AN
ACT Relating to long-term care training; amending RCW 18.20.010, 70.128.005, 70.128.120,
70.128.130, 74.39A.005, and 74.39A.050; adding a new section to chapter 18.20
RCW; adding new sections to chapter 70.128 RCW; and adding new sections to
chapter 74.39A RCW.
BE IT ENACTED BY THE
LEGISLATURE OF THE STATE OF WASHINGTON:
Sec.
1. RCW
18.20.010 and 1985 c 297 s 1 are each amended to read as follows:
The
purpose of this chapter is to provide for the development, establishment, and
enforcement of standards for the maintenance and operation of boarding homes,
which, in the light of advancing knowledge, will promote safe and adequate care
of the individuals therein. It is further the intent of the legislature that
boarding homes be available to meet the needs of those for whom they care by
recognizing the capabilities of individuals to direct their self-medication or
to use supervised self-medication techniques when ordered and approved by a
physician licensed under chapter 18.57 or 18.71 RCW or a ((podiatrist)) podiatric
physician and surgeon licensed under chapter 18.22 RCW.
The
legislature finds that many residents of community-based long-term care
facilities are vulnerable and their health and well-being are dependent on
their caregivers. The quality, skills, and knowledge of their caregivers are
often the key to good care. The legislature finds that the need for
well-trained caregivers is growing as the state's population ages and
residents' needs increase. The legislature intends that current training
standards be enhanced.
NEW
SECTION. Sec. 2. A
new section is added to chapter 18.20 RCW to read as follows:
(1)
The definitions in this subsection apply throughout this section unless the
context clearly requires otherwise.
(a)
"Caregiver" includes any person who provides residents with hands-on
personal care on behalf of a boarding home, except volunteers who are directly
supervised.
(b)
"Direct supervision" means oversight by a person who has demonstrated
competency in the core areas or has been fully exempted from the training
requirements pursuant to this section, is on the premises, and is quickly and
easily available to the caregiver.
(2)
Training must have the following components: Orientation, basic training,
specialty training as appropriate, and continuing education. All boarding home
employees or volunteers who routinely interact with residents shall complete
orientation. Boarding home administrators, or their designees, and caregivers
shall complete orientation, basic training, specialty training as appropriate,
and continuing education.
(3)
Orientation consists of introductory information on residents' rights,
communication skills, fire and life safety, and universal precautions.
Orientation must be provided at the facility by appropriate boarding home staff
to all boarding home employees before the employees have routine interaction
with residents.
(4)
Basic training consists of modules on the core knowledge and skills that
caregivers need to learn and understand to effectively and safely provide care
to residents. Basic training must be outcome-based, and the effectiveness of
the basic training must be measured by demonstrated competency in the core
areas through the use of a competency test. Basic training must be completed
by caregivers within one hundred twenty days of the date on which they begin to
provide hands-on care or within one hundred twenty days of March 1, 2002,
whichever is later. Until competency in the core areas has been demonstrated,
caregivers shall not provide hands-on personal care to residents without direct
supervision. Boarding home administrators, or their designees, must complete
basic training and demonstrate competency within one hundred twenty days of
employment or within one hundred twenty days of March 1, 2002, whichever is
later.
(5)
For boarding homes that serve residents with special needs such as dementia,
developmental disabilities, or mental illness, specialty training is required
of administrators, or designees, and caregivers. Specialty training consists
of modules on the core knowledge and skills that caregivers need to effectively
and safely provide care to residents with special needs. Specialty training
should be integrated into basic training wherever appropriate. Specialty
training must be outcome-based, and the effectiveness of the specialty training
measured by demonstrated competency in the core specialty areas through the use
of a competency test. Specialty training must be completed by caregivers
within one hundred twenty days of the date on which they begin to provide
hands-on care to a resident having special needs or within one hundred twenty
days of March 1, 2002, whichever is later. However, if specialty training is
not integrated with basic training, the specialty training must be completed within
ninety days of completion of basic training. Until competency in the core
specialty areas has been demonstrated, caregivers shall not provide hands-on
personal care to residents with special needs without direct supervision.
