SEATTLE - Two studies released this month show a dilemma for Washington's home health-care industry: how to attract more people to jobs that provide daily living assistance to elderly and individuals with disabilities. One report paints Home Care Aides' jobs as chronically low-paid; the other says the demand for their services will boom in coming years.

If most people want to remain at home as they age instead of in a nursing home, Washington will need tens of thousands more Home Care Aides in the next 20 years, according to a report from the University of Washington's Center for Health Workforce Studies. That means changing the perception that home care is a low-paying, dead-end job.

A state law which took effect in January could help. It requires 75 hours of training, a certification exam, and more extensive background checks for Home Care Aides. Sue Skillman, who authored the UW report as the center's deputy director, says these workers are already in short supply.

"This is a part of the health-care workforce that doesn't get as much attention as the primary-care physicians or registered nurses, but they're extremely important. It's one way to enter health-care careers or social-service careers, through home care aide."

The number of Washingtonians age 65 and older is expected to triple by 2030, the UW report says, and the number of low-income people on Medicaid will double.

Another report, issued by SEIU Healthcare Northwest, the union that represents Home Care Aides, says many of them are struggling financially and more than half are age 50 or older. Charissa Raynor, who heads the union's training partnership, says the new requirements will increase the professionalism of Home Care Aides.

"It's very difficult to recruit, even in this environment, for jobs that pay $10 an hour and have low benefits. More training and hope for a career pathway could begin to turn the dial on making this more attractive work for job-seekers."

Raynor says more skills and training should allow them to command a higher wage in some cases. SEIU's survey of Home Care Aides in Washington shows nearly one-third have incomes below the federal poverty level, affecting job satisfaction and turnover rates.

The UW research is at http://depts.washington.edu. The SEIU report is at http://seiumaster.3cdn.net.


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After more than 50 years of use, some Michigan lawmakers say naloxone may not be the best choice in an overdose situation.

Naloxone is sometimes called the "Lazarus drug" because of its powerful ability to seemingly resurrect people after a drug overdose.

Sen. Kevin Hertel, D-St. Clair Shores, and some of his colleagues have introduced a bill which would open the door for what they say are more costly, but more powerful, antidotes.

"Given the prevalence of fentanyl in our communities, and how much stronger some of these drugs that we're now seeing are, we believe -- and in talking with others -- that there should be other tools to respond to an overdose," Hertel explained. "To make sure we're doing everything we can to save somebody's life."

Not everyone is on board with the proposed legislation, Senate Bill 542. Opponents argued the more expensive naloxone alternatives are not necessary, and using them would only increase profits for the pharmaceutical industry.

Jonathan Stoltman, director of the Opioid Policy Institute in Grand Rapids, said while the naloxone alternatives do help in overdose situations, they can also cause nasty side effects.

"The newer approaches, they put people into more severe withdrawal," Stoltman pointed out. "That's a pretty profound negative side effect. The one approach is very inexpensive and works great; the other approach is far more expensive and has this strong negative side effect."

Sponsors of the bill say they're hoping to give Michigan residents a chance to chime in on the issue in a public hearing sometime in June. Michigan saw more than 3,000 opioid overdose deaths in 2021.


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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.

Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.

"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained

Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.

Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.

"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.

Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.

New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.

The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.

"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.

Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.

Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."

"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.

Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.