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EMPLOYEE TRAINING
L A L D
ICENSED SSISTED IVING IRECTOR
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ASSISTED LIVING EMPLOYMENT RELATED TRAINING
Nicole M.Mattson,Vice President of Strategic Initiatives Care Providers of Minnesota Jill Schewe, LALD, Director ofAssisted Living, Housing &Home Care Care Providers of Minnesota
INTRODUCTIONS
Nicole M. Mattson, VicePresident of StrategicInitiatives Care Providers of Minnesota
Nicole Mattsonis VicePresident ofStrategicInitiatives for CareProviders of Minnesota, whereshe focuses on Advocacy, Workforceand Quality.Nicole is alicensed nursinghome administratorand a Health Services Executive candidate.She has a master’s degree in Human Resource Management fromSt.Mary’s University, and anundergrad from Metropolitan State University. Sheholds SPHR certification fromthe Human Resource Certification Institute and SHRM-SCP fromthe Society of Human Resource Management. She has over 25 years of experience in the senior care profession, in various capacities, most recentlyas an AdministratorwithGood Samaritan Society-Specialty CareCommunity. Nicole isa SeniorExaminerforthe AHCAQualityAward Program and is the Chairpersonof the Hennepin Carver Workforce Development Board.
Jill Schewe, LALD, Director ofAssisted Living, Housing & Home Care Care Providers ofMinnesota
DirectorofAssisted Living,Housing &Home Care, CareProviders of Minnesota Jill Schewe has worked in and with assistedliving communities herentire career.As aformer assisted livingmanager, her experiencewas in startup, management, and operations ofseveral assisted livingcommunities. In hercurrent role, Jill works with assistedliving providerson any topicthey need helpwith toaid in their success, including licensing, policy, payment, and operationalsystems. Sheunderstands the needsofolder adultsand home- and community-based servicesalike. And most recentlyshe obtainedher Assisted LivingDirector license.
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Content for this module:
• We’re going to cover some of the staffing, orientation, training and human resource components of 144G Assisted Living Licensure and
Assisted Living Rule 4659 • We’ll also cover some Minnesota specific employer laws • Federal laws pertaining to employment and general human resource practices will be covered elsewhere
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Pre-employment Screening
•Minnesota Statute Consideration of Criminal Records https://www.revisor.mn.gov/statutes/cite/364.021 •So called “Ban the Box” law •Doesn’t prevent employers from considering an applicant’s criminal history. •It’s a timing thing. Employers must wait until a job applicant has been selected for an interview, or a conditional offer of employment has been extended, before asking the applicant about their criminal record or conducting a criminal background record check. •Does not remove your requirements under statute 144.057 to perform a DHS
Background Study on all employees before they have access to residents/clients/tenants •A good practice to inform potential candidates that successful completion of a
DHS Background Study is requirement of employment Statutes: • 364.021, • 144G.41 Subd. 2 & • 144G.60 Subd.1
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Background Studies
• Must conduct a Minnesota Department of Human Services background study for all employees, volunteers and contractors • Using NETStudy 2.0 https://mn.gov/dhs/general-public/backgroundstudies/ • Must read and follow the information on the notifications received from
DHS regarding status of the background study:
• Background study on the individual has been completed and the individual may provide direct contact services for the agency for which the background study was completed or • More time is needed to complete the background study for the individual and the individual may provide direct contact services while the background study is being completed or • More time is needed to complete the background study for the individual and they must be supervised at all times. If constant direct supervision by another qualified individual is not possible, the person cannot work while the study is pending or • A notice stating that the individual is disqualified from any position allowing direct contact with or access to, people receiving services. Note – Individuals with this result cannot be employed. Statutes: • 144G.41Subd. 2 (2) & • 144G.60Subd. 1
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Employee Records
Must maintain an employee record that includes:
•Evidence of current professional licensure,registrationor certificate, if required •Records of all training and in-service education required and/or providedincluding record of competency testing as required •Currentsignedjob description, which includes qualifications, responsibilities, and identification of supervisors, if any •Documentation of annual performance reviews that identify areas of improvement needed and training needs •For individuals providing Assisted Living services, verification that required health screeningsfor Tuberculosis (TB) have taken place and the dates of those screenings(keep medical information in a separate employee medical file) •Documentation of a competed criminal background study •Evidence that a reference check has been completed •Verification ofcompletedorientation and annualtrainingandcompetency testing as required Statute: • 144G.42 Subd. 8
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Employee Records
Other documents that may beincluded in an employee record include:
•Completed employee application •Resume (when provided) •Proof of I-9 compliance •Completed W-4 •Verification thatreferencechecks were completed prior to hire •Record of annual training on A Workplace Accident and Injury Reduction (AWAIR) program •Record of Minnesota Employee Right to Know Act (MERTKA) training upon hire •Record of HIPAA training upon hire •Record of Vulnerable adult prevention and reporting/abuseandneglect preventionplan training •Information regarding employee benefits provided or elected •Other records deemed appropriate •Proof that written notice was given to employee uponstart of employmentthat contains information as required byMN WageTheft Law
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Employee Records
Other health related documents should be kept in a separate file:
•Employee injury records, including any exposure to bloodborne pathogens •Workerscompensation records •Any other health screenings required by infection control programs established •Other applicable health records •Employee exposure and medical records should be maintained 30 years per https://www.osha.gov/lawsregs/regulations/standardnumber/191 0/1910.1020 with a few exceptions outlined in the rule Other things to remember with employee records:
•Obligation to maintain confidentiality and security. •Minnesota employers are required to provide employees with access to their personnel record upon written request. A current employee is entitled to review his or her personnel record once every six months. A former employee may either request to review his or her personnel file once a year or obtain a copy of his or her personnel file free of charge once a year for as long as the record is maintained •Records should be maintained for a minimum of 3 years 144G.42 Subd8.
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Licensed AL Director (LALD)
•Each facility to have and maintain a licensed or permitted Assisted Living Director from the Board of Executives for Long Term Services and Supports https://mn.gov/boards/nursing-home/ •Complete an approved training course and pass an examination approved by the board that is designed to test for competence and that includes assisted living facility laws in Minnesota. • Assisted Living Director-in-Residence (ALDIR) ALDIR is designed to allow individuals who are currently serving as Director and do not qualify an opportunity to apply for licensure and complete their education and experience while working in an assisted living setting as a Director under supervision/mentorship for up to a year as they complete their licensure requirements. • Assisted Living Director Frequently Asked Questions • ALD Flowchart/Application Guide Statute: • 144G.10
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Delegation and Supervision
•A Registered Nurse (or other licensed health professional where appropriate) will determine what nursing services may be delegated to properly trained and competency tested unlicensed personnel. •Only unlicensed personnel who are determined to be competent and possess the knowledge and skills consistent with the complexity of tasks being delegated will be permitted to perform such delegated tasks. •Ifunlicensed personnel havenot regularly performed the delegated home care task for a period of 24 consecutive months, the unlicensed personnel must demonstratecompetency in the task to the registered nurse or appropriate licensed health professional. •TheAssisted Living facilitywill have a system in place to communicate up-to-date information to a RN regarding current available staff and their competencies.