Boarding home administrators, or their designees, must complete specialty
training and demonstrate competency within one hundred twenty days of March 1,
2002, if the boarding home serves one or more residents with special needs.
(6)
Continuing education consists of ongoing delivery of information to caregivers
on various topics relevant to the care setting and care needs of residents.
Competency testing is not required for continuing education. Continuing
education is not required during the first year following completion of the
basic training. If specialty training is completed, the specialty training
applies toward any continuing education requirement for up to two years
following the completion of the specialty training.
(7)
Persons who successfully challenge the competency test for basic training are
fully exempt from the basic training requirements of this section. Persons who
successfully challenge the specialty training competency test are fully exempt
from the specialty training requirements of this section.
(8)
Licensed persons who perform the tasks for which they are licensed are fully or
partially exempt from the training requirements of this section, as specified
by the department in rule.
(9)
In an effort to improve access to training and education and reduce costs,
especially for rural communities, the coordinated system of long-term care
training and education must include the use of innovative types of learning
strategies such as internet resources, videotapes, and distance learning using
satellite technology coordinated through community colleges or other entities,
as defined by the department.
(10)
The community long-term care training and education steering committee
established under section 8 of this act shall develop criteria for the approval
of orientation, basic training, and specialty training programs.
(11)
Boarding homes that desire to deliver facility-based training with facility
designated trainers, or boarding homes that desire to pool their resources to
create shared training systems, must be encouraged by the department in their
efforts. The community long-term care training and education steering
committee shall develop criteria for reviewing and approving trainers and
training materials that are substantially similar to or better than the
materials developed by the steering committee.
(12)
The department shall adopt rules by March 1, 2002, for the implementation of
this section based on the recommendations of the community long-term care
training and education steering committee established in section 8 of this act.
(13)
The orientation, basic training, specialty training, and continuing education
requirements of this section take effect March 1, 2002, and shall be applied
prospectively. However, nothing in this section affects the current training
requirements under RCW 74.39A.010.
NEW
SECTION. Sec. 3. A
new section is added to chapter 70.128 RCW to read as follows:
(1)
The definitions in this subsection apply throughout this section unless the
context clearly requires otherwise.
(a)
"Caregiver" includes all adult family home resident managers and any
person who provides residents with hands-on personal care on behalf of an adult
family home, except volunteers who are directly supervised.
(b)
"Indirect supervision" means oversight by a person who has
demonstrated competency in the core areas or has been fully exempted from the
training requirements pursuant to this section and is quickly and easily
available to the caregiver, but not necessarily on-site.
(2)
Training must have three components: Orientation, basic training and
continuing education. All adult family home providers, resident managers, and
employees, or volunteers who routinely interact with residents shall complete
orientation. Caregivers shall complete orientation, basic training, and
continuing education.
(3)
Orientation consists of introductory information on residents' rights,
communication skills, fire and life safety, and universal precautions.
Orientation must be provided at the facility by appropriate adult family home
staff to all adult family home employees before the employees have routine
interaction with residents.
(4)
Basic training consists of modules on the core knowledge and skills that
caregivers need to learn and understand to effectively and safely provide care
to residents. Basic training must be outcome-based, and the effectiveness of
the basic training must be measured by demonstrated competency in the core
areas through the use of a competency test. Basic training must be completed
by caregivers within one hundred twenty days of the date on which they begin to
provide hands-on care or within one hundred twenty days of March 1, 2002,
whichever is later. Until competency in the core areas has been demonstrated, caregivers
shall not provide hands-on personal care to residents without indirect
supervision.
(5)
For adult family homes that serve residents with special needs such as
dementia, developmental disabilities, or mental illness, specialty training is
required of providers and resident managers. Specialty training consists of
modules on the core knowledge and skills that providers and resident managers
need to effectively and safely provide care to residents with special needs.
