In accordance with HB 485 (2021-163 L.O.F.) the Agency proposes to adopt a new rule to implement section 400.141(1)(w), F.S., relating to the Personal Care Attendant Training Program.

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Health Facility and Agency Licensing

RULE NO.:RULE TITLE:

59A-4.1081Personal Care Attendant Training Program Requirements

PURPOSE AND EFFECT: In accordance with HB 485 (2021-163 L.O.F.) the Agency proposes to adopt a new rule to implement section 400.141(1)(w), F.S., relating to the Personal Care Attendant Training Program.

SUMMARY: In accordance with HB 485 (2021-163 L.O.F.) proposed rule 59A-4.1081, F.A.C., will outline requirements for the Personal Care Attendant Training Program. The program permits a nursing home licensed pursuant to Chapter 400 Part, II, F.S., to employ trained personal care attendants (PCAs) and will enable PCAs to obtain skills and training from their employer towards the goal of successfully passing the Certified Nursing Assistant exam.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: A SERC has not been prepared by the agency. For rules listed where no SERC was prepared, the Agency prepared a checklist for each rule to determine the necessity for a SERC. Based on this information at the time of the analysis and pursuant to section 120.541, Florida Statutes, the rule will not require legislative ratification.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 400.141, F.S.

LAW IMPLEMENTED: 400.141, 400.211, 400.23, F.S.

A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: February 25, 2022, from 2:00 pm – 4:00 pm

PLACE: Agency for Health Care Administration, Building 3, Conference Rooms A, B and C, 2727 Mahan Drive, Tallahassee, FL 32308. The agenda and related materials can also be found on the web at:

https://ahca.myflorida.com/MCHQ/Health_Facility_Regulation/Rulemaking.shtml.

PUBLIC CALL-IN INFORMATION: You may participate by phone by dialing the Open Voice conference line, 1(888)585-9008, then enter the conference room number followed by the pound sign, 476-211-242#.

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 3 days before the workshop/meeting by contacting: Jacqueline Williams, Long Term Care Services Unit, 2727 Mahan Drive, Tallahassee, Florida, [phone].. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Jacqueline Williams at [phone] or email at [e-mail]

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

59A-4.1081 Personal Care Attendant Training Program Requirements.

(1) This program permits a nursing home licensed pursuant to Chapter 400 Part II, Florida Statutes (F.S.) to employ a trained Personal Care Attendant. 

(2) Purpose – This Personal Care Attendant Training Program will enable the Personal Care Attendant to further obtain skills and training from their employer toward the goal of successfully passing the Certified Nursing Assistant (CNA) exam.

(3) Definitions.

(a) “Personal Care Attendant” or “PCA” means a person who meets the training requirement in this rule and s. 400.141(1)(w), F.S., and provides care to and assists residents with tasks related to the activities of daily living.

(b) “Training Program” means the Personal Care Attendant Training Program as specified in 400.211, F.S.

(4) Scope – The Training Program must consist of a minimum of sixteen (16) hours of education.  The 16 hours of required education and eight (8) hours of simulation must be completed before the PCA has any direct contact with a resident.

(5) Program Requirements.

(a) A candidate for the Training Program must be at least eighteen (18) years of age. 

(b) The candidate must be able to read, write and complete written materials pertinent to their job duties.

(6) Training Standards.

(a) Completion of all training and documentation requirements for PCA candidates is the ultimate responsibility of the hiring facility.

(b) Training must consist of a minimum of sixteen (16) hours of classroom teaching and eight (8) hours of supervised simulation in which the PCA candidate is required to demonstrate competency in all areas of training.

(c) Upon completion of classroom instruction, PCA candidates must simulate and demonstrate competency in all required areas of instructions and competency in accordance with section (7) of this rule.

(d) The PCA Training Program must be taught by a registered nurse.  For the purposes of this training program, the instructor must be a licensed professional registered nurse.

(e) Under observation by the instructor, PCA candidates will first simulate procedures while working together in pairs or teams.  Next, the instructor must observe each candidate’s simulation of required skills and document the candidate’s competency.

(f) Upon completion of the Training Program, the facility must maintain a record of all PCA candidates who complete training and demonstrate the required competencies.  The facility shall post daily the names of the PCAs on duty.  When requested by the Agency, the facility will provide the names of all PCAs working in the facility at the time of the request.

(g) PCAs must be supervised by a licensed nurse and shall report to the facility’s nursing management or supervisor.

(h) The facility must notify its certified and licensed staff members that PCAs have a limited scope of permissible work, and detail duties they may not be delegated to perform as PCAs. If the facility learns that any PCA is performing duties outside the limited scope of permissible work, the facility must immediately intervene, stop the PCA, and reassign those duties to authorized personnel.

(i) Upon completion of the 16 hour education requirement and eight (8) hour simulation requirement, the PCA will work under the supervision of the licensed nursing staff and in collaboration with the Certified Nursing Assistants.

(7) Required areas of classroom instruction (16 hours).

(a) Residents’ rights (2 hours).

