Lawmakers consider expanding state registry of health care workers

State lawmakers are considering a bill that would expand Iowa’s registry of the direct-care workers who provide services for the sick, elderly and disabled.

Backers say an expanded registry would help the state and its employers identify and utilize qualified health care workers. It’s a tool, they say, that could have been of use during the current COVID-19 pandemic.

The bill, House File  402, would require the Iowa Department of Inspections and Appeals to expand its existing, federally mandated registry of direct-care workers to include not only the certified nurse assistants who work in nursing homes and care facilities, but all types of direct-care workers, regardless of their employment setting.

Direct-care workers include not only nurse aides, but home care and hospice aides, universal workers, patient care technicians, direct support professionals and others. Advocates says an expanded registry would help seniors remain in their homes longer and help employers determine just how much training and work experience prospective employees have.

“From an employer perspective, if there was a singular location to find the information that this would capture, it just makes vetting and hiring that much quicker,” said Jim Knoepfler of EveryStep Care & Support Services. “In the face of this pandemic where caregivers have been desperately needed, it certainly would have been an avenue, a conduit to find people that have the training and the capability that maybe aren’t currently in that role.”

The legislation is backed by AARP of Iowa, United Way of Central Iowa, the Iowa Rural Health Association and the Older Iowans Legislature. It is opposed by several companies and organizations that employ direct-care workers in Iowa, including Mosaic, Exceptional Persons and Nishna Productions.

Earlier this week, the bill was introduced in the Iowa House and referred to the House committee on human resources.

There are an estimated 60,000 direct-care workers in Iowa, but according to the professional association Iowa CareGivers, the number of people working in the field is shrinking at the same time demand for their services is increasing.

The association says the expanded registry would help organize and coordinate a fragmented system of providing health care in Iowa. That system is beset with inconsistencies and a lack of portability with regard to training requirements, as well as a lack of continuing education standards that would enable workers to retain their credentials. Those factors make it difficult for employers to recruit and retain direct-care workers, the association says.

The bill would require the Department of Inspections and Appeals to convene a stakeholder advisory workgroup that would develop a plan for the expansion of the registry and to submit that plan to the governor by year’s end.

In Iowa, the average annual turnover of direct-care workers in nursing homes is 64%. Because nurse aides deliver so much of the hands-on delivery of care in those facilities, the high turnover rate has always been considered a major contributor to deficient care. The median wage for Iowa’s direct-care workers is $13.80 an hour.

Michael Owens, a direct support professional in Iowa, said with no statewide database to maintain training records, direct-care workers are sometimes forced to undergo costly and repetitive training. “I see so much in-house training going on at facilities and when you leave you don’t take those new credentials with you,” he said. “You have to start all over and be retrained somewhere else.”

The lack of a comprehensive registry also means there’s no listing of qualified home health aides that can make it easier for older Iowans to remain in their home rather than move to a care facility.

“Iowans who already struggle with health and disability related issues should not have to struggle to find caregivers,” said Jenn Wolff, Iowa Disability League.

Tony Vola of the Older Iowans Legislature said Iowa employers currently depend on workers to disclose their training and work experience, but the state isn’t capturing any of that data. Doing so, he said, “will help ensure we have the correct workforce available to employers to meet demand and changing environments.”