REFRESHER: Caregiver Training & Background Checks for Assisted Living, Home Care & Health

Many members have been asking clarifying questions about the new laws for home care aides, formerly known as caregivers, as they contemplate compliance requirements for new hires and existing employees of assisted living, adult family homes and home care.  This is a comprehensive compilation of the topics discussed with members to date:

Contact Julie Martin for assistance, additional information or if you have challenges with any of the embedded links below. 

1. Re: Background checks in general: A new crime has been added to the DSHS List of Crimes and Negative Actions as of December 1, 2011, Endangerment with a Controlled Substance. This is a permanently disqualifying crime for unsupervised access to vulnerable adults. The revised disqualifying crime list can be accessed here.
2. UPDATED: Newly hired (on or after January 7, 2012) long term care workers must undergo FBI Fingerprint Background Checks in addition to the state’s BCCU checks.  This includes RNs, LPNs, NACs and non-credentialed direct care workers.
3. FBI Background Checks are not required of existing boarding home caregivers or of boarding home administrative/clerical workers. They are not required of nursing home workers.  For those of you who might share staff between care settings on your campus, this detail will need to be factored in to your hiring/screening processes.
4. You will continue to use your Assisted Living Background Check Account Number as you do now for the state's BCCU check.  Do not use your Nursing Home Background Check Account Number for new assisted living employees.
5. FBI Fingerprint Background Checks can only be scheduled AFTER you receive the Interim Result Letter from BCCU. 
6. On this Interim Result Letter will be found a BCCU Inquiry ID/OCA Number. The BCCU Inquiry ID/OCA Number is a required component of the application form for the FBI Background Check.
7. This ID/OCA Number is also a requirement of the employee's application to the Dept. of Health for certification as a home care aide.  Remember that this application is due within three days of hire, and must be accompanied by a non-refundable $60.00 fee.  A conditionally hired new employee is not considered an official hire for the purpose of this three day time period, as BCCU may take more than three days to complete their work and the ID/OCA number will not be available until you've been notified of their interim results. 
8. You may apply for a Fingerprint Background Check appointment online or via telephone.  Unfortunately, there are limited locations and times available for appointments.  Note: A company contracted by the state is conducting the Fingerprint Background Check system.  You will not be coordinating this part of the process through DSHS' BCCU. 
9. Your applicant/new hire must go to an external location to have their fingerprints taken.
10. Once the FBI background check has been completed, you will receive a final Result Letter, also from BCCU.  Note that this letter looks substantially similar to the Interim Result Letter you would have received from BCCU before you scheduled the FBI Fingerprint Background Check.  Read it carefully.
11. You may conditionally hire a long term care worker, as you have in the past, pending the results of either the state or FBI background checks required. 
12. A long term care worker is only allowed 120 days of conditional employment while awaiting the results of the FBI Background Check.
13. NEW: A member has raised a question about the ability of an FBI fingerprint background check result to ‘transfer’ to another place of employment subject to Initiative 1163.  As an example, an employee is hired after January 2, 2012 by Boarding Home A for part time work.  Boarding Home A submits the state background check application and then the FBI check.  The employee is hired – the checks came back ‘clear’.  The same person applies for part time work at Boarding Home B, also after January 2, 2012.  May Boarding Home B rely on the FBI background check conducted as a result of employment through Boarding Home A?  The answer is YES – as long as the employee brings a copy of the complete FBI background check results (including findings if there are any, which means that there may be more than just the final Result Letter from BCCU) with them to Boarding Home B as a part of the application/hiring process.  Boarding Home B needs to keep this documentation on file so that they have proof that they hired based on satisfactory results.  NOTE: The employee/applicant will need to request the full file/packet of documents from the FBI or contractor doing the fingerprint checks if they do not have it.  Interestingly, there is no timeframe at the present time for when an FBI background check is no longer ‘good’ and thus not able to be relied upon for hire in our settings.  An FBI check of 12 months prior is as the same as if it was done within the prior 30 days.
14. You must complete a Character, Competence and Suitability Review and may use the DSHS-developed (C/C/S) form when making the decision(s) to conditionally hire based upon the results of either background check.  For instructions and guidance on using this form, read the information at the bottom of this page.
15. Should you decide NOT to conditionally hire based upon the state background check, you will not schedule a FBI Fingerprint Background Check.
