State’s home care initiative increased patient safety, created burdensome aide certification process, audit finds

A landmark Washington initiative succeeded in making home care patients safer but also created a long, arduous certification process for their aides – a process about two-thirds of applicants never complete, according to a new audit. 

Initiative 1163, passed in 2011, set new standards for the training and certification of home care aides. Home care aides help people perform activities of daily living such as dressing, bathing and transferring in and out of a wheelchair or bed.  

Legislators asked if I-1163 is achieving its intended outcomes, and what improvements might benefit both aides and their clients. In response, the Office of the Washington State Auditor conducted a performance audit looking at key goals of the initiative, including increasing both patient safety and the availability of trained home care aides. 

Among the audit’s findings: 

• The initiative’s requirement that employers conduct an FBI background check of prospective home care aides when they are hired clearly contributes to patient safety. 

• However, the law also requires the state Department of Health (DOH) to confirm that background check months later – a redundant, time-consuming step for thousands of applicants that requires three full-time state workers to process. 

• Aides are required to apply to DOH for a certificate before they start training, but many never complete the training or do not take the required tests – in fiscal year 2024, that made the processing of more than half of 12,900 applications a waste of state time. 

• Most (88%) home care aides complete their required training within 120 days of hire. 

• However, aides then wait months to take required tests and receive state certification – it took DOH an average of 86 days to issue a certificate to a fully qualified aide in fiscal year 2025.  

• Recognizing the challenges aides faced in meeting a statutory deadline of certification of 200 days after hire, the Legislature allowed a later deadline – 365 days in 2025. Nonetheless, in fiscal year 2025, certification took an average of 463 days after hire.  

Overall, auditors found about a third (39 percent) of applicants for home care aide certification are eventually certified.  

The audit found a few changes could transform the certification process for aides and employers alike. The audit recommends a more streamlined certification process, in part modelled on DOH’s own successful nursing assistant program. For example, skills and knowledge testing could be incorporated into training programs, an option offered by some programs now. 

“It is possible to smooth the path for those who want to take on this challenging work, while continuing to protect the vulnerable Washingtonians who need and deserve their help,” said State Auditor Pat McCarthy.  

The full audit, including detailed findings and recommendations, can be found on the State Auditor’s Office website: Evaluating Success of the Restoring Quality Home Care Initiative (I-1163). 

Media questions: Assistant Director of Communications Adam Wilson, Adam.Wilson@sao.wa.gov, 564-999-0799.