Or. Admin. Code § 411-049-0125 - Caregiver Qualifications
(1)
LICENSEE AND ADMINISTRATOR QUALIFICATIONS. An AFH licensee or administrator
must:
(a) Live in the home that is to be
licensed at least five 24-hour days per week and function as the primary
caregiver as defined in OAR
411-049-0102 unless:
(A) There is, or shall be upon licensure, an
approved resident manager who lives in the home and works five days and nights
per week as the primary caregiver;
(B) There is, or shall be upon licensure, two
approved primary caregivers who live in the home and work three and four days
and nights per week respectively; or
(C) The home is staffed 24-hours a day at
least five days a week with a combination of approved shift caregivers. (See
OAR 411-049-0125(6)).
(b) Subsections (a)(A), through
(a)(C) of this section are not intended to prohibit the occasional and
temporary absence of the primary caregivers from the AFH.
(c) Be at least 21 years of age.
(d) Possess physical health, mental health,
good judgment, and good personal character, including truthfulness, determined
necessary by the Department to provide 24-hour care for adults who are older or
adults with physical disabilities. An applicant and licensee must have a
statement from a physician, nurse practitioner, or physician assistant
indicating that the applicant or licensee is physically, cognitively, and
emotionally capable of providing care to residents. An applicant or licensee
with documented history or substantiated complaints of substance abuse or
mental illness must provide evidence satisfactory to the Department of
successful treatment, rehabilitation, or references regarding current
condition.
(e) Have an approved
background check in accordance with OAR
411-049-0120 and maintain that
approval as required.
(f) Be
proficient in the English language and demonstrate the ability to comprehend
and communicate in English orally and in writing with the residents and the
residents' family members or representatives, emergency personnel (e.g.,
emergency operator, law enforcement, paramedics, and fire fighters), licensed
health care professionals, case managers, DHS and LLA staff, and others
involved in the care of the residents.
(g) Be able to respond appropriately to
emergency situations at all times.
(h) Have a clear understanding of their
responsibilities, knowledge of the residents' care plans, and the ability to
provide the care specified for each resident; and not be listed on either of
the Exclusion Lists.
(2)
LICENSEE AND ADMINISTRATOR TRAINING REQUIREMENTS. For licensees designated as
corporate entities, at least one administrator must meet the training
requirements described in (2)(a) - (2)(g) of this rule in addition to obtaining
a variance as outlined in OAR
411-049-0160(2)(c)(C).
(a) Licensees and administrators must have
the education, experience, and training to meet the requirements of the
requested classification of the home. (See OAR
411-049-0125).
(b) A potential applicant or applicant must
complete the following training requirements prior to obtaining a license:
(A) Attend a DHS-approved orientation program
conducted by the LLA responsible for the licensing of the proposed
AFH.
(B) Attend the Department's
Ensuring Quality Care Course and pass the examination to meet application
requirements for licensure.
(i) Applicants who
fail the first examination may take the examination a second time; however,
successful completion of the examination must take place within 90 calendar
days of the end of the Department's Ensuring Quality Care Course.
(ii) Potential applicants and applicants who
fail a second examination must retake the Department's Ensuring Quality Care
Course prior to repeating the examination.
(C) Comply with the Department's current
Ensuring Quality Care Course student policies.
(D) Have and maintain current CPR and First
Aid certification.
(i) Accepted CPR and First
Aid courses must be provided by or meet the standards of the American Heart
Association or the American Red Cross.
(ii) CPR or First Aid courses conducted
online are only accepted by the Department when an in-person skills competency
check is conducted by a qualified instructor meeting the standards of the
American Heart Association, the American Red Cross.
(c) All caregivers must complete
dementia training approved by the Department before providing direct care as
mandated by ORS 443.743. The training shall be
based on current standards in dementia care, and shall include:
(A) Education on the dementia disease
process, including the progression of the disease, memory loss, and psychiatric
and behavioral symptoms.