1. Immediate reporting of abuse and neglect to nurse/manager on duty.

2. Sample scenarios of situations involving resident rights, abuse, and neglect.

3. Review of immediate protection of resident until assistance arrives if abuse is in process.

4. Review of duty to immediately report abuse or neglect to nurse/manager on duty.

5. Department of Children and Families (DCF) reporting requirements for mandated reporters.

6. Maintaining resident privacy and honoring resident preferences.

(b) Confidentiality of residents’ personal information and medical records (1.5 hours ).

1. How to maintain confidentiality of resident information.

2. Response to a witnessed (or reported) breach.

(c) Control of contagious and infectious diseases (2 hours of classroom education and 1.5 hours of simulation).

1. How infection is spread (chain of infection/modes of transmission) and how to prevent infection.

2. Hand hygiene; handwashing, alcohol-based hand rub (ABHR), cough etiquette.

3. Standard precautions/personal protective equipment.

4. Handling of clean and soiled linens.

5. Disinfection of common use articles/equipment/high touch objects/areas.

6. Personal protective equipment (PPE) use and disposal.

7. The PCA will not be assigned or provide care or services to a resident on isolation precautions.

(d) Emergency response measures (2 hours of classroom education and 1.5 hours of simulation).

1. Fall prevention.

2. What to do when a resident is found on the floor.

3. Choking: abdominal thrusts.

4. Fire safety.

5. Weather safety.

(e) Assistance with activities of daily living (4 hours of classroom education and 2 hours of simulation).

1. Initial steps/responding to a call light.

2. Obtaining a temperature (all routes other than rectal), reporting/documentation.

3. Making an unoccupied bed/handling of linens.

4. Turning and repositioning the resident while in bed.

5. Transfer from bed to chair/wheelchair/use of Gait belt – one person standby/transfer.

6. For anything beyond a one-person transfer, the PCA may only assist and must be directed by a certified/licensed staff member.

7. Assistance with dressing/undressing.

8. Incontinence/perineal care.

9. Assist to toilet/use of urinal (only for a resident requiring one person/standby assistance).

10. Oral care – conscious residents only.

11. Devices/use/storage.

a. Hearing aids.

b. Eyeglasses.

c. Dentures.

12. PCA may not apply or don orthotics and prosthetics devices or braces.

13. Final steps/observations to report to the nurse.

14. Assistance with bathing/showering.

(f) Measuring vital signs  (1 hour of classroom education and 1.5 hours of simulation).

(g) Skin care and pressure sores prevention (30 minutes of classroom education and 1 hour of simulation).

1. Basic care/interventions/devices.

2. Offloading/floating heels.

3. Observations to report to the nursing management or supervisor on duty.

a. Open area or skin condition observed to be lacking a dressing - emphasis on no dressing applied by the PCA.

b. Observed bruises, abrasions, or skin tears.

(h) Portable oxygen use and safety (30 minutes of classroom education and 30 minutes of simulation).

1. Nasal cannula/tubing/storage/observing liter flow.

2. Potential hazards safety.

(i) Nutrition and hydration (30 minutes).

1. Mechanically altered diets/thickened liquids/adherence to diet.

2. Passing trays/retrieving trays (set up/opening packages for residents who can consume meals independently).

3. Passing ice water.

4. Food storage/safety.

5. PCAs cannot feed a resident prior to completing the training for paid feeding assistants required in section 400.141, F.S.

(j)  Dementia care (1 hour).

1. Stages of dementia/overview.

2. Tips on communicating with cognitively impaired residents.

3. Recognition of when to seek additional staff assistance.

(k) Mental health/challenging behaviors (1 hour).

1. Responding to a challenging behavior.

2. Recognition of when to seek additional staff assistance.

3. Reporting a challenging behavior to nurse/manager on duty.

4. Trauma informed care.

(8) Required areas of hands on simulation (8 hours).

(a) Hand hygiene; handwashing, alcohol-based hand rub (ABHR), cough etiquette.

(b) Handling of clean and soiled linens.

(c) Disinfection of common use articles/equipment/high touch objects/areas.

(d) Personal protective equipment (PPE) use and disposal.

(e) What to do when a resident is found on the floor.

(f) Choking: abdominal thrusts.

(g) Fire safety.

(h) Initial steps/responding to a call light.

(i) Obtaining a temperature (all routes other than rectal), reporting/documentation.

(j) Making an unoccupied bed/handling of linens.

(k) Turning and repositioning the resident while in bed.

(l) Transfer from bed to chair/wheelchair/use of gait belt – one person standby/transfer.

(m) Assistance with dressing/undressing.

(n) Incontinence/perineal care.

(o) Assist to toilet/use of urinal (only for a resident requiring one person/standby assistance).

(p) Assistance with bathing/showering.

(q) Oral care – conscious residents only.

(r) Measuring Vital Signs.

(s) Basic care/interventions/devices.

(t) Offloading/floating heels.

(u) Nasal cannula/tubing/storage/observing liter flow.

(9) This rule is in effect for five years from its effective date.

Rulemaking Authority 400.141 FS., Law Implemented 400.141, 400.211, 400.23 FS., History–New______________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Jacqueline Williams

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Simone Marstiller

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: 1/18/2022

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: 10/06/2021