Oregon Department of Human Services, Aging and People with Disabilities and Developmental Disabilities
Staffing Requirements and Training
(1) STAFFING REQUIREMENTS. Facilities must have qualified awake direct care staff, sufficient in number to meet the 24-hour scheduled and unscheduled needs of each resident. Direct care staff provide services for residents that include assistance with activities of daily living, medication administration, resident-focused activities, supervision, and support. (a) If a facility employs universal workers whose duties include other tasks (e.g., housekeeping, laundry, food service), in addition to direct resident care, staffing must be increased to maintain adequate resident care and services. (b) Prior to providing care and services to residents, direct care staff must be trained as required in sections (2) - (4) of this rule. (c) The following facility employees are ancillary to the caregiver requirements in this section: (A) Individuals whose duties are exclusively housekeeping, building maintenance, clerical, administrative, or food preparation. (B) Licensed nurses who provide services as specified in OAR 411-054-0045 (Resident Health Services) (Resident Health Services). (C) Administrators. (d) The Department retains the right to require minimum staffing standards based on acuity, complaint investigation or survey inspection. (e) Based on resident acuity and facility structural design there must be adequate direct care staff present at all times, to meet the fire safety evacuation standards as required by the fire authority or the Department. (f) The licensee is responsible for assuring that staffing is increased to compensate for the evaluated care and service needs of residents at move-in and for the changing physical or mental needs of the residents. (g) A minimum of two direct care staff must be scheduled and available at all times whenever a resident requires the assistance of two direct care staff for scheduled and unscheduled needs. (h) In facilities where residents are housed in two or more detached buildings, or if a building has distinct and segregated areas, a designated caregiver must be awake and available in each building and each segregated area at all times. (i) Facilities must have a written, defined system to determine appropriate numbers of direct care staff and general staffing based on resident acuity and service needs. Such systems may be either manual or electronic. (A) Guidelines for systems must also consider physical elements of a building, use of technology if applicable and staff experience. (B) Facilities must be able to demonstrate how their staffing system works. (2) REQUIREMENTS APPLICABLE TO ALL TRAINING. The facility shall: (a) Have a training program that includes methods to determine competency of direct care staff through evaluation, observation, or written testing. Facility shall also maintain documentation regarding each direct care staff’s demonstrated competency. (b) Maintain written documentation of all trainings completed by each employee. (3) PRE-SERVICE ORIENTATION FOR ALL EMPLOYEES. (a) Prior to beginning their job responsibilities, all employees must complete an orientation that includes training regarding: (A) Residents’ rights and the values of community-based care. (B) Abuse and reporting requirements. (C) Standard precautions for infection control. (D) Preventing and containing disease outbreaks, as described in section (4) of this rule.(E) Fire safety and emergency procedures. (b) If the staff member’s duties include preparing food, they must have a food handler’s certificate. (c) All staff must receive a written description of their job responsibilities. (4) PRE-SERVICE INFECTIOUS DISEASE TRAINING FOR ALL EMPLOYEES. (a) Prior to beginning their job responsibilities, unless the employee received the training described below within the 24-month period prior to the time of hiring, all employees must complete training addressing the prevention, recognition, control and reporting of the spread of infectious disease. The Department, in consultation with the Oregon Health Authority, has determined this training must address the following: (A) Transmission of communicable disease and infections. (B) Standard precautions. (C) Hand hygiene. (D) Use of personal protective equipment. (E) Cleaning of physical environment, including, but not limited to: (i) Disinfecting high-touch surfaces and equipment. (ii) Handling, storing, processing and transporting linens to prevent the spread of infection. (F) Isolating and cohorting of residents during a disease outbreak.(b) Employees must also receive training on the rights and responsibilities of employees to report disease outbreaks under ORS 433.004 (Reportable diseases) and safeguards for employees who report disease outbreaks. (c) The pre-service training may be provided in person, in writing, by webinar or by other electronic means, including online training made available by the Department by July 1, 2021. (d) Administrators and employees will be required to complete annual training on infectious disease outbreak and infection control. Such training will be included within the current number of required annual training hours and will not necessitate additional hours of training. These annual training requirements will be required no earlier than January 1, 2023. (e) This section (4) will not go into effect until January 1, 2022. (5) PRE-SERVICE TRAINING FOR ALL DIRECT CARE STAFF. (a) Prior to providing care to residents, all direct care staff must complete an approved pre-service dementia training. (b) Pre-service dementia care training requirements for: (A) 2018 - Direct care staff hired on or before December 31, 2018 shall complete pre-service dementia care training outlined in OAR 411-054-0070 (Staffing Requirements and Training) by December 31, 2018, regardless of when they first provide direct care to residents. (B) 2019 and beyond - Direct care staff hired on or after January 