Specialty training should be integrated into basic training wherever
appropriate. Specialty training must be outcome-based, and the effectiveness
of the specialty training measured by demonstrated competency in the core
specialty areas through the use of a competency test. Specialty training must
be completed by providers and resident managers before admitting and serving
residents who have been determined to have special needs related to mental
illness, dementia, or a developmental disability. Should a resident develop
special needs while living in a home without specialty designation, the
provider and resident manager have one hundred twenty days to complete
specialty training.
(6)
Continuing education consists of ongoing delivery of information to caregivers
on various topics relevant to the care setting and care needs of residents.
Competency testing is not required for continuing education. Continuing
education is not required during the first year following completion of the
basic training. If specialty training is completed, the specialty training
applies toward any continuing education requirement for up to two years
following the completion of the specialty training.
(7)
Persons who successfully challenge the competency test for basic training are
fully exempt from the basic training requirements of this section. Persons who
successfully challenge the specialty training competency test are fully exempt
from the specialty training requirements of this section.
(8)
Licensed persons who perform the tasks for which they are licensed are fully or
partially exempt from the training requirements of this section, as specified
by the department in rule.
(9)
In an effort to improve access to training and education and reduce costs,
especially for rural communities, the coordinated system of long-term care
training and education must include the use of innovative types of learning
strategies such as internet resources, videotapes, and distance learning using
satellite technology coordinated through community colleges, private associations,
or other entities, as defined by the department.
(10)
Adult family homes that desire to deliver facility-based training with facility
designated trainers, or adult family homes that desire to pool their resources
to create shared training systems, must be encouraged by the department in
their efforts. The community long-term care training and education steering
committee shall develop criteria for reviewing and approving trainers and
training materials.
(11)
The department shall adopt rules by March 1, 2002, for the implementation of
this section based on the recommendations of the community long-term care
training and education steering committee established in section 8 of this act.
(12)
The orientation, basic training, specialty training, and continuing education
requirements of this section take effect March 1, 2002, and shall be applied
prospectively. However, nothing in this section affects the current training
requirements under RCW 70.128.120 and 70.128.130.
Sec.
4. RCW
70.128.005 and 1995 c 260 s 1 are each amended to read as follows:
The
legislature finds that adult family homes are an important part of the state's
long-term care system. Adult family homes provide an alternative to
institutional care and promote a high degree of independent living for
residents. Persons with functional limitations have broadly varying service
needs. Adult family homes that can meet those needs are an essential component
of a long-term system. The legislature further finds that different
populations living in adult family homes, such as the developmentally disabled
and the elderly, often have significantly different needs and capacities from
one another.
It
is the legislature's intent that department rules and policies relating to the
licensing and operation of adult family homes recognize and accommodate the
different needs and capacities of the various populations served by the homes.
Furthermore, the development and operation of adult family homes that can
provide quality personal care and special care services should be encouraged.
The
legislature finds that many residents of community-based long-term care
facilities are vulnerable and their health and well-being are dependent on
their caregivers. The quality, skills, and knowledge of their caregivers are
often the key to good care. The legislature finds that the need for
well-trained caregivers is growing as the state's population ages and residents'
needs increase. The legislature intends that current training standards be
enhanced.
Sec.
5. RCW
70.128.120 and 1996 c 81 s 1 are each amended to read as follows:
Each
adult family home provider and each resident manager shall have the following
minimum qualifications:
(1)
Twenty-one years of age or older;
(2)
Good moral and responsible character and reputation;
(3)
Literacy;
(4)
Management and administrative ability to carry out the requirements of this
chapter;
(5)
Satisfactory completion of department-approved ((initial)) basic
training and continuing education training as specified by the department in
rule, based on recommendations of the community long-term care training and
education steering committee and working in collaboration with providers,
consumers, caregivers, advocates, family members, educators, and other
interested parties in the rule-making process;
(6)
Satisfactory completion of department-approved, or equivalent, special care
training before a provider may provide special care services to a resident;
(7)
Not been convicted of any crime listed in RCW 43.43.830 and 43.43.842; and
(8)
Effective July 1, 1996, registered with the department of health.
Sec.