(B)
Techniques for understanding and managing behavioral symptoms, including, but
not limited to reducing the use of psychotropic medications for nonstandard
uses.
(C) Strategies for addressing
the social needs of persons with dementia and providing them with meaningful
activities.
(D) Specific aspects of
dementia care and ensuring the safety of residents with dementia, including,
but not limited to, how to:
(i) Address
pain.
(ii) Provide food and
fluids.
(iii) Prevent wandering and
elopement.
(iv) Use a
person-centered approach.
(d) Licensees, administrators, resident
managers, floating resident managers, or shift caregivers must complete the
required dementia training as mandated by ORS
443.743.
(e) Licensees, administrators, resident
managers, floating resident managers, shift caregivers, and substitute
caregivers must complete the Department-approved LGBTQIA2S+ training as
mandated by ORS 441.111 to
441.122. The Department-approved
training shall address the elements described in paragraph (11)(c) of this
rule. The following dates apply to the initial LGBTQIA2S+ trainings:
(A) Effective December 31, 2024, all staff
must have completed the required training. All new staff, hired on or after
January 1, 2025, must complete the required training prior to beginning job
responsibilities.
(B) The
Department-approved LGBTQIA2S+ trainings shall address the elements described
in paragraph (11) of this rule.
(f) HOME AND COMMUNITY-BASED SERVICES (HCBS)
TRAINING. All caregivers, including licensees, administrators, resident
managers, floating resident managers, shift caregivers or substitute caregivers
are required to complete the Department-approved HCBS training, as provided
below:
(A) Effective March 31, 2024, all
caregivers must have completed the required training.
(B) All new caregivers, hired on or after
April 1, 2024, must complete the required training prior to beginning job
responsibilities.
(g)
CAREGIVER ORIENTATION. Prior to providing care to any resident, all caregivers
must be oriented to the home and to the residents by the licensee or other
qualified primary caregiver. Orientation must be clearly documented in the
facility records. Orientation includes, but is not limited to:
(A) Location of any fire
extinguishers.
(B) Demonstration of
evacuation procedures.
(C)
Instruction of the emergency preparedness plan.
(D) Location of resident records.
(E) Location of telephone numbers for the
residents' physicians, the licensee, and other emergency contacts.
(F) Location of medications and the key for
the medication cabinet.
(G)
Introduction to residents.
(H)
Instructions for caring for each resident.
(I) How to administer medications
properly.
(J) How to document on
the resident's medication administration record and other resident
records.
(K) Making arrangements
with a registered nurse to delegate any nursing procedure that requires
delegation prior to the caregiver performing that task.
(L) Understanding the home's policies and
procedures related to Advance Directives. (See OAR
411-050-0750).
(3) FINANCIAL
REQUIREMENTS. A licensee applicant and licensee must have the financial ability
and maintain sufficient liquid resources to pay the operating costs of the AFH
for at least two months without solely relying on potential resident income.
(a) If an initial license applicant is unable
to demonstrate the financial ability and resources required by this section,
the Department may require the applicant to furnish a financial guarantee, such
as a line of credit or guaranteed loan, to fulfill the requirements of this
rule.
(b) If at any time there is
reason to believe an applicant or licensee may not have sufficient financial
resources to operate the home in compliance with these rules, the LLA may
request additional documentation, which may include verification of the
applicant's or licensee's ability to readily access the requested funds.
Circumstances that may prompt the request of additional financial information
include, but are not limited to, reports of insufficient food, inadequate heat,
or failure to pay employees, utilities, rent, or mortgage. Additional
documentation of financial resources may include, but are not limited to:
(A) The Department's Verification of
Financial Resources form (APD 0448F) completed and stamped or notarized by the
applicant's or licensee's financial institutions.
