H.F. _____ Section 1. NEW SECTION . 135N.1 Purpose —— principles —— 1 goals. 2 1. The purpose of this chapter is to establish minimum 3 dementia-specific training and competency evaluation 4 requirements for staff members working in facilities or 5 programs and for service providers that serve persons with 6 Alzheimer’s disease or other dementias. 7 2. The initial dementia-specific training curriculum 8 shall incorporate principles of person-centered dementia care 9 including through recognition of the individual’s unique 10 abilities and needs; a focus on the individual’s optimal 11 functioning and quality of life; and use of problem solving 12 approaches to care. 13 3. All training shall be taught and applied in a culturally 14 competent manner. 15 4. The goal of the initial dementia-specific training 16 and competency evaluation shall be to train staff members 17 adequately and appropriately to gain the competency necessary 18 to best address the needs of the populations they serve. 19 Sec. 2. NEW SECTION . 135N.2 Definitions. 20 As used in this chapter, unless the context otherwise 21 requires: 22 1. “Covered administrative staff member” means a staff member 23 who is a senior manager of a facility, program, or service 24 provider including administrators, as well as other managerial 25 staff members who directly supervise covered direct service 26 staff members and other covered staff members. 27 2. “Covered direct service staff member” means a staff member 28 whose work involves extensive contact with residents, tenants, 29 program participants, or service recipients. Such staff 30 members include certified nursing assistants, nurse aides, 31 homemaker-home health aides, personal care aides, licensed 32 or certified home care workers, licensed practical nurses, 33 registered nurses, licensed social workers, activity directors, 34 dietary staff, physician assistants, advanced registered 35 -1- LSB 5614YC (2) 86 pf/nh 1/ 10

H.F. _____ nurse practitioners, and physical, speech, and occupational 1 therapists. 2 3. “Covered staff member” means covered administrative 3 staff members, covered direct service staff members, and other 4 covered staff members. 5 4. “Department” means the department of inspections and 6 appeals. 7 5. “Facility, program, or service provider” means a 8 health care facility as defined in section 135C.1, an elder 9 group home as defined in section 231B.1, an assisted living 10 program as defined in section 231C.2, an adult day services 11 program as defined in section 231D.1, a hospice program as 12 defined in section 135J.1, or any other facility, program, 13 or service provider including but not limited to a home and 14 community-based services provider, a homemaker-home health 15 aide services provider, a home care aide provider, and other 16 providers of in-home services, if the facility, program, or 17 service provider is regulated by the state or receives any 18 state or federal funding. 19 6. “Other covered staff member” means a staff member who 20 has incidental contact on a recurring basis with residents, 21 tenants, program participants, or service recipients including 22 housekeeping staff, front desk staff, maintenance staff, and 23 other support staff and individuals who have such incidental 24 contact with residents, tenants, program participants, or 25 service recipients. 26 7. “Staff member” means a full-time or part-time employee, 27 consultant, contractor, or subcontractor and the staff of any 28 consultant, contractor, or subcontractor. 29 Sec. 3. NEW SECTION . 135N.3 Initial dementia-specific 30 training and competency evaluation requirements —— continuing 31 education —— state oversight. 32 1. Completion requirements —— competency determination. 33 Facilities, programs, and service providers shall provide 34 initial dementia-specific training and a competency evaluation, 35 -2- LSB 5614YC (2) 86 pf/nh 2/ 10

H.F. _____ approved by the department, as required under this section in 1 accordance with all of the following: 2 a. All covered staff members initially hired by the 3 facility, program, or service provider on or after January 4 1, 2017, shall complete the required initial training 5 and competency evaluation prior to unsupervised contact 6 with residents, tenants, program participants, or service 7 recipients, as applicable, not later than within thirty days of 8 initial hiring of the covered staff member. 9 b. All covered staff members hired by a facility, program, 10 or service provider prior to January 1, 2017, who have not 11 successfully completed and documented completion of initial 12 training and a competency evaluation equivalent to the 13 required initial training and competency evaluation within the 14 twenty-four-month period prior to that date, shall complete the 15 required initial training and competency evaluation by April 16 1, 2017. 17 c. All covered staff members hired by a facility, program, 18 or service provider prior to January 1, 2017, who have 19 successfully completed and documented completion of initial 20 training and a competency evaluation equivalent to the 21 required initial training and competency evaluation within the 22 twenty-four-month period prior to that date, shall be deemed 23 to have satisfied the requirement for completion of initial 24 training and a competency evaluation. The department shall 25 adopt rules to specify deeming protocol under this paragraph. 26 d. The requirements for initial dementia-specific training 27 and a competency evaluation under this section shall be 28 considered satisfied only after the covered staff member has 29 completed the initial training requirements and successfully 30 passed a competency evaluation demonstrating the requisite 31 competency necessary to best address the needs of the 32 population served. 33 2. State prior approval of training, curricula, and 34 evaluations. A facility, program, or service provider shall 35 -3- LSB 5614YC (2) 86 pf/nh 3/ 10