Statute: • 144G.62
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Delegation and Supervision
Staff who provide delegated nursing or therapy tasks to residents will be supervised by an RNor appropriate licensed health professionalwhere the services are being provided to verify that work is being performed competently and to identify problems and solutions related to the staff person’s ability perform the tasks.Supervision will include observation of the staff administering the medication or treatment and the interaction withresident. •Direct supervision of staff performing delegated tasksmust beprovided within 30 calendar days after the date on which the individual begins working and first performs the delegated tasks for residentsand thereafter as needed based on performance. •This requirement also applies to staff that have not performed delegated tasks for one(1)year or longer. •The supervision should be through the direct and indirect observation of the unlicensed personnel performing the services.Theresidentorresident’s responsible person may be interviewed to assure they are satisfied with the services they are receiving. •It is the responsibility of the RN staff to ensure the supervision is done within the time frames outlined above and specified on the client’s service plan. •Documentation of supervision activitieswillbe retained intheemployee’srecord. Statute: • 144G.62
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Orientation
All staffproviding and supervising directservices must complete an orientation to Assisted Living facilitylicensing requirements and regulations before providingassisted living services toresidents. •The materials and/or type of training (i.e.video, lecture, reading, etc.) will be documented for compliance. •The orientation must contain the following topics: 1.An overview ofthe appropriateAssisted Livingstatutes and rules 2.An introduction and review of the facility's policies and procedures related to the provision of assistedliving services by the individual staff person 3.Handling of emergencies and use of emergency services 4.Compliance with and reporting of the maltreatment of vulnerable adults under section 626.557 to theMinnesota Adult Abuse Reporting Center (MAARC) 5.The assisted living bill of rights and staff responsibilitiesrelated to ensuring the exercise and protectionof those rights 6.Principles of person-centered planning and service delivery and how they apply to direct supportservices provided by the staff person
Statute: • 144G.63. Rule: • 4659.019
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Orientation
7.Handling of residents' complaints, reporting of complaints, and where to report complaints, including information on the Office of Health Facility Complaints 8.Consumer advocacy services of the Office of Ombudsman for Long-Term Care,
Office of Ombudsman for Mental Health and Developmental Disabilities, Managed
Care Ombudsman at the Department of Human Services, county-managed care advocates, or other relevant advocacy services 9.A review of the types of assisted living services the employee will be providing and the facility's category of licensure 10.The staff person's job description upon hire and whenever there is a change to the job description that changes the nature of the job or how the job is to be performed 11.The facility's organization chart and the roles of staff within the facility, andthe services offered by the facility as identified in the uniform checklist disclosure of services 12.The identification of incidents of maltreatment as defined under
MinnesotaStatutes, section 626.5572, subdivision 15, including abuse, financial exploitation, andneglect, and an explanation that any act that constitutes maltreatment is prohibited. Statute: • 144G.63. Rule: • 4659.019
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Orientation
Statute: • 144G.61
In addition to the topics previously listed, orientation may also contain training on providing services to residents with hearing loss. Any training on hearing loss provided under this subdivision must be high quality and research based, may include online training, and must include training on one or more of the following topics: 1.An explanation of age-related hearing loss and how it manifests itself, its prevalence, and the challenges it poses to communication 2.Health impacts related to untreated age-related hearing loss, such as increased incidence of dementia, falls, hospitalizations, isolation, and depression; or 3.Information about strategies and technology that may enhance communication and involvement, including communication strategies, assistive listening devices, hearing aids, visual and tactile alerting devices, communication access in real time, and closed captions.
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Orientation
•Staff providing assisted living services must be oriented specifically to each individual resident and the services to be provided. This orientation may be provided in person, orally, in writing, or electronically •All direct care staff and supervisors providing direct services must demonstrate an understanding of the training specified •Evidence of the completion of required orientation topics must be kept in the employee record of each staff person having completed the orientation.
Statute: • 144G.61
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Dementia Care-AL Facilities
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Dementia Care-AL with Dementia Care licensed facilities
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Staff Competency Evaluation
Statute: • 144G.41 Subd. 2 (3) & • 144G.61 Subd. 2
Training and competency evaluations for all Unlicensed Personnelwillinclude: 1.Documentation requirements for all services provided 2.Reports of changes in the resident's condition to the supervisor designated by the facility 3.Basic infection control, including blood-borne pathogens 4.Maintenance of a clean and safe environment 5.Appropriate and safe techniques in personal hygiene and grooming, including: 1.hair care and bathing 2.care of teeth, gums, and oral prosthetic devices 3.care and use of hearing aids 4.dressing and assisting with toileting 6.Training on the prevention of falls
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Staff Competency Evaluation
Topics continued: 7.Standby assistance techniques and how to perform them 8.Medication, exercise, and treatment reminders 9.Basic nutrition, meal preparation, food safety, and assistance with eating 10.Preparation of modified diets as ordered by a licensed health professional 11.Communication skills that include preserving the dignity of the resident and showing respect forthe resident and the resident's preferences, cultural background, and family 12.awareness of confidentiality and privacy 13.Understanding appropriate boundaries between staff and residents and the resident's family 14.Procedures to use in handling various emergency situations 15.Awareness of commonly used health technology equipment and assistive devices.