6. RCW
70.128.130 and 1995 c 260 s 6 are each amended to read as follows:
(1)
Adult family homes shall be maintained internally and externally in good repair
and condition. Such homes shall have safe and functioning systems for heating,
cooling, hot and cold water, electricity, plumbing, garbage disposal, sewage,
cooking, laundry, artificial and natural light, ventilation, and any other
feature of the home.
(2)
Adult family homes shall be maintained in a clean and sanitary manner,
including proper sewage disposal, food handling, and hygiene practices.
(3)
Adult family homes shall develop a fire drill plan for emergency evacuation of
residents, shall have smoke detectors in each bedroom where a resident is
located, shall have fire extinguishers on each floor of the home, and shall not
keep nonambulatory patients above the first floor of the home.
(4)
Adult family homes shall have clean, functioning, and safe household items and
furnishings.
(5)
Adult family homes shall provide a nutritious and balanced diet and shall recognize
residents' needs for special diets.
(6)
Adult family homes shall establish health care procedures for the care of
residents including medication administration and emergency medical care.
(a)
Adult family home residents shall be permitted to self- administer medications.
(b)
Adult family home providers may administer medications and deliver special care
only to the extent authorized by law.
(7)
Adult family home providers shall either: (a) Reside at the adult family home;
or (b) employ or otherwise contract with a qualified resident manager to reside
at the adult family home. The department may exempt, for good cause, a
provider from the requirements of this subsection by rule.
(8)
A provider will ensure that any volunteer, student, employee, or person
residing within the adult family home who will have unsupervised access to any
resident shall not have been convicted of a crime listed under RCW 43.43.830 or
43.43.842. Except that a person may be conditionally employed pending the
completion of a criminal conviction background inquiry.
(9)
A provider shall offer activities to residents under care as defined by the
department in rule.
(10)
An adult family home provider ((shall)) must ensure that staff
are competent and receive necessary training to perform assigned tasks. Staff
must satisfactorily complete department-approved staff orientation, basic
training, and continuing education as specified by the department by rule.
NEW
SECTION. Sec. 7. A
new section is added to chapter 70.128 RCW to read as follows:
By
March 1, 2002, the department must, by rule, create an approval system for
those seeking to conduct department-approved training under section 3 of this
act and RCW 70.128.120 (5) and (6) and 70.128.130(10). The department shall
adopt rules based on recommendations of the community long-term care training
and education steering committee established in section 8 of this act.
NEW
SECTION. Sec. 8. A
new section is added to chapter 74.39A RCW to read as follows:
(1)
The secretary shall appoint a steering committee for community long-term care
training and education to advise the department on the development and approval
of criteria for training materials, the development of competency tests, the
development of criteria for trainers, and the development of exemptions from
training. The community long-term care training and education steering
committee shall also review the effectiveness of the training program or
programs, including the qualifications and availability of the trainers. The
steering committee shall also review the appropriateness of the adopted rules
implementing this section. The steering committee shall advise the department
on flexible and innovative learning strategies that accomplish the training
goals, such as competency and outcome-based models and distance learning. The
steering committee shall review and recommend the most appropriate length of
time between an employee's date of first hire and the start of the employee's
basic training.
(2)
The steering committee shall, at a minimum, consist of a representative from
each of the following: Each of the state-wide boarding home associations, two
adult family home associations, each of the state-wide home care associations,
the long-term care ombudsman program, the area agencies on aging, the
department of health representing the nursing care quality assurance
commission, and a consumer, or their nonprovider designee, from a boarding
home, adult family home, home care served by an agency, and home care served by
an individual provider. A majority of the members currently serving constitute
a quorum.
(3)
Nothing in this chapter shall prevent the adult family home advisory committee
from enhancing training requirements for adult family providers and resident
managers, regulated under chapter 18.48 RCW, at the cost of those providers and
resident managers.
(4)
Establishment of the steering committee does not prohibit the department from
utilizing other advisory activities that the department deems necessary for
program development. However, when the department obtains input from other
advisory sources, the department shall present the information to the steering
committee for review and approval.