1, 2019 shall complete required pre-service dementia training prior to providing direct care to residents. (c) Documentation of dementia training: (A) A certificate of completion shall be issued to direct care staff who satisfactorily complete approved dementia training. Facilities shall also maintain records of all direct care staff who have successfully completed pre-service dementia training. (B) Each facility shall maintain written documentation of continuing education completed, including required pre-service dementia training, for all direct care staff. (d) Portability of pre-service dementia training: After completing the pre-service training, if a direct care staff person is hired within 24 months by a different facility, the hiring facility may choose to accept the previous training or require the direct care staff to complete the hiring facility’s pre-service dementia training. (e) A certificate of completion must be made available to the Department upon request. (f) Pre-service dementia care training must include the following subject areas: (A) Education on the dementia disease process, including the progression of the disease, memory loss, and psychiatric and behavioral symptoms. (B) Techniques for understanding, communicating, and responding to distressful behavioral symptoms, including, but not limited to, reducing the use of antipsychotic medications for non-standard uses. (C) Strategies for addressing social needs of persons with dementia and engaging them with meaningful activities. (D) Information concerning specific aspects of dementia care and ensuring the safety of residents with dementia, including, but not limited to, how to: (i) Identify and address pain. (ii) Provide food and fluids. (iii) Prevent wandering and elopement. (iv) Use a person-centered approach. (g) Pre-service orientation to resident: (A) Prior to providing personal care services for a resident, direct care staff must receive an orientation to the resident, including the resident’s service plan. (B) Staff members must be directly supervised by a qualified person until they have successfully demonstrated satisfactory performance in any task assigned and the provision of individualized resident services, as applicable. (6) TRAINING WITHIN 30 DAYS OF HIRE FOR DIRECT CARE STAFF. (a) The facility is responsible to verify that direct care staff have demonstrated satisfactory performance in any duty they are assigned. (b) Knowledge and performance must be demonstrated in all areas within the first 30 days of hire, including, but not limited to: (A) The role of service plans in providing individualized resident care. (B) Providing assistance with the activities of daily living. (C) Changes associated with normal aging. (D) Identification of changes in the resident’s physical, emotional and mental functioning and documentation and reporting on the resident’s changes of condition. (E) Conditions that require assessment, treatment, observation and reporting. (F) General food safety, serving and sanitation. (G) If the direct care staff person’s duties include the administration of medication or treatments, appropriate facility staff, in accordance with OAR 411-054-0055 (Medications and Treatments) (Medications and Treatments) must document that they have observed and evaluated the individual’s ability to perform safe medication and treatment administration unsupervised. (7) ANNUAL IN-SERVICE TRAINING FOR DIRECT CARE STAFF. (a) All direct care staff must complete and document a minimum of 12 hours of in-service training annually on topics related to the provision of care for persons in a community-based care setting, including training on chronic diseases in the facility population and dementia training. Annual in-service training hours are based on the anniversary date of hire. (b) Requirements for annual in-service dementia training: (A) Except as provided in paragraph (B) of this section, each direct care staff must complete 6 hours of annual in-service training on dementia care. (B) Exception: Staff hired prior to January 1, 2019 must complete 6 hours of dementia care in-service training by the anniversary of their hire date in 2020 and annually thereafter. (C) Dementia care training may be included in the required minimum 12 hours of annual in-service training described in subsection (a) above. (D) Dementia care training must reflect current standards for dementia care and be informed by the best evidence in the care and treatment of dementia. (E) The facility shall determine the competency of direct care staff in dementia care in the following ways: (i) Utilize approved dementia care training for its direct care staff, coupled with methods to perform a competency assessment as defined in OAR 411-054-0005 (Definitions)(19). (ii) Ensure direct care staff have demonstrated competency in any duty they are assigned. Facility staff in a supervisory role shall perform assessment of each direct care staff. (iii) Maintain written documentation of all dementia care training completed by each direct care staff and shall maintain documentation regarding each employee’s assessed competency. (8) APPROVAL OF DEMENTIA TRAINING CURRICULUM. All dementia care training provided to direct care staff must be approved by a private or non-profit organization that is approved by the Department through a “Request for Application” (RFA) process. (9) ADDITIONAL REQUIREMENTS. Staff: (a) Under 18 years of age may not perform medication administration or delegated nursing tasks. Staff under the age of 18 must be directly supervised when providing bathing, toileting, incontinence care or transferring services. (b) Must be trained in the use of the abdominal thrust and First Aid. Cardiopulmonary resuscitation (CPR) training is recommended, but not required. (c) Must have sufficient communication and language skills to enable them to perform their duties and communicate with residents, other staff, family members, and health care professionals, as needed.