Professionalizing Direct Care Work In Washington State: An Advocacy Coalition Framework Analysis of Initiative 1163

Background and Purpose

The quality of long-term care in the United States is closely associated with the working conditions of direct care workers (DCWs) across states. Washington State (WA) is widely recognized as a leader in long-term care policy, in part due to Initiative 1163 (I-1163, 2011), which institutionalized training, certification, and enhanced background checks for long-term care workers. However, prior to I-1163, a nearly identical measure, Initiative 1029 (I-1029, 2008), passed by voters but was indefinitely delayed due to fiscal constraints, reflecting repeated legislative conflict over the same policy issues. This study examines how advocacy coalitions and the broader policy environment shaped the formation and institutionalization of I-1163. The central research questions are: What advocacy coalitions formed around I-1163? How did their belief systems compete? And how did external contextual factors shape the policy environment?

Methods

This study employs a policy analysis design using the Advocacy Coalition Framework (ACF) as its theoretical lens. The ACF is particularly suited for analyzing contentious policy processes by grouping diverse actors into coalitions based on shared belief systems. Data were collected from the NewsBank database using keyword searches for "Initiative 1029" and "Initiative 1163" combined with "WA," yielding 298 and 266 articles, respectively, published between 2008 and 2011. After excluding duplicates, brief mentions, and redundant items, approximately 70 articles related to I-1029 and 50 related to I-1163 were retained for analysis. Newspaper articles and letters to the editor were analyzed through the ACF's core analytical elements: relatively stable parameters, external events, advocacy coalitions, belief systems, and policy-oriented learning.

Results

Two advocacy coalitions persisted throughout the policy subsystem surrounding I-1163. The pro-initiative coalition, comprising SEIU 775, AARP, the Alzheimer's Association, and Democratic legislators, shared a policy core belief in government responsibility for care quality and the necessity of formal training and certification. The opposing coalition, including home care provider associations, business groups, Republican politicians, and regional newspaper editorial boards, prioritized market accessibility and minimizing regulatory burden. Policy-oriented learning was observed primarily within the pro-initiative coalition, which responded to I-1029's implementation failure by incorporating more explicit fiscal provisions and independent audit requirements into I-1163. This learning, however, remained at the level of secondary beliefs and did not produce convergence in the core beliefs of the competing coalitions.

Conclusions and Implications

I-1163 is understood not as a resolution of underlying policy conflict, but as an outcome produced by the interaction between WA's initiative process and the prevailing policy environment. Key implications include: (1) long-term care policy reforms must be designed with secure funding and clear implementation structures to ensure sustainability; (2) public discourse incorporating the voices of care recipients strengthens policy legitimacy; (3) reframing long-term care as social infrastructure moves policy debate beyond cost containment; and (4) expanding DCWs' institutional pathways for political participation is essential for equitable workforce policy development. Future research should incorporate in-depth interviews with policy actors and DCWs, and examine the effects of I-1163 on labor conditions and care quality following implementation.