Statute: • 144G.41 Subd. 2 (3) & • 144G.61 Subd. 2
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Staff Competency Evaluation
Additionally, training and competency evaluation for unlicensed personnel providingassisted living services must include:
1.Observing, reporting, and documenting resident status 2.Basic knowledge of body functioning and changes in body functioning, injuries, or other observedchanges that must be reported to appropriate personnel 3.Reading and recording temperature, pulse, and respirations of the resident 4.Recognizing physical, emotional, cognitive, and developmental needs of the resident 5.Safe transfer techniques and ambulation 6.Range of motioning and positioning 7.Administering medications or treatments as required Statute: • 144G.41 Subd. 2 (3) & • 144G.61 Subd. 2
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Staff Competency Evaluation
Additional nursing tasks that could be delegated to unlicensed personnel that would require training and competency testing by a RN include (this list is not all inclusive):
•Use of glucometers •TED stockings •Foley catheter care and cleaning •Peak lung capacity flow (asthma protocol) •Oxygen Administration and Oxygen saturation levels (pulse oximeter) •Dressing Changes •Nebulizers •Ace bandage application •Splints •Urostomy care •Thickened liquid preparation •Use of alarms •Leg braces •Protective boots, soft casts, and inflatable boots •Exercises ordered by Physical Therapy •Wound care procedures
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Staff Competency Evaluation
List continued:
•Blood pressure checks •Use of mechanical lifts •Catheter procedures •C-PAP machines •Lymphedema wraps •AFO Brace •Inhalers •Nebulizers •Nasal Sprays •Eye drops •Peak Flow meters •Insulin •PRN meds (pain, eye drops, nitro-stat, inhalers, etc.) •Dialysis catheter dressing changes (and instructions for showering) •Medication Patches •Medications via gastrostomy tube
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Staff Competency Evaluation
Other things to remember with competency evaluations •When appropriately specific to the client, the registered nurse or licensed health professional must document instructions for the delegated tasks in the client's record. •Competency may be demonstrated via a written, oral, or practical test of the skill. •A copy of all education, training, and competency testing shall be kept in eachemployee’spersonnel file. •Training and competency evaluations must be conducted by individuals with work experience and training in said areas. And training of unlicensed personnel will be conducted by a RN, or another instructor may provide the training in conjunction with a RN.
Statutes: • 144G.41 Subd. 1 (2) • 144G.61 Subd. 1
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Annual Training
All staffthat perform direct care services atwill completeat least eight (8)hours of annual training for each 12 months of employment. •A training record, kept in employee records,will be retained for each employee who performs direct services to track compliance with annual training requirements. •Annual training may be obtained from thefacilityor another source and must include topics relevant to the provision ofassisted livingservices. •The following training elements MUST be includedevery12 months to allstaff who performs direct care services: 1.Training on reporting of maltreatment of vulnerable adults under section 626.557 2.Review of the assisted living bill of rights and staff responsibilities related to ensuring the exerciseand protection of those rights 3.Review of infection control techniques used in the home and implementation of infection controlstandards including a review of hand washing techniques; the need for and use of protective gloves, gowns,and masks; appropriate disposal of contaminated materials and equipment, such as dressings, needles,syringes, and razor blades; disinfecting reusable equipment; disinfecting environmentalsurfaces; and reportingcommunicable diseases 4.Effective approaches to use to problem solve when working with a resident's challenging behaviors,and how to communicate with residents who have dementia, Alzheimer's disease, or related disorders 5.Review of the facility's policies and procedures relating to the provision of assisted living servicesand how to implement those policies and procedures 6.Principles of person-centered planning and service delivery and how they apply to direct support services provided by the staff person. Statute: • 144G.61 Subd.5
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Annual Training
•In addition to the topicspreviously listed, annual training may also contain training on providingservices to residents with hearing loss. Any training on hearing loss provided under this subdivision mustbe high quality and research based, may include online training, and must include training on one or moreof the following topics: 1.An explanation of age-related hearing loss and how it manifests itself, its prevalence, and challengesit poses to communication 2.Health impacts related to untreated age-related hearing loss, such as increased incidence ofdementia, falls, hospitalizations, isolation, and depression 3.Information about strategies and technology that may enhance communication and involvement,including communication strategies, assistive listening devices, hearing aids, visual and tactile alertingdevices, communication access in real time, and closed captions.