(B) Documentation on letterhead of the
applicant's or licensee's financial institutions that includes:
(i) The last four digits of the applicant's
or licensee's account number;
(ii)
The name of the account holder, and if the account is not in the applicant's or
licensee's name, verification the applicant or licensee has access to the
account's funds;
(iii) The highest,
lowest, and current balance for each of the most recent three full
months;
(iv) The line of credit
balance available for each of the most recent three full months, if
applicable;
(v) The number of any
non-sufficient fund (NSF) payments in each of the last three full months, if
any; and
(vi) The date and
signature of the banking institution's representative completing the
form.
(C) Demonstration
of cash on hand equal to a minimum of two months of operating
expenses.
(c) The LLA
must request the least information necessary to verify compliance with this
section.
(4) RESIDENT
MANAGER REQUIREMENTS. A resident manager must live in the home as specified in
section (1)(a)(A) of this rule and function as the primary caregiver under the
licensee or administrator's supervision. A resident manager must meet and
maintain the qualification and training requirements specified in sections
(1)(c) through (2)(g) of this rule. The LLA shall verify all the requirements
of these rules have been satisfied prior to approval of a resident
manager.
(5) FLOATING RESIDENT
MANAGER REQUIREMENTS.
(a) A floating resident
manager must meet and maintain the qualification and training requirements
specified in sections (1)(c) through (2)(g) of this rule, except as indicated
in (5)(b) of this rule.
(b) If the
licensee has one or more homes within the jurisdiction of more than one LLA, a
currently approved floating resident manager is not required to complete the
Department-approved orientation in more than one licensing authority's
jurisdiction. This exception does not prohibit the LLA within an exempt area
from requiring the floating resident manager applicant to attend the LLA's
orientation.
(c) The floating
resident manager must be oriented to each home prior to providing resident care
in each home.
(d) Facility records
in each of the homes a floating resident manager is assigned to work must
maintain proof the floating resident manager has a current and approved
background check.
(e) A floating
resident manager may not be used in lieu of a shift caregiver, except on
temporary basis, when the regular shift caregiver is unavailable due to
circumstances, such as illness, vacation, or termination of
employment.
(6) SHIFT
CAREGIVER REQUIREMENTS
(a) Shift caregivers
may be used in lieu of a resident manager. If shift caregivers are used, each
shift caregiver must meet or exceed the experience and training qualifications
for the license classification requested.
(b) Shift caregivers must meet and maintain
the qualification and training requirements specified in sections (1)(c)
through (2)(g) of this rule. The LLA shall verify all the requirements of these
rules have been satisfied prior to approval of a shift caregiver.
(7) SUBSTITUTE CAREGIVER
REQUIREMENTS. A substitute caregiver left in charge of the residents for any
period of time, may not be a resident, and must at a minimum, meet all the
following qualifications prior to working alone in the home.
(a) Be at least 18 years of age.
(b) Have an approved background check in
accordance with OAR 411-049-0120 and maintain that
approval as required.
(c) Be
proficient in the English language and demonstrate the ability to comprehend
and communicate in English orally and in writing with the residents and the
residents' family members and representatives, emergency personnel (e.g.,
emergency operator, law enforcement, paramedics, and fire fighters), licensed
health care professionals, case managers, Department and LLA staff, and others
involved in the care of the residents.
(d) Be able to respond appropriately to
emergency situations at all times.
(e) Have a clear understanding of their
responsibilities, have knowledge of the residents' care plans, and be able to
provide the care specified for each resident, including appropriate delegation
or consultation by a registered nurse.
(f) Possess physical health, mental health,
good judgment, and good personal character, including truthfulness, determined
necessary by the Department to provide care for adults who are older or adults
with physical disabilities, as determined by reference checks and other sources
of information.
(g) Substitute
caregivers must complete CPR and First Aid training and certification within 30
calendar days of the start of employment. Certification must be maintained
according to the standards established in (2)(b)(D) of this rule.
(h) Not be listed on either of the Exclusion
Lists.
(A) The licensee or administrator must
verify the substitute caregiver is not listed on either of these Exclusion
Lists; and
(B) Clearly document
that verification in the facility's records.
