Jonathan Hill and Cathy Griffin | Home Care & Assisted Living Program Dementia Work Group Jonathan Hill and Cathy Griffin | Home Care & Assisted Living Program October 25, 2018

Dementia Care Training – Citation New in Chapter 144D Housing with Services Establishment 144D.065 Training in Dementia Care Required 144D.066 Enforcement of Dementia Care Training Requirements 144D.10 Manager Requirements One of the most recent hot topics is the dementia training. Hopefully, you are all aware that there are new requirements for housing with services establishments that obligates housing with services providers, along with home care providers, to assure their staff have a foundational level of understanding about meeting the needs of people with dementia. The requirements are found in 144D in three locations. The first is in 065 where the description about who needs to be trained and what the training looks like. And, in 066 where is describes who and how the requirements are enforced along with the penalties for non-compliance. Lastly, at 10 we learn that managers of housing with services establishments are also required to be trained.

Dementia Care Training – Citation Reminder Existing in Chapter 144A 144A.4796 Orientation and Annual Training Requirements Subd. 5. Training required relating to Alzheimer’s disease and related disorders Direct care and supervisors working with Must get training Current explanation about Effective approaches How to communicate We don’t want anyone to forget that along with the requirements for housing with services providers, there was and still is a requirement in 144A that requires training related to dementia for all direct care staff and the supervisors who work with them. So, while we are focusing on the 144D requirements, those requirements are not isolated from 144A.

Dementia Care Training – Implementation January – December 2016 During survey Technical assistance The actual implementation of the dementia training requirements at 144D started in January of 2016. During the entire year of 2016 when we were conducting surveys of home care providers, we were discussing the requirements with providers and offering technical assistance about what the requirement means for them along with resources to help them understand and comply with the requirements. No citations or fines were imposed during calendar year 2016.

Dementia Care Training – New Phase January 2017 During survey Fines for noncompliance $200 Every staff (hired on or after 1/1/2016) With no training record Before fining, must allow two weeks Fine does not negate need for training At the start of this calendar year, we are required to review compliance with the dementia training requirements for home care providers during all surveys. If it’s determined that the training requirements are not fulfilled, we will issue a fine for the noncompliance. The fine is $200 for every staff member who requires dementia training and does not have documentation that they obtained the training. However, before we issue the fine, we must notify the provider of the noncompliance and allow two weeks for the staff to get trained. If after two weeks the staff are still not trained, the fine will be issued. And, to be clear, getting fined and even paying the fine does not negate the need for training. Staff still must obtain the training and the provider must pay the fine.

Dementia Care Training – With or Without Registered HWS with Special program or unit Advertise, market or promote 4-8 hours within 120-160 working hours 2 hours every 12 months thereafter Registered HWS without Special program or unit / don’t advertise, etc. 4 hours within 120 – 160 working hours We know the law is a bit cumbersome to sort out, so we did our best to try to keep it simple. As you consider who needs what amount of training, think about a couple of key concepts. The first is with or without. Is the physical building a housing with services with a special dementia program or unit or do they advertise, market or promote themselves as having a special dementia program or unit. I If the answer is with, then staff must have at least 4-8 hours of training within the first 120 -160 working hours and at least 2 hours training every 12 months thereafter. If the answer is without, then staff must have at least 4 hours of training within the first 120 – 160 working hours and at least 2 hours every 12 months thereafter

Dementia Care Training – Direct or Not Direct With Direct Yes Supervisors of direct staff and managers Initial – at least 8 hours Within 120 working hours Each 12 months – at least 2 hours Direct care staff Within 160 working hours With Direct No Not direct care staff Initial – at least 4 hours Within 160 working hours Each 12 months – at least 2 hours The next question to ask is if the staff provide direct care or not. In a physical plant that is a housing with services that has a special dementia program or unit or advertises, market or promotes that they have a special dementia unit then you need to look for three different type of staff: supervisors of direct staff and housing managers, direct care staff and those staff who do not provider direct care such as maintenance, housekeeping and food service. Supervisors and managers must have at least 8 hours of training within the first 120 hours of employment and at least 2 hours every 12 months thereafter. Direct care staff must have as least 8 hours of training within the first 160 hours of employment and at least 2 hours every 12 months thereafter. None direct care staff must have at least 4 hours of training within the first 160 hours of employment and at least 2 hours every 12 months thereafter.

