S.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 28 member whose work involves extensive contact with residents, 29 tenants, program participants, or service recipients. Such 30 staff members include certified nursing assistants, nurse 31 aides, homemaker-home health aides, personal care aides, home 32 care workers, licensed practical nurses, registered nurses, 33 licensed social workers, activity directors, dietary staff, 34 physician assistants, advanced registered nurse practitioners, 35 -1- LSB 5614XC (7) 86 pf/nh 1/ 10

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

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

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

S.F. _____ symptoms. 1 (2) Communication issues. 2 4. State-approved trainings, curricula, and competency 3 evaluations. 4 a. A variety of methods shall be utilized to provide 5 competency-based training including but not limited to formal 6 lecture, observation, self-study, supervised practices, online, 7 and audio-visual methods. The department, in collaboration 8 with the department of public health, department on aging, 9 and department of human services, and other appropriate 10 entities shall identify and designate trainings, curricula, and 11 competency evaluation instruments that meet the requirements 12 of this section. The department shall identify standardized 13 trainings, including online trainings, and shall establish a 14 process for approving nonstandardized trainings that meet the 15 training requirements. 16 b. At a minimum, all approved training, curricula, and 17 competency evaluation instruments shall meet all of the 18 following requirements, as applicable: 19 (1) Whether online or in-person, all training modules, 20 presentations, materials, and competency evaluations shall 21 reflect current standards and best practices in the care and 22 treatment of persons with dementia. 23 (2) All approved competency evaluation components shall 24 require a demonstration of the skills and knowledge acquired 25 related to the required topic areas specified under subsection 26 3, and may also include written or oral tests, and care 27 recipient and family surveys. The competency evaluation 28 instrument may be an independent competency evaluation 29 instrument or an instrument developed by the department. 30 (3) The initial dementia-specific training curriculum 31 shall incorporate principles of person-centered dementia care 32 including through recognition of the individual’s unique 33 abilities and needs; a focus on the individual’s optimal 34 functioning and quality of life; and use of problem-solving 35 -5- LSB 5614XC (7) 86 pf/nh 5/ 10

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

S.F. _____ 7. Requirements for trainers. Persons responsible for 1 conducting in-person dementia-specific training under this 2 chapter shall have a demonstrated ability to teach adult 3 learners and also meet at least one of the following criteria: 4 a. Have a minimum of two years of experience providing care 5 or services for individuals with Alzheimer’s disease or other 6 dementias in a professional or other capacity. 7 b. Have successfully completed at least the required minimum 8 initial training and competency evaluation for covered direct 9 service staff members and covered administrative staff members. 10 8. Training and continuing education costs. The costs 11 of required initial training and competency evaluations 12 and of continuing education shall be borne by the facility, 13 program, or service provider. A covered staff member shall 14 not be required to bear any of the costs of initial training, 15 competency evaluation, or continuing education, or the costs 16 of attending such initial trainings, competency evaluations, 17 or continuing education. A covered staff member shall receive 18 the staff member’s normal compensation when attending required 19 initial trainings, competency evaluations, and continuing 20 education. 21 9. State oversight. The department shall oversee 22 dementia-specific training, curricula, competency evaluations, 23 and continuing education requirements and activities under this 24 chapter. Such oversight shall include all of the following: 25 a. Ensuring that a facility, program, or service provider 26 provides approved initial training and competency evaluations. 27 b. Ensuring that a facility, program, or service provider 28 provides continuing education opportunities. 29 c. Ensuring that a facility, program, or service provider 30 utilizes approved online training programs or appropriate 31 in-person training. 32 d. Reviewing competency evaluations, including evaluation 33 of the competency measures, for appropriate demonstration of 34 knowledge acquired. 35 -7- LSB 5614XC (7) 86 pf/nh 7/ 10

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

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

S.F. _____ or replace, other dementia-specific training requirements 1 otherwise applicable to covered staff members. The department 2 is required to interpret and administer the bill in a manner so 3 as to avoid duplication of requirements while ensuring that the 4 minimum requirements are met and covered staff members achieve 5 the requisite level of competency necessary to best address the 6 needs of the populations served. 7 -10- LSB 5614XC (7) 86 pf/nh 10/ 10