(i) All substitute caregivers must complete
dementia training as stated in (2)(c).
(j) All substitute caregivers must complete
LGBTQIA2S+ training as outlined by OAR
411-049-0125(2)(e).
(k) All substitute caregivers must complete
HCBS training as outlined in OAR
411-049-0125(2)(f).
(l) A substitute caregiver must be oriented
to the home, as stated in (2)(g) of this rule, by the licensee or administrator
at the home, before providing direct care to any residents.
(m) A substitute caregiver must complete the
Department's Caregiver Preparatory Training Study Guide (DHS 9030) and Workbook
(DHS 9030-W) and receive instruction in specific care responsibilities from the
licensee or administrator prior to working or training in the home. The
Workbook must be completed by the substitute caregiver without the help of any
others. The Workbook is considered part of the required orientation to the home
and residents.
(A) The LLA may grant a
variance to the Caregiver Preparatory Training Study Guide and Workbook
requirement for a substitute caregiver who:
(i) Holds a current Oregon license as a
health care professional, such as a physician, nurse practitioner, physician
assistant, registered nurse, or licensed practical nurse; and
(ii) Demonstrates the ability to provide
adequate care to residents based on similar training or at least one year of
experience providing direct care to adults who are older or adults with
physical disabilities.
(B) A certified nursing assistant (CNA) or
certified medical assistant (CMA) must complete the Caregiver Preparatory
Training Study Guide and Workbook and have a certificate of completion signed
by the licensee or administrator.
(8) Contractors who provide services or
supports directly to residents must complete the LGBTQIA2S+ trainings outlined
in paragraph (11)(c) of this rule.
(a)
Contractors who must be trained include, but are not limited to, RN consultants
and administrative consultants, housekeeping services, dietary services,
beauticians, barbers, or other contractors who provide services or supports
directly to residents.
(b) Exempt
from this training requirement are contractors who contract directly with the
resident or the resident's representative, and contractors who do not generally
provide services or supports directly to residents, including but not limited
to, contractors for landscaping, pest control, deliveries and building
repairs.
(c) By December 31, 2024,
licensees or administrators shall ensure that all contracts entered into with
entities described in paragraph (a) of this section shall include language
requiring contractors provide Department-approved LGBTQIA2S+ training to their
employees within 12 months of entering into the contract with the licensee or
administrator and every two years thereafter.
(d) For existing contracts in effect January
1, 2025, licensees or administrators shall require the contractor provide
Department-approved LGBTQIA2S+ training to employees by December 31, 2025, and
every two years thereafter.
(e) For
new contracts created after January 1, 2025, licensees or administrators shall
require contractors provide the Department-approved LGBTQIA2S+ training to
employees within 12 months of entering into the contract with the facility, and
every two years thereafter.
(f)
Licensees or administrators must inform contractors that the cost of all
LGBTQIA2S+ trainings for contracted employees shall be paid by the
contractor.
(9) TRAINING
WITHIN FIRST YEAR OF INITIAL LICENSURE OR APPROVAL. Within the first year of
obtaining an initial license or approval, the licensee, administrator, resident
manager, floating resident manager, and shift caregivers must complete the "DHS
Six Rights of Safe Medication Administration" and a Fire and Life Safety
training as available. The Department or LLA and the Office of the State Fire
Marshal or the local fire prevention authority may coordinate the Fire and Life
Safety training program.
(10)
ANNUAL TRAINING REQUIREMENTS.
(a) Each year
after initial licensure, the licensee, administrator, resident manager,
floating resident manager, and shift caregivers must complete at least 12 hours
of Department-approved training related to the care of adults who are older or
adults with physical disabilities in an AFH setting. Up to:
(A) Four hours of the required annual
training may be related to the business operation of the AFH.
(B) Two hours of CPR training and two hours
of First Aid training may count as part of the required annual
training.
(b) A
licensee, administrator, resident manager, floating resident manager, and shift
caregivers, as applicable, must maintain approved CPR and First Aid
certification.