Statute: • 144G.61 Subd.5
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Training Records
Facility must maintain record of all required staff training and competency that documents the following information for each competency evaluation, training, retraining, and orientation topic must include: 1.Facility name, location, and license number 2.Name of the training topic or training program 3.The training methodology, such as classroom style, web-based training, video, or oneto-one training 4.Date of the training and the competency evaluation, and the total amount of time of the training and competency evaluation 5.Name and title of the instructor and the instructor's signature, and the name and title of the competency evaluator, if different from the instructor, and the evaluator's signature with a statement attesting that the employee successfully completed the training and competency evaluation,and 6.Name and title of the staff person completing the training, and the staff person's signature with a statement attesting that the staff person successfully completed the training as described in the training documentation. 7.Documentation of the completed competency evaluation, training, retraining, or orientationwillbe provided to the employee at the time the evaluation or training is completed. Rule: • 4659.0190 Subp.6
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Portability of Training
•Unlicensed personnel providing assisted living services who transfer from one licensed facility to another or who are newly hired by a licensed assisted living facility, may satisfy 144G.61 Subd2 training requirements by providing written proof of previously completed training within the past 18 months. •The accepting facility must complete a competency evaluation, conducted by a competency evaluator who has meet the assisted living license requirements.
Rule: • 4659.0190Subp. 5
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#CPMEducates CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | MN Employer Laws
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• Minnesota Wage Theft Prevention Act MN Statute 16C.285 Subd. 3 •Passed in 2019 Legislaturepassed thewage theft law to createadditional protections for workers, including addingcriminal penalties for employers that commit wage theft, whichoccurs when employers do not pay their workers what is owed them for the work they have performed. •All employers must provide each employee with a written notice at the start of their employment and keep a signed copy of the notice on file. The notice must contain required information about an employee's employment status and terms of employment. The notice must include a statement, in multiple languages, that informs employees they may request the notice be provided to them in another language.Employers may use the example notice or create their own. •In Minneapolis, employers may have additional wage theft requirements under the city's Wage Theft Ordinance.
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MN Employer Laws
• Pregnancy and Parenting Leave Employees may take up to 12 weeks of unpaid leave upon the birth or adoption of their child when: 1. they work for a company with 21 or more employees at one site; 2. they have been with the company for at least 12 months; and 3. they worked at least half time during the past 12 months. Could qualify for
FMLA, runs concurrent, total leave not to exceed 12 weeks MN Statute 181.941 • Minnesota’s School Conference and Activities Leave law allows eligible employees up to 16 hours of unpaid leave from work to attend their child’s school conferences and activities each year and for each child MN Statute 181.9412 • Sick and Safe Leave Employers that allow employees to take time off for their own injury or illness must also allow the employee to take time off: to care for an ill or injured minor child, adult child, spouse, sibling, parent, mother-in-law, father-in-law, grandchild, grandparent or stepparent in the same manner the employer would allow an employee to use the leave for themselves OR For themselves or a relative (as listed above) to provide or receive assistance because of sexual assault, domestic abuse or stalking. This leave does is not required to be paid MN Statute 181.9413 • Pregnancy and Lactation Accommodation An employer must provide reasonable accommodations to an employee for health conditions related to pregnancy or childbirth if she so requests, with the advice of her licensed health care provider or certified doula, unless the employer demonstrates that the accommodation would impose an undue hardship on the operation of the employer's business MN Statute 181.9414. And nursing mothers must be provided reasonable break times-effective 1/1/2022.