H.F. _____ receive prior approval from the department for the training, 1 curriculum, and competency evaluation components provided by 2 the facility, program, or service provider to ensure that the 3 training complies with minimum curriculum requirements and 4 that the competency evaluation component adequately measures 5 competency of a covered staff member, as appropriate to the 6 type of covered staff member, required to complete the training 7 and competency evaluation. 8 3. Minimum curricula. 9 a. For covered direct service staff members and covered 10 administrative staff members, the minimum curriculum used 11 for the required initial training shall cover all of the 12 following topics as specified in the most recently published 13 edition of the Alzheimer’s association dementia care practice 14 recommendations appropriate to the type of covered staff 15 member: 16 (1) Dementia care fundamentals, including the progression 17 of the disease, memory loss, and psychiatric and behavioral 18 symptoms. 19 (2) Strategies for providing person-centered care. 20 (3) Communication issues. 21 (4) Techniques for understanding and approaching behavioral 22 symptoms, including alternatives to physical and chemical 23 restraints. 24 (5) Strategies for addressing social engagement, social 25 needs, and involvement in meaningful activities. 26 (6) Information on addressing specific aspects of care and 27 safety including but not limited to pain management, food and 28 fluid consumption, and wandering. 29 b. For other covered staff members, the minimum curriculum 30 for the required initial training shall include all of the 31 following topics as specified in the most recent edition of the 32 Alzheimer’s association dementia care practice recommendations: 33 (1) Dementia care fundamentals, including the progression 34 of the disease, memory loss, and psychiatric and behavioral 35 -4- LSB 5614YC (2) 86 pf/nh 4/ 10

H.F. _____ symptoms. 1 (2) Communication issues. 2 4. State-approved trainings, curricula, and competency 3 evaluations. 4 a. The department, in collaboration with the department of 5 public health, department on aging, and department of human 6 services, and other appropriate entities shall identify and 7 designate trainings, curricula, and competency evaluation 8 instruments that meet the requirements of this section. The 9 department shall identify standardized trainings, including 10 online trainings, and shall establish a process for approving 11 nonstandardized trainings that meet the training requirements. 12 b. At a minimum, all approved training, curricula, and 13 competency evaluation instruments shall meet all of the 14 following requirements, as applicable: 15 (1) Whether online or in-person, all training modules, 16 presentations, materials, and competency evaluations shall 17 reflect current standards and best practices in the care and 18 treatment of persons with dementia. 19 (2) All approved competency evaluation components shall 20 require a demonstration of the skills and knowledge acquired 21 related to the required topic areas specified under subsection 22 3, and may also include written or oral tests, and care 23 recipient and family surveys. The competency evaluation 24 instrument may be an independent competency evaluation 25 instrument or an instrument developed by the department. 26 (3) The initial dementia-specific training curriculum 27 shall incorporate principles of person-centered dementia care 28 including through recognition of the individual’s unique 29 abilities and needs; a focus on the individual’s optimal 30 functioning and quality of life; and use of problem-solving 31 approaches to care. 32 (4) All training shall be taught and applied in a culturally 33 competent manner. 34 5. Portability. 35 -5- LSB 5614YC (2) 86 pf/nh 5/ 10

H.F. _____ a. A facility, program, or service provider shall issue 1 a certificate of completion to covered staff members upon 2 successful completion of initial dementia-specific training and 3 a competency evaluation, which certification shall be portable 4 between facility, program, and service provider settings. 5 Covered staff members shall maintain their own personal records 6 of certification of completion. 7 b. A covered staff member who has been issued a certificate 8 of completion and does not have a lapse in employment involving 9 dementia-related direct service or administration for a 10 period of twenty-four consecutive months or more, shall not be 11 required to repeat initial dementia-specific training and a 12 competency evaluation. 13 c. Nothing in this section shall be construed as requiring 14 a facility, program, or service provider to maintain records of 15 completion of initial dementia-specific training and competency 16 evaluation for current or former employees. 17 6. Continuing education. In addition to successful 18 completion of initial dementia-specific training and a 19 competency evaluation, the department shall require all of the 20 following: 21 a. That each facility, program, or service provider 22 establish a system for ongoing, on-site support, supervision, 23 and mentoring for its covered staff members related to the 24 treatment and care of persons with dementia. 25 b. That each covered staff member complete continuing 26 dementia-specific education that includes new information 27 on best practices in the treatment and care of persons with 28 dementia. The department shall adopt rules pursuant to chapter 29 17A that specify the minimum number of required continuing 30 education hours within a specified time period. 31 7. Requirements for trainers. Persons responsible for 32 conducting in-person dementia-specific training under this 33 chapter shall meet all of the following minimum criteria: 34 a. Have two years of work experience related to Alzheimer’s 35 -6- LSB 5614YC (2) 86 pf/nh 6/ 10