(c) HOME AND
COMMUNITY-BASED SERVICES (HCBS) TRAINING.
(A)
All caregivers, including licensees, administrators, resident managers,
floating resident managers, shift caregivers or substitute caregivers are
required to complete the Department-approved annual HCBS training.
(B) These annual training requirements will
be required as of April 1, 2025.
(d) Registered nurse delegation or
consultation, and the Ensuring Quality Care Course (not including approved EQC
refresher courses), AFH orientation, Ventilator Assisted Care Course and skills
competency checks, or consultation with an accountant do not count toward the
required 12 hours of annual training.
(11) BIENNIAL TRAINING REQUIREMENTS.
Licensees, administrators, resident managers, floating resident managers,
shift-caregivers, substitute caregivers, and contracted staff, shall be
required to complete biennial training addressing LGBTQIA2S+ protections, as
described in this section. Licensees or administrators are responsible for the
cost of providing this training to all staff.
(a) Each AFH shall designate two employees,
as reasonable, one to represent management and one to represent direct care
staff by July 1, 2024. The individual designated to represent management shall
serve as a point of contact for the AFH regarding compliance with preservice
training and biennial training. This person shall develop a general training
plan for the AFH. For licensees and administrators that are also the primary
caregiver, only one staff person will be required to be designated.
(b) The licensee or administrator must select
the LGBTQIA2S+ training to be used by the AFH by either:
(A) Choosing to use the standard
Department-approved biennial LGBTQIA2S+ training; or
(B) Applying to the Department to request
approval of a biennial LGBTQIA2S+ training to be developed and provided by the
licensee or administrator.
(c) ORS
441.116 requires all LGBTQIA2S+
trainings address:
(A) Caring for LGBTQIA2S+
residents and residents living with human immunodeficiency virus; and
(B) Preventing discrimination based on a
resident's sexual orientation, gender identity, gender expression or human
immunodeficiency virus status.
(C)
The defined terms commonly associated with LGBTQIA2S+ individuals and human
immunodeficiency virus status.
(D)
Best practices for communicating with or about LGBTQIA2S+ residents and
residents living with human immunodeficiency virus, including the use of an
individual's chosen name and pronouns.
(E) A description of the health and social
challenges historically experienced by LGBTQIA2S+ residents and residents
living with human immunodeficiency virus, including discrimination when seeking
or receiving care at care facilities and the demonstrated physical and mental
health effects within the LGBTQIA2S+ community associated with such
discrimination.
(F) Strategies to
create a safe and affirming environment for LGBTQIA2S+ residents and residents
living with human immunodeficiency virus, including suggested changes to care
facility policies and procedures, forms, signage, communication between
residents and their families, activities, in-house services and staff
training.
(G) The individual or
entity providing the training must demonstrate a commitment to advancing
quality care for LGBTQIA2S+ residents and residents living with human
immunodeficiency virus in this state.
(d) The proposal for training submitted by a
licensee, administrator, entity, or individual shall include:
(A) The regulatory criteria described in
paragraph (c) of this section as part of the proposal.
(B) The following elements must be included
in the proposal:
(i) A statement of the
qualifications and training experience of the individual or entity providing
the training.
(ii) The proposed
methodology for providing the training either online or in person.
(iii) An outline of the training.
(iv) Copies of the materials to be used in
the training.
(C) The
Department will review the materials and determine whether to approve or deny
the training. No later than 90 days after the request is received, the
Department will inform the licensee or administrator in writing of the
Department's decision.
Notes
Statutory/Other Authority: ORS 409.050, 410.070, 413.085, 441.122, 443.001, 443.004, 443.725, 443.730, 443.735, 443.738, 443.742, 443.767, 443.775 & 443.790
Statutes/Other Implemented: ORS 409.050, 410.070, 413.085, 441.116, 441.118, 443.001 - 443.004, 443.705 - 443.825, 443.875 & 443.991
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