Evaluating Success of the Restoring Quality Home Care Initiative (I-1163)

To become a certified home care aide, applicants navigate a multistep process involving several organizations.

• The Department of Health (DOH) receives and processes applications, contracts with a statewide testing vendor, and certifies applicants who pass the required exams.
• The Department of Social and Health Services (DSHS) designs the training, approves training providers, and conducts background checks.
• Training programs include the Training Partnership—a nonprofit school operated by SEIU 775 Benefits Group—and other DSHS‑approved instructors.
• Employers also play a role by initiating background checks, helping applicants complete documentation, and supporting them through training and testing.

Once certified, home care aides may be employed by private home care agencies, by clients directly, or by the Consumer Direct Care Network Washington under contract with DSHS.

I‑1163 included several measures designed to better protect people who rely on long‑term care services.

• Expanded background checks. Requiring FBI background checks for all long‑term care workers adds a layer of protection beyond Washington’s existing checks, and the State Auditor’s Office found this requirement contributes to client safety.
• More training for aides. Additional training hours and new skills and knowledge tests aim to ensure aides are prepared to handle issues like infection control, food safety, and respecting client rights.
• A registry of substantiated findings. This tool helps employers see whether an applicant has a record of abuse, neglect, financial exploitation or abandonment, which can serve as an essential safeguard for vulnerable clients.

However, we found the state lacks the baseline data needed to measure the initiative’s full benefit. No agency collected baseline safety data before I‑1163 took effect. Without it, the state cannot determine whether it improved outcomes such as reduced abuse or neglect. Older data predating 2011 is also difficult to retrieve, making long‑term trend analysis challenging.

A safe long‑term care system requires not only strong protections but also enough trained caregivers. Workforce shortages limit clients’ access to care and can undermine the initiative’s broader goal of protecting vulnerable residents.

Even as some I‑1163 requirements improve safety, Washington—like the rest of the country—faces a persistent shortage of long‑term care workers. The situation is not as severe as in some states, but some policymakers and providers worry the certification process may have reduced the number of people who enter the field. While national data suggests training requirements alone do not significantly affect who becomes a direct care worker, Washington’s complex process does pose challenges.

The audit found many applicants do not complete certification

Of roughly 13,000 applicants in FY 2024, only 5,000 were certified. Nearly two‑thirds did not finish training, testing or certification. While aides can drop out for many reasons, including changing career path or leaving the state, this high number indicates the system itself may discourage potential workers.

The possible loss – for whatever reason – of about 8,000 potential caregivers may contribute to access gaps for clients: Medicaid data shows about one‑third of clients used 75% or less of their authorized care hours. Some groups of clients tended to use very low percentages of hours, with significant trends for characteristics including age (specifically if the client was a child), provider type, race and geographic region. The greatest influence was whether the client was cared for by an individual provider or through an agency.

Washington’s home care aide certification process has become increasingly complicated since I‑1163 took effect. The initiative split responsibilities between two major state agencies — one designing and regulating training, the other administering certification and testing — resulting in a fragmented system that is difficult for applicants to navigate.

• Early application requirement adds extra burden at DOH. DOH requires aides to apply as soon as possible. Many applicants later abandon the process, yet DOH staff must still process their initial paperwork.
• Testing delays outside the state’s control. The state’s contracted testing vendor schedules and delivers exams. Its limited capacity, shifting test dates and restricted sites create delays, however without competition for the contract, DOH has little leverage to make the contractor improve these services.
• Redundant background check verification. I‑1163 added a second FBI check verification step at DOH even though DSHS already processes fingerprint‑based checks. This duplication slows the timeline with no added safety benefit.
• Technology and workflow delays compounded the problem. Pandemic‑related timeline changes and DOH’s 2024 licensing system rollout contributed to backlogs that further slowed certification.

Put together, these inefficiencies have created a long, confusing process that can leave applicants caught between agencies, vendors and a nonnegotiable timeline.

The inefficiencies in Washington’s home care aide certification process have real effects on both workers and the people who rely on long‑term care workers. These barriers can discourage applicants and strain employers who depend on reliable staffing.

• High dropout rate. About two‑thirds of applicants do not complete certification—even though they initially showed interest and submitted an application.
• Long delays affect employment. Few applicants receive certification within the statutory 200‑day window. These delays may leave aides unable to work the hours their clients need or unable to continue in their roles.
• Workarounds that undermine the system. Some employers fire and immediately rehire aides to reset their “hire date” and avoid missing certification deadlines—a practice enabled by statutory changes but not intended by policymakers. Applicants themselves sometimes attempt to bypass barriers. Faced with repeated delays or conflicting directions from agencies, some as-yet uncertified aides seek informal ways to navigate the system or avoid certain requirements.

The audit noted improvements that could transform the certification process.

• Model home care aides on the nursing assistant program. The latter provides simpler applications, a faster process and better testing infrastructure.
• Integrate home care aide testing into training. DOH is making important progress in this area, following a 2022 performance audit that recommended DOH allow applicants to test at the same location where they train. Training programs report they want to offer the skills and knowledge tests, although some anticipate challenges.
• Accept and review applications only after aides successfully pass their tests. Some other states only accept applications after aides have finished training and testing; DOH program managers support this idea and the agency can pursue it without statutory changes.

However, the Legislature would need to change state law to make other improvements to the certification process, for example to eliminate DOH’s redundant verification of the FBI background check. In addition, to reduce the burden of administrative delays, the Legislature could replace the licensure timeline with a training and testing timeline.

We made a series of recommendations to the Department of Health to address delays in the certification process, including to continue integrating testing into training and to only receive applications once applicants have completed training and testing.

We also recommended the Department of Social and Health Services work with DOH to address concerns that some training programs may not be able to test applicants. The two agencies should determine together if some or all training programs should be required to integrate testing into training. In addition, we recommended the Legislature amend laws to facilitate former aides returning to the profession and to streamline the process.