Dementia Care Training – Without Direct or Not Direct Without and Direct Yes Supervisors of direct staff and managers Initial – at least 4 hours Within 120 working hours Each 12 months – at least 2 hours Direct care staff Within 160 working hours Without and Direct No Not direct care staff Initial – at least 4 hours Within 160 working hours Each 12 months – at least 2 hours So now, what about the have nots or the withouts!?! In a physical plant that is a housing with services that does not have a special dementia program or unit or does not advertise, market or promote that they have a special dementia unit then you still need to look for the three types of staff: supervisors of direct staff and housing managers, direct care staff and those staff who do not provider direct care such as maintenance, housekeeping and food service. Supervisors and managers must have at least 4 hours of training within the first 120 hours of employment and at least 2 hours every 12 months thereafter. Direct care staff must have as least 4 hours of training within the first 160 hours of employment and at least 2 hours every 12 months thereafter. None direct care staff must have at least 4 hours of training within the first 160 hours of employment and at least 2 hours every 12 months thereafter.

Dementia Care Training – Until Complete Direct care staff Initial – at least 4(without) or 8 (with) hours Within 160 working hours Until initial is complete Must not provide direct care unless: Another employee onsite who: Completed initial 4/8 hours of training Can act as a resource and assist or A trainer of the requirements or supervisor who meets the requirements: Must be available to consult until training complete You probably noticed that the law provides flexibility about when the training must be completed. However, it is critically important for direct care staff to understand key elements about dementia as well as best practices for approaching assistance with ADLS, redirecting behaviors and other important components of care delivery. However, there is an understanding that sometimes you just really need new staff to provide direct care before they are able to complete all the training requirements. In those situations, it is possible to have staff employed and working directly with people who need care and support so long as another employee is onsite who completed the initial training and can act as a resource and assist the new person who has not completed their training. There is also an OR to this which is that a person who provides the training for the dementia requirements or a supervisor who has met the training requirements must be available to consult with the direct care staff person until their training is complete.

Dementia Care Training – Required Content Explanation of Alzheimer’s disease and related disorders Assistance with ADLs Problem solving with challenging behaviors and Communication skills Hint: ACT on Alzheimer’s The content of the required training is specific but yet vague enough to allow for a variety of training that will fulfil the requirements. And I think staff who have a passion for caring for people with dementia will find the more they know about and are challenged by people with dementia, the more they will want to learn. There are of course many options for how and what to learn about dementia but we know that using the ACT resource alone you will find more than enough to cover the required hours of training.

Dementia Care Training – Enforcement Staff working in HWS setting under 144G Direct care and supervisors Not direct care Managers Part of HWS registration application and renewal Request anytime Staff working in HWS setting under 144A Direct care and supervisors Not direct care Part of home care provider survey Request anytime Two ways that MDH will enforce the dementia training requirements. Training for those staff working in a HWS setting under 144A including direct care staff, supervisors and non-direct care staff will reviewed as part of each home care provider survey and, of course the commissioner may request your training records at any time. Training for staff working in a HWS setting under 144G including direct care staff, supervisors, managers and non-direct care staff will be reviewed as part of the housing with services registration application and renewal process and, of course the commissioner may request your training records at any time. Information Bulletin 16-03 which is on the MDH web site provides and explanation, links to the statute and also provides a sample form providers can choose to use to document the training staff receive.

What We Know – Violations The majority of care related violations identified during the survey of a licensed comprehensive home care provider are in memory care units of housing with services setting

What We Know – Our/My View on the Issue… Home care works if you can direct your own care or live with someone who directs your care.

What We Know – Specific Violations/Conditions Medications Treatments Staffing Assessment Availability of licensed staff

We have a shared responsibility to do better so let’s do it!