State Moving Toward Licensing Home Health Workers

by David Gorn


Two bills have been proposed to regulate an estimated one million unlicensed home health workers in California. The big questions are, how much regulation is needed, and how much that type of program will cost. One of the bills, AB 899 by Mariko Yamada (D-Davis), has looser requirements and is currently stuck in the Assembly appropriations committee.

The one more likely to make it to the floor is SB 411 by Curren Price (D-Inglewood), which would require background checks and care instruction for all home health care workers. It is expected to be taken up for a floor vote as soon as the end of January.

SB 411 is the one up for debate and possible amendment, according to Jordan Lindsey, director of policy and public affairs for CAHSAH, the California Association for Health Services at Home.

The big issue we're facing [with SB 411] is the cost," Lindsey said. "It's a huge new program, which might be a lot to ask, given the budget constraints we're going through."

Last year's estimate from appropriations was that the program would cost about $1 million to start up, and $8 million every year to run the background checks. But new analysis points to a cost of as much as $25 million a year, Lindsey said.

The bill passes some of the cost of the program on to home health care agencies and individuals in the form of licensing fees. "What it breaks down to is about $4,000 a year in licensing fees," Lindsey said. "I think most of the agencies can do that. But then for every home health aide, it would be another $165 per aide per year."

And if that turns out to be the cost, he said, that's a significant burden to agencies. "Basically you're paying $20,000 a year just to stay in business," Lindsey said.

The bill, backed by the Service Employees International Union, has ramifications for labor unions as well as for consumer protection.

CAHSAH is pushing an amendment that abandons a complete online registry in favor of a system resembling Trustline, the state's background check service for child care providers.

Tim Colling
Cynthia - again, I do not mean to belittle your awful experience. I'm interested to know: was the agency that placed those caregivers with your mother an employer-model company, that is, did they acknowledge that they were the employer of the caregivers?
Tim Colling
Just to be very transparent and clear with everyone, here's my disclosure: I own a small business that has been in the private-sector, employer-model home care business for nine years. We have provided thousands of hours of service and have never had any incidents of harm being done to clients. We actually believe that home care companies should be licensed. We support the other home care licensing bill, AB 899, because that bill is much more achievable and much less intrusive. So, do I have a particular point of view, based on my work? Yes. How about the others on this thread? Care to share?
Tim Colling
Are the workers in Adult Day Health Centers all required to be individually licensed, with the cost of the license required to be paid by the employer, not the employee? Are the names of all the employees of the centers published in a list on the web, violating their privacy? Those are two of the things required under this bill.
Tim Colling
Lupe and Cynthia are mistaken. This bill will do little to reduce harm done to the majority of consumers, because it only applies to companies and caregivers when the company acts as the employer of the caregivers. This bill does NOT apply to: 1) non-employee caregivers provided by non-employer “domestic referral agencies” 2) caregivers hired privately by the clients themselves or their families 3) IHSS caregivers Why don't we require that ALL caregivers be individually licensed by the state? Why don't we make ALL caregivers pay for the cost of that license themselves, just like other skilled trades that require such licenses like contractors, etc. This is bill increases the cost of doing business for employers, and it makes it easier for the unions to identify and target the workers in those companies to try to bully them into joining a union. Unions win, consumers don't, in this one.
Lupe Feldhaus
Cynthia is correct. Let's do what is right for the patient. We do not need to read about any more abuse cases. Many of us working with the most vulnerable know that licensing and certification is an absolute. A license and a certificate will not bring down the numbers of abuse cases; however it will weed out a good percentage of individuals that should not be allowed to work in the care giving industry. As for the other comments…let’s not get political and start a blame game (i.e. Unions, Democrats, etc.)...we all must work together for the change.

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