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AB-2850 Nurse assistant training programs: online and distance learning.(2017-2018)

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Date Published: 04/19/2018 04:00 AM
AB2850:v98#DOCUMENT

Amended  IN  Assembly  April 18, 2018

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill No. 2850


Introduced by Assembly Member Rubio

February 16, 2018


An act to amend Section 1337 1337.1 of the Health and Safety Code, relating to health facilities.


LEGISLATIVE COUNSEL'S DIGEST


AB 2850, as amended, Rubio. Nurse assistant training programs: geriatric medication technician. online and distance learning.
Existing law establishes the State Department of Public Health and sets forth its powers and duties, including the licensing and administration of health facilities, as defined, including skilled nursing facilities and intermediate care facilities. Violation of these provisions is a crime.
Existing law requires skilled nursing facilities and intermediate care facilities to adopt certified nurse assistant training programs approved by the department. Existing law requires a training program to include 60 hours of classroom training, as specified, which may be conducted within a facility or at an educational institution.
This bill would authorize the required classroom training to be offered through online or distance learning classes approved by the department.

This bill would include a geriatric medication technician, as defined, within the category of “certified nurse assistant” for these purposes. Because a violation of these provisions would be a crime, this bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YESNO  

The people of the State of California do enact as follows:


SECTION 1.

 The Legislature finds and declares all of the following:
(a) Over 1,100 people turn 65 years of age every day in California, and there are approximately 110,000 licensed skilled nursing beds in the state.
(b) About 25 percent of older adults will need nursing home care at some time in their lives.
(c) There is a shortage of qualified nurses available to meet the needs of patients in California health care facilities, particularly those patients in the state’s 1,200 skilled nursing facilities.
(d) California’s skilled nursing facilities currently face a challenge not only in recruiting qualified nursing staff, but also in retaining quality nursing staff.
(e) With over 65 percent of our residents on Medi-Cal, California’s skilled nursing facilities are an integral part of the health care continuum, with over 13.5 million Californians on Medi-Cal.
(f) The occupancy rate of California’s skilled nursing facilities is above the national average and is currently at 88 percent.
(g) Certified nurse assistants are an important component of skilled nursing facilities, but unfortunately the workforce in that area is stagnant and extremely limited in various counties.
(h) Over 1,600 additional certified nurse assistants in skilled nursing facilities will be needed to meet the increased minimum staffing level mandate by July 1, 2018.
(i) According to the Office of Statewide Health Planning and Development, in 2016, over 63 percent of skilled nursing facility direct care staff are certified nurse assistants, over 23 percent are licensed vocational nurses (LVNs), and over 9 percent are registered nurses (RNs).
(j) The California HealthCare Foundation has determined that: “... California may not have adequate numbers of nurses with appropriate skills. The result could be decreased patient access, higher health care costs, and lower quality of service.”
(k) The quality of patient care in California long-term care facilities is directly dependent upon the availability of an adequate supply of appropriately trained workers.

(l)Expanding the long-term care workforce requires coordinated strategies that address wages, working conditions, educational opportunities, career advancement opportunities, and personal preferences.

(m)A survey done by the Office of Statewide Health Planning and Development found overwhelming support among facility nursing staff, residents and their families, physicians, and other members of the health care team for a new category of paraprofessional health care worker authorized to provide medication assistance under the seven-year Health Manpower Pilot Project No. 152 conducted in the County of Sonoma from 1988 to 1995.

(n)At least 18 other states allow appropriately trained paraprofessional staff to give medicines and administer certain treatments to nursing home residents, if they have been trained and certified, and are supervised by licensed nursing staff.

(o)The other states that allow the paraprofessional staff in nursing homes have reported quality outcomes, increased resident and staff satisfaction, no increase in medication errors, no decrease in licensed nursing staff levels, and have offered effective career ladder opportunities for certified nursing assistants.

(p)The creation of additional training and certification programs necessary to establish a new permanent category of paraprofessional health care worker who can provide medication assistance to patients in skilled nursing facilities should be included in the range of solutions implemented to address the workforce shortage.

SEC. 2.Section 1337 of the Health and Safety Code is amended to read:
1337.

(a)The Legislature finds that the quality of patient care in skilled nursing and intermediate care facilities is dependent upon the competence of the personnel who staff its facilities. The Legislature further finds that direct patient care in skilled nursing and intermediate care facilities is currently rendered largely by certified nurse assistants. To assure the availability of trained personnel in skilled nursing and intermediate care facilities, the Legislature intends that all such facilities in this state participate in approved training programs established under this article. This article shall not apply to intermediate care facilities/developmentally disabled habilitative, intermediate care facility/developmentally disabled-nursing, and intermediate care facility/developmentally disabled-continuous nursing which have staff training programs approved by the State Department of Developmental Services, general acute care hospitals, acute psychiatric hospitals, or special hospitals.

