes.
&sqbul;	Creating an approval system for trainers as required by the RCWs.

&sqbul;	Caregivers in boarding homes that contract with DSHS; and
&sqbul;	All licensed adult family home providers and caregivers.

&sqbul;	The Joint Executive-Legislative Long Term Care Task Force's subcommittee on training. This task force reported to the legislature in December 1998 and January 2000.
&sqbul;	The training task force, which DSHS, the Department of Health, and the Nursing Care Quality Assurance Commission created, under legislative directives, to review caregiver training. This task force reported to the legislature in December 1998.

&sqbul;	Increase the number of caregivers who will be trained;
&sqbul;	Ensure that all caregivers have an orientation when they begin to work with residents; and
&sqbul;	Allow more boarding homes and adult family homes to teach their own staff and use their own curricula.

&sqbul;	The statewide organizations that represent the 2084 adult family homes, and 513 boarding homes affected by these proposed rules.
&sqbul;	The residential care services and management services divisions of the Aging and Adult Services Administration.

&sqbul;	The trainer's wages and benefits (if an on-staff trainer is used, as for orientation);
&sqbul;	The trainee's wages and benefits; and
&sqbul;	Costs for training materials (if training is on site) or for tuition, if off-site.

&sqbul;	For orientation, using a registered nurse as the orientation trainer, and assuming a one-on-one training, rather than in a group;
&sqbul;	For basic training, assuming the facility will pay tuition rather than providing training at the facility.
&sqbul;	For continuing education, assuming the facility will pay tuition rather than providing training at the facility.

&sqbul;	Orientation is a new requirement for all boarding homes. It is always provided at the facility, by facility staff.
&sqbul;	Basic training is a new requirement for boarding homes that do not contract with DSHS. It may be provided by the facility or staff may be sent to another educator for training.
&sqbul;	Continuing education is a new requirement for boarding homes that do not contract with DSHS. It includes ten hours of training on caregiving issues, per calendar year. The requirement begins the second year after the basic training is completed. It may be provided by the facility, or staff may be sent to another educator for training.

Training	Personnel & other costs	Wages	Benefits & Taxes	Total per hour	Hours	Tuition (if applies)	Total Cost
Orientation	Trainer (RN)	$24.24	$6.14	$30.38	2	N/A	$60.76
	Trainee	$9.15	$2.32	$11.475 43.86	2	N/A	$22.94
	Materials						$10.00
	Total per trainee						$93.70

Basic	Trainee	$9.15	$2.32	$11.47	28	$129.00	$450.16

	Total per trainee, first year						$543.86

Continuing Education
	Trainee	$9.15	$2.32	$11.47	10	$50.00	$164.70
	CE total per trainee per year						$164.70

&sqbul;	Orientation training costs can be significantly reduced if the person doing the orientation is not an RN (high wage rate), for instance, if an LPN does the orientation, the median hourly wage is estimated to be $15.72, and a social worker's median hourly wage is $18.74 (compared to an RN at $24.24). for instance, an RN's median hourly wage is estimated to be $24.24. If an LPN does the orientation, the hourly wage drops to $15.72; if a social worker does the orientation, the hourly wage is $18.74. Both are qualified to do this training. The organization has a choice of who to use in conducting the orientation training.
&sqbul;	Orientation training costs are further reduced if the facility orients more than one person at a time. This can be done any time the facility hires several new caregivers and has them start working at the same time.
&sqbul;	Individuals who have already been oriented at another facility can have a much briefer orientation at a new facility, which is a savings for the second business. The orientation can be shorter because basic information on the required topics will be consistent across facilities. The facility will be able to spend less time on basic information, and focus primarily on information specific to the facility.
&sqbul;	Basic training costs may be mitigated if the training is done on-site. The rules allow for facilities to train their own staff if the instructor(s) meet minimum qualifications. This means the facility does not have to pay tuition for each student, nor pay for travel time and expenses to the training.
&sqbul;	Individuals who take basic, specialty training, or continuing education will not be required to take it again if hired at another business where training is required, which is a savings for the second business.
&sqbul;	Boarding homes with a new requirement for basic training for caregivers will have up to one hundred twenty days following the effective date of the rule to meet the requirement.
&sqbul;	The continuing education requirement does not start until January of the second year after an employee takes the basic training.
&sqbul;	Continuing education costs may be mitigated by holding this training at the facility rather than sending staff to an educator, paying for each student's tuition and travel. No pre-approval of trainer or instructor is required.

&sqbul;	The orientation reduces the time it takes new employees to begin to provide quality care to residents, which translates into higher satisfaction for the clients, and better word-of-mouth publicity for the agency, which may increase income.
&sqbul;	Well-trained employees generally have higher job satisfaction and this leads to a lower turnover rate, significantly reducing overall costs. Turnover rates have been estimated as 50% or higher per year, for caregivers. Village Green, a Washington state boarding home, determined that monthly turnover for caregivers dropped from 21% to under 5% after implementing a thorough orientation program.

Washington State Code Reviser's Office