(5)
Each member of the steering committee shall serve without compensation.
Consumer representatives may be reimbursed for travel expenses as authorized in
RCW 43.03.060.
(6)
The steering committee recommendations must implement the intent of RCW
74.39A.050(14) to create training that includes skills and competencies that
are transferable to nursing assistant training.
(7)
The steering committee shall cease to exist on July 1, 2004.
Sec.
9. RCW
74.39A.005 and 1993 c 508 s 1 are each amended to read as follows:
The
legislature finds that the aging of the population and advanced medical
technology have resulted in a growing number of persons who require
assistance. The primary resource for long-term care continues to be family and
friends. However, these traditional caregivers are increasingly employed
outside the home. There is a growing demand for improvement and expansion of
home and community-based long-term care services to support and complement the
services provided by these informal caregivers.
The
legislature further finds that the public interest would best be served by a
broad array of long-term care services that support persons who need such
services at home or in the community whenever practicable and that promote
individual autonomy, dignity, and choice.
The
legislature finds that as other long-term care options become more available,
the relative need for nursing home beds is likely to decline. The legislature
recognizes, however, that nursing home care will continue to be a critical part
of the state's long-term care options, and that such services should promote
individual dignity, autonomy, and a homelike environment.
The
legislature finds that many recipients of in-home services are vulnerable and
their health and well-being are dependent on their caregivers. The quality,
skills, and knowledge of their caregivers are often the key to good care. The
legislature finds that the need for well-trained caregivers is growing as the
state's population ages and clients' needs increase. The legislature intends
that current training standards be enhanced.
Sec.
10. RCW
74.39A.050 and 1999 c 336 s 5 are each amended to read as follows:
The
department's system of quality improvement for long-term care services shall
use the following principles, consistent with applicable federal laws and
regulations:
(1)
The system shall be client-centered and promote privacy, independence, dignity,
choice, and a home or home-like environment for consumers consistent with
chapter 392, Laws of 1997.
(2)
The goal of the system is continuous quality improvement with the focus on
consumer satisfaction and outcomes for consumers. This includes that when
conducting licensing inspections, the department shall interview an appropriate
percentage of residents, family members, resident managers, and advocates in
addition to interviewing providers and staff.
(3)
Providers should be supported in their efforts to improve quality and address
identified problems initially through training, consultation, technical
assistance, and case management.
(4)
The emphasis should be on problem prevention both in monitoring and in
screening potential providers of service.
(5)
Monitoring should be outcome based and responsive to consumer complaints and a
clear set of health, quality of care, and safety standards that are easily
understandable and have been made available to providers.
(6)
Prompt and specific enforcement remedies shall also be implemented without
delay, pursuant to RCW 74.39A.080, RCW 70.128.160, chapter 18.51 RCW, or
chapter 74.42 RCW, for providers found to have delivered care or failed to
deliver care resulting in problems that are serious, recurring, or uncorrected,
or that create a hazard that is causing or likely to cause death or serious
harm to one or more residents. These enforcement remedies may also include,
when appropriate, reasonable conditions on a contract or license. In the
selection of remedies, the safety, health, and well-being of residents shall be
of paramount importance.
(7)
To the extent funding is available, all long-term care staff directly
responsible for the care, supervision, or treatment of vulnerable persons
should be screened through background checks in a uniform and timely manner to
ensure that they do not have a criminal history that would disqualify them from
working with vulnerable persons. Whenever a state conviction record check is
required by state law, persons may be employed or engaged as volunteers or
independent contractors on a conditional basis according to law and rules
adopted by the department.
(8)
No provider or staff, or prospective provider or staff, with a stipulated
finding of fact, conclusion of law, an agreed order, or finding of fact,
conclusion of law, or final order issued by a disciplining authority, a court
of law, or entered into a state registry finding him or her guilty of abuse,
neglect, exploitation, or abandonment of a minor or a vulnerable adult as defined
in chapter 74.34 RCW shall be employed in the care of and have unsupervised
access to vulnerable adults.
