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Eliminating Hurry-Up-and-Wait Licensing for New Jersey’s Home Health Aides

Making home healthcare workers wait months for a license only encourages them to leave a field where they’re badly needed, a lose-lose situation

home health aide

The work isn’t glamorous, but a position as a home health aide can be the first step to financial independence for someone with little formal education, few job skills, or a limited ability to speak English. And the care these workers provide can be a lifeline for homebound seniors.

But despite a growing need for home health workers, it can now take months for a qualified applicant to be certified by the New Jersey Board of Nursing. As a result, many potential aides opt for fast-food or retail jobs that come up before the state grants them a license, industry advocates said.

“These are people with limited financial resources trying to get on that first rung of the financial ladder by becoming a home health aide,” said Sen. Robert Gordon (D-Bergen), who said he has been working on the issue for several years.

“They expend personal funds for training and find themselves waiting a very long time … to get certified and start work,” Gordon said. “Many of them simply can’t afford to do that.”

Gordon has been working closely in recent months with officials in the Division of Consumer Affairs, which oversees the nursing board, to speed up the review of homemaker and home health aide applications. These workers bathe, dress, and feed elderly patients, help with household chores and shopping, or similar non-medical tasks.

Home health aides are the workers “keeping people out of nursing homes,” noted Sen. Fred Madden (D-Gloucester), while also benefitting the patient’s family emotionally and financially. And as the Baby Boomer population ages, home health aides will be in even greater demand, experts said.

But with changes not coming as fast as he would like, Gordon introduced legislation earlier this year to allow potential aides to begin work in as few as seven days on a temporary permit. The bill (S-2036), approved by a unanimous vote Monday in the Senate Health Committee, would give the nursing board 120 days to review the full application and issue a license.

The proposal would also urge the nursing board to establish an online application process -- everything is handled on paper now, with some agencies filing information by certified U.S. Mail -- and identify other ways to streamline their review. It would also require the board to establish a home health advisory panel within three months.

“These agencies are beyond frustrated,” said Chrissy Buteas, president and CEO of the Home Care and Hospice Association of New Jersey, which represents most of the organizations that coordinate home health care for Medicaid and private paying patients.

While she praised the state’s recent efforts to improve the process, Buteas noted that the agencies were already struggling to recruit workers, who generally earn between $9.50 and $15 an hour. When new recruits factor in the 76-hour state-required home health-aide training course -- which costs several hundred dollars, a fee not always covered by the agency -- and the $70 state application fee and then must wait for weeks to be certified and start earning, “It’s a double whammy,” Buteas said.

“It’s getting increasingly more difficult” for these organizations to stay in business, she said. “These agencies used to have waiting lists.”

Paul Loriquet, a spokesman for the office of the attorney general, which oversees the Consumer Affairs Division that operates the nursing-licensing board, said the state has been able to speed its licensing processing significantly in recent weeks. Since reforms were implemented in mid-April, staff can now review and rule on an application in 10 to 14 days, he said.

That said, a whopping 80 percent of the applications are incomplete, Loriquet noted, missing personal information, a photograph, proof that the individual completed training, or a letter from the potential employer, all of which are required. Staff will now reach out to the applicant within 48 hours to notify them of any problem and “zero in on that deficiency,” he said.

Loriquet said he did not think it was necessary to codify processing deadlines in law, as Gordon’s bill would do. “We’re seeing a nice turnaround,” he said.

According to state records, the board certified more than 7,000 home health aides in 2015 and nearly 8,000 the year before. There are more than 47,800 aides currently licensed and they must be recertified every two years.

But Buteas said the law makes sense. “Despite having those numbers (certified) we are still seeing a shortage in the workforce,” she said. “And these are folks who needed to work yesterday.”

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