H.F. _____ disease or other dementias or in health care, gerontology, or 1 another related field. 2 b. Have successfully completed at least the required minimum 3 initial training and competency evaluation for covered direct 4 service staff members and covered administrative staff members. 5 8. Training and continuing education costs. The costs 6 of required initial training and competency evaluations 7 and of continuing education shall be borne by the facility, 8 program, or service provider. A covered staff member shall 9 not be required to bear any of the costs of initial training, 10 competency evaluation, or continuing education, or the costs 11 of attending such initial trainings, competency evaluations, 12 or continuing education. A covered staff member shall receive 13 the staff member’s normal compensation when attending required 14 initial trainings, competency evaluations, and continuing 15 education. 16 9. State oversight. The department shall oversee 17 dementia-specific training, curricula, competency evaluations, 18 and continuing education requirements and activities under this 19 chapter. Such oversight shall include all of the following: 20 a. Ensuring that a facility, program, or service provider 21 provides approved initial training and competency evaluations. 22 b. Ensuring that a facility, program, or service provider 23 provides continuing education opportunities. 24 c. Ensuring that a facility, program, or service provider 25 utilizes approved online training programs or appropriate 26 in-person training. 27 d. Reviewing competency evaluations, including evaluation 28 of the competency measures, for appropriate demonstration of 29 knowledge acquired. 30 e. Observing and assessing the proficiencies of covered 31 staff members. 32 f. Ensuring and enforcing compliance with all requirements 33 specified under this chapter. 34 10. Interpretation and administration. The requirements 35 -7- LSB 5614YC (2) 86 pf/nh 7/ 10

H.F. _____ of this chapter shall be interpreted to enhance, not supplant 1 or replace, other dementia-specific training requirements 2 otherwise applicable to covered staff members. The department 3 shall interpret and administer this chapter in a manner so as 4 to avoid duplication of requirements while ensuring that the 5 minimum requirements under this chapter are met and covered 6 staff members achieve the requisite level of competency 7 necessary to best address the needs of the populations served. 8 EXPLANATION 9 The inclusion of this explanation does not constitute agreement with 10 the explanation’s substance by the members of the general assembly. 11 This bill establishes a requirement for successful 12 completion of initial dementia-specific training and competency 13 evaluations and continuing education for certain covered staff 14 members of facilities, programs, and service providers. The 15 bill provides the purpose, principles, and goals of the Code 16 chapter and definitions. 17 The bill specifies the requirements for completion of 18 initial dementia-specific training and a competency evaluation 19 based on when the covered staff member is initially employed 20 relative to January 1, 2017. The bill also provides that 21 certain covered employees who have successfully completed 22 equivalent training and an evaluation shall be deemed to have 23 completed the required training and evaluation. 24 The bill requires prior approval by the department of 25 inspections and appeals of the training, curriculum, and 26 competency evaluation components provided by a facility, 27 program, or service provider, specifies minimum curriculum 28 requirements based on specifications in the most recently 29 published edition of the Alzheimer’s association dementia care 30 practice recommendations, and requirements for training and 31 competency evaluations. The bill provides for portability of a 32 certificate of completion of initial training and competency 33 evaluation and clarifies that the covered staff member, not the 34 facility, program, or service provider, is required to maintain 35 -8- LSB 5614YC (2) 86 pf/nh 8/ 10

H.F. _____ the covered member’s own records of completion of initial 1 dementia-specific training and competency evaluation for the 2 covered staff member. 3 The bill requires that in addition to successful completion 4 of initial dementia-specific training and a competency 5 evaluation, each facility, program, or service provider must 6 establish a system for ongoing, on-site support, supervision, 7 and mentoring for its covered staff members related to the 8 treatment and care of persons with dementia. Covered staff 9 are also required to complete continuing dementia-specific 10 education in accordance with rules adopted by the department. 11 The rules are to specify the minimum number of required 12 continuing education hours within a specified time period that 13 a covered staff member is required to complete. 14 The bill also establishes minimum requirements for those 15 conducting in-person dementia-specific trainings. The costs 16 of required initial training and competency evaluations and of 17 continuing education shall be borne by the facility, program, 18 or service provider, and covered staff members shall not 19 be required to bear any of the costs of initial training, 20 competency evaluation, or continuing education, or the costs 21 of attending such initial trainings, competency evaluations, 22 or continuing education. Additionally, covered staff members 23 shall receive their normal compensation when attending required 24 initial trainings, competency evaluations, or continuing 25 education. 26 The bill provides for ongoing state oversight of 27 dementia-specific training, curricula, competency evaluation, 28 and continuing education, and provides the requirements 29 of the bill shall be interpreted to enhance, not supplant 30 or replace, other dementia-specific training requirements 31 otherwise applicable to covered staff members. The department 32 is required to interpret and administer the bill in a manner so 33 as to avoid duplication of requirements while ensuring that the 34 minimum requirements are met and covered staff members achieve 35 -9- LSB 5614YC (2) 86 pf/nh 9/ 10