(9)
The department shall establish, by rule, a state registry which contains
identifying information about personal care aides identified under this chapter
who have substantiated findings of abuse, neglect, financial exploitation, or
abandonment of a vulnerable adult as defined in RCW 74.34.020. The rule must
include disclosure, disposition of findings, notification, findings of fact,
appeal rights, and fair hearing requirements. The department shall disclose,
upon request, substantiated findings of abuse, neglect, financial exploitation,
or abandonment to any person so requesting this information.
(10)
The department shall by rule develop training requirements for individual
providers and home care agency providers. Effective March 1, 2002,
individual providers and home care agency providers must satisfactorily
complete department-approved orientation, basic training, and continuing
education within the time period specified by the department in rule. The
department shall adopt rules by March 1, 2002, for the implementation of this
section based on the recommendations of the community long-term care training
and education steering committee established in section 8 of this act. The
department shall deny payment to an individual provider or a home care provider
who does not complete the training requirements within the time limit
specified by the department by rule.
(11)
In an effort to improve access to training and education and reduce costs,
especially for rural communities, the coordinated system of long-term care
training and education must include the use of innovative types of learning
strategies such as internet resources, videotapes, and distance learning using
satellite technology coordinated through community colleges or other entities,
as defined by the department.
(12)
The department shall create an approval system by March 1, 2002, for those
seeking to conduct department-approved training. In the rule-making process,
the department shall adopt rules based on the recommendations of the community
long-term care training and education steering committee established in section
8 of this act.
(13)
The department shall establish, by rule, training, background checks, and other
quality assurance requirements for personal aides who provide in-home services
funded by medicaid personal care as described in RCW 74.09.520, community
options program entry system waiver services as described in RCW 74.39A.030, or
chore services as described in RCW 74.39A.110 that are equivalent to
requirements for individual providers.
(((12)))
(14) Under existing funds the department shall establish internally a
quality improvement standards committee to monitor the development of standards
and to suggest modifications.
(((13)))
(15) Within existing funds, the department shall design, develop, and
implement a long-term care training program that is flexible, relevant, and
qualifies towards the requirements for a nursing assistant certificate as
established under chapter 18.88A RCW. This subsection does not require
completion of the nursing assistant certificate training program by providers
or their staff. The long-term care teaching curriculum must consist of a
fundamental module, or modules, and a range of other available relevant
training modules that provide the caregiver with appropriate options that
assist in meeting the resident's care needs. Some of the training modules may
include, but are not limited to, specific training on the special care needs of
persons with developmental disabilities, dementia, mental illness, and the care
needs of the elderly. No less than one training module must be dedicated to
workplace violence prevention. The nursing care quality assurance commission
shall work together with the department to develop the curriculum modules. The
nursing care quality assurance commission shall direct the nursing assistant
training programs to accept some or all of the skills and competencies from the
curriculum modules towards meeting the requirements for a nursing assistant
certificate as defined in chapter 18.88A RCW. A process may be developed to
test persons completing modules from a caregiver's class to verify that they
have the transferable skills and competencies for entry into a nursing
assistant training program. The department may review whether facilities can
develop their own related long-term care training programs. The department may
develop a review process for determining what previous experience and training
may be used to waive some or all of the mandatory training. The department of
social and health services and the nursing care quality assurance commission
shall work together to develop an implementation plan by December 12, 1998.
NEW
SECTION. Sec. 11. A
new section is added to chapter 74.39A RCW to read as follows:
All training curricula and material, except competency testing
material, developed by or for the department and used in part or in whole for
the purpose of improving provider and caregiver knowledge and skill are in the
public domain unless otherwise protected by copyright law and are subject to
disclosure under chapter 42.17 RCW. Any training curricula and material
developed by a private entity through a contract with the department are also
considered part of the public domain and shall be shared subject to copyright
restrictions. Any proprietary curricula and material developed by a private
entity for the purposes of training staff in facilities licensed under chapter
18.20 or 70.128 RCW or individual providers and home care agency providers
under this chapter and approved for training by the department are not part of
the public domain.