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MN Employer Laws
• Wage Disclosure and Protection Act Every
Minnesota employermust comply with the Wage
Disclosure Protection law in the Women's
Economic Security Act.Under this law, no employer can prohibit employees from disclosing their own wages MN Statute 181.172
• Employee Notice Law Minnesota labor standards law requires employers to provide each employee with a written notice detailing important terms of employment, including how much the employee will earn, when they will be paid and who owns the company they will be working for. See the rule for details on what items are required to be included on the notice.
• Youth employment restrictions on hours and scheduling. Remember that there are applicable rules for lifts usage for 16 & 17 year olds
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#CPMEducates CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | MN Employer Laws
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•The state minimum wage is higher than the federal minimum wage and there are some municipalities with minimum wage laws as well Minneapolis and St. Paul
•Most employees and all direct care workers are entitled to overtime protections under Fair Labor
Standards Act (FLSA), which would be overtime 40 per workweek (any fixed and regularly recurring period of 168 hours –seven consecutive 24-hour periods) at a rate not less than one and one-half times the regular rate of pay.
See the Department of Labor and Industry http://www.dli.mn.gov/business/employmentpractices for more information on employment practices in Minnesota
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Workplace Safety
MNOSHA in addition to federal standards here are some Minnesota OSHA regulations:
• A Workplace accident and injury reduction (AWAIR) program found in ALL manual 11.01-see required elements of how accidents and injury prevention will be handled. Minnesota Statutes 182.653,subd. 8; Minnesota Rules 5208.1500 • Employee Right-to-Know toidentify hazardous substances, harmful physical agents and infectious agents that are present in the workplace and provide information and training to employees who are “routinely exposed” to those substances or agents.in ALL manual 11.03 Minnesota Rules Chapter 5206)
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Workplace Safety
• Safe patient handling mechanical lifts in addition to federal rules pertaining to lifts, see the Minnesota safe patient handling requirements • Safety Committee (Minnesota Statutes 182.676) –The statute requires all employers with more than 25 employees to have a safety committee. The statute also requires employers with 25 or fewer employees to have a safety committee if they have eithera lostworkday caseincidence rate in the top 10% of all rates for employers in the same industry or with a workers' compensation premium classification rate in the top 25% of premium rates for all classes. • MN OSHA Consultation can provide no cost assistance to help you improve safety for workers and compliance with state and federal
OSHA regulations.
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#CPMEducates CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | Workers Compensation
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• MN statute ch176 • MN Workers Compensation •A no-fault system •Employee does not need to prove negligence on the part of the employer to establish liability. •employer cannot use negligence on the part of the employee as a defense to a claim. •Provides benefits for work-related injuries or illnesses •Covers conditions caused or aggravated by employment activities •Benefits paid by the insurer (employer’s insurance company or by employer, if self-insured) •There is a 3-day waiting period before benefits kick in • Presumption of coverage for COVID-19 MN Statute 176.011 Subd. 15, which expires 12/31/2021
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#CPMEducates CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | Unemployment
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• MN Unemployment Employers Guide •To be in compliance with Minnesota Unemployment
Insurance Law, employers must do all of the following: • Register for an employer account • Display current version of the Unemployed? • Maintain current account information • Submit Quarterly Wage Detail Report by due date • Submit payment by due date • Maintain complete records • Provide requested audit information •MN Unemployment Statute https://www.revisor.mn.gov/statutes/cite/268 • 2021 new legislation regarding COVID-19 related unemployment claims not being used in employer experience rating
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