(b)The requirement that certified nurse assistants obtain a criminal record clearance upon certification and biannually thereafter shall apply regardless of the setting in which the certified nurse assistant is employed.

(c)The department shall develop procedures to ensure that certified nurse assistants, including, but not limited to, those certified as geriatric medication technicians, employed by intermediate care facilities for the developmentally disabled/habilitative and intermediate care facilities for the developmentally disabled/nursing shall not be required to obtain multiple criminal record clearances.

(d)For the purpose of this article:

(1)“Nurse assistant” means any unlicensed aide, assistant, or orderly, who performs nursing services directed at the safety, comfort, personal hygiene, or protection of patients in a skilled nursing or intermediate care facility.

(2)“Approved training program” means a program for the training of nurse assistants that meets the criteria established and approved under this chapter.

(3)(A)“Certified nurse assistant” means any person who holds himself or herself out as a certified nurse assistant and who, for compensation, performs basic patient care services directed at the safety, comfort, personal hygiene, and protection of patients, and is certified as having completed the requirements of this article. These services shall not include any services which may only be performed by a licensed person and otherwise shall be performed under the supervision of a registered nurse, as defined in Section 2725 of the Business and Professions Code, or a licensed vocational nurse, as defined in Section 2859 of the Business and Professions Code.

(B)“Geriatric medication technician” means a certified nurse assistant who has been certified as successfully completing medication administration training with a geriatric focus pursuant to this article.

(4)“State department” means the State Department of Public Health.

SEC. 2.

 Section 1337.1 of the Health and Safety Code is amended to read:

1337.1.
 A skilled nursing or intermediate care facility shall adopt an approved training program that meets standards established by the department. The approved training program shall consist of at least all of the following:
(a) An orientation program to be given to newly employed nurse assistants prior to providing direct patient care in skilled nursing or intermediate care facilities.
(b) (1) A precertification training program consisting of at least 60 classroom hours of training on basic nursing skills, patient safety and rights, the social and psychological problems of patients, and resident abuse prevention, recognition, and reporting pursuant to subdivision (e). The 60 classroom hours of training may be conducted within a skilled nursing or intermediate care facility or in an educational institution. A skilled nursing or intermediate care facility or an educational institution may conduct the 60 classroom hours of training in an online or distance learning course format, as approved by the department.
(2) In addition to the 60 classroom hours of training required under paragraph (1), the precertification training program shall consist of at least 100 hours of supervised and on-the-job training clinical practice. The 100 hours may consist of normal employment as a nurse assistant under the supervision of either the director of nurse training or a licensed nurse qualified to provide nurse assistant training who has no other assigned duties while providing the training.
(3) At least two hours of the 60 hours of classroom training shall address the special needs of persons with developmental and mental disorders, including intellectual disability, cerebral palsy, epilepsy, dementia, Parkinson’s disease, and mental illness. At least two hours of the 60 hours of classroom training shall address the special needs of persons with Alzheimer’s disease and related dementias.
(4) At least four hours of the 100 hours of supervised clinical training shall address the special needs of persons with developmental and mental disorders, including intellectual disability, cerebral palsy, epilepsy, Alzheimer’s disease and related dementias, and Parkinson’s disease.
(5) In a precertification training program subject to this subdivision, credit shall be given for the training received in an approved precertification training program adopted by another skilled nursing or intermediate care facility.
(6) This subdivision shall not apply to a skilled nursing or intermediate care facility that demonstrates to the department that it employs only nurse assistants with a valid certification.
(c) Continuing in-service training to ensure continuing competency in existing and new nursing skills.
(d) Each facility shall consider including training regarding the characteristics and method of assessment and treatment of acquired immune deficiency syndrome (AIDS).
(e) (1) The approved training program shall include, within the 60 hours of classroom training, a minimum of six hours of instruction on preventing, recognizing, and reporting instances of resident abuse utilizing those courses developed pursuant to Section 13823.93 of the Penal Code, and a minimum of one hour of instruction on preventing, recognizing, and reporting residents’ rights violations.
(2) A minimum of four hours of instruction on preventing, recognizing, and reporting instances of resident abuse, including instruction on preventing, recognizing, and reporting residents’ rights violations, shall be included within the total minimum hours of continuing education or in-service training required and in effect for certified nursing assistants.

SEC. 3.

No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.