16. The applicant/new hire must be given a copy of both state and FBI background checks completed.
17. You will not be completing an FBI background check on volunteers, contractors, etc.
18. NACs, RNs and LPNs hired on or after January 7, 2012 are no longer required to take the Modified Fundamentals of Caregiving.  
19. NACs, RNs and LPNs hired on or after September 9, 2011 (no more than 120 days prior to January 7, 2012) but before January 7, 2012 must continue to take/test for the Modified Fundamentals as that was a requirement at their time of hire.
20. The Revised Fundamentals of Care formally required of all non-credentialed caregivers will now be only ONE component of several that are required of the new hires.  If your boarding home/assisted living only hires NACs (as the minimum credential accepted) after January 6 of this year, this is a reminder that they are not subject to the requirements of the 70 hours of basic training and certification as a home care aid through the Department of Health.
21. CLARIFICATION: The required 2 hours of orientation and 3 hours of safety training must be completed before a non-credentialed new hire is able to provide care. (NOTE: DOH and DSHS have agreed that NACs, LPNs and RNs are NOT subject to the new 5 hours of safety and orientation training. Also, see the Dear Provider letter linked here.)  DSHS has developed curriculum you may use for these two trainings, if you have not received your own curriculum approval or do not wish to develop and submit your own. You do not need to obtain curriculum approval for the DSHS curriculum, found here.  You must obtain, however, approval to teach the orientation and safety training. Click here for the form and simple instructions.
22. Long term care workers may not be employed by you or anyone else as a caregiver/home care aide/long term care worker at any time that they are out of compliance with these timeframes/deadlines.
23. A new employee is considered a long term care worker and must obtain a home care aide certification if they provide assistance with either Activities of Daily Living OR Activities of Daily Living AND Instrumental Activities of Daily Living. 
24. A person is not required to obtain certification if they provide only instrumental activities of daily living.  DSHS advises caution in your application of this law.  For instance: If your shuttle driver, on occasion, needs to help with the “transfer” of a resident or “assist” the resident onto the shuttle, then they may be performing both activities of daily living AND instrumental activities of daily living.  However, if there is another worker who accompanies the residents and that person is expected to take care of any transfer or assistance, then the shuttle driver may very well be performing only instrumental activities of daily living. If your housekeeper assists the resident off the couch or helps to feed the resident, they may be providing both types of services. If your kitchen or dining staff assists a resident with eating, they may be providing both types of services.  It is up to you to assure that you correctly require certification of any employee who may be performing both types of duties.
25. Note: Based on your staffing models and service delivery, you will likely determine different ‘types’ of staff who may be considered to be a long term care worker and must take the training and become certified.  Activity directors, drivers, housekeeping, kitchen staff are a few that come to mind – just apply the logic of above but perhaps err on the side of caution.
26. If you hire a new Nursing Assistant Registered (NAR), they are exempt from the new training and home care aide certification requirements if they are in an approved training program for certified nursing assistants under chapter 18.88A RCW.  However, they must become credentialed as an NAC within 4 months (120 days) of their employment date.
27. The specialty training requirements such as dementia, mental health and DD remain in place, unchanged, for both new and existing long term care workers.
28. It is incumbent upon you as the employer to obtain and keep records of any employee’s exemptions from the training and certification requirements.  You will need this documentation, if asked, during licensing inspections.  The caregiver, of course, is also liable to fulfill necessary requirements and keep their own proof of completion or exemption as necessary. 
29. If the employee worked for another boarding home in 2011 or prior to January 7, 2012 and fulfilled their training requirements while employed by someone other than your community, you will need proof of that for your own files, i.e. copy of Revised or Modified Fundamentals completion, specialty training, etc., as well as documentation of their prior employment, dates of employment, etc.  If they worked for you in 2011 or prior to January 7, 2012, you will want to document these same details in your files so they are easily available and understandable to the department.
30. UPDATED:  Between now and June 30, 2012 you may continue your current process/system regarding Continuing Education for your NACs and non-credentialed caregivers.  New requirements do not take effect until July 1, 2012. Forms for submittal of instructors and curriculum ARE NOT YET AVAILABLE from DSHS.