D.C. Law 23-201. Dementia Training for Direct Care Workers Support Amendment Act of 2020.
AN ACT
To require dementia training of at least 8 hours for a staff member whose work involves extensive contact with residents or program participants, to require facilities to establish procedures for ongoing staff support regarding the treatment and care of persons with dementia, to require the Department of Health to identify and designate standardized trainings, and to require facilities to issue a certificate to direct care workers upon completion of dementia training; and to require the Department of Health Care Finance to conduct a rate study to determine the existing wage structure and projected wage structure necessary to ensure a vital and adequately compensated class of direct support.
BE IT ENACTED BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That this act may be cited as the "Dementia Training for Direct Care Workers Support Amendment Act of 2020".
Sec. 2. The Department of Health Functions Clarification Act of 2001, effective October 3, 2001 (D.C. Law 14-28; D.C. Official Code § 7-731 et seq.), is amended as follows:
(a) Section 4948 (D.C. Official Code § 7-744.01) is designated as section 4951.
(b) A new section 4952 is added to read as follows:
"Sec. 4952. Dementia training for direct care workers.
"(a) For the purposes of this section, the term:
"(1) "Department" means the Department of Health.
"(2) "Facilities or programs" means residential facilities or home-based and community-based programs that provide supportive services, including Skilled Nursing Facilities, as defined in 42 U.S.C. § 1395i-3(a), Assisted Living Residences, as defined in
"(3) "Covered administrative staff member" means a senior employee at a facility or program, including an administrator as well as a managerial staff member who directly supervises covered direct service staff members.
"(4) "Covered direct service staff members" refers to staff members whose work involves extensive contact with residents or program participants, including certified nursing assistants, nurse aides, personal care assistants, home health or personal care aides, licensed practical nurses, licensed vocational nurses, registered nurses, social workers, activity directors and staff, dietary staff, physician assistants, nurse practitioners, physical, speech therapists, and occupational therapy staff.
"(5) "Other covered staff member" refers to a staff member who is either a full-time or part-time employee, independent consultant, or a staff member of a contractor or subcontractor who has contact on a recurring basis with, but does not provide medical services for, residents or program participants, including housekeeping staff, front desk staff, other administrative staff, and other individuals who have incidental contact.
"(b)(1) Facilities or programs shall provide initial training of at least 8 hours to:
"(A) All covered direct service staff members, covered administrative staff members, and other covered staff members hired on, or within 6 months after, the applicability date of this section who shall begin dementia training within 90 days of the hire date, and complete the training within 120 days of the hire date; and
"(B) All covered direct service staff members, covered administrative staff members, and other covered staff members who were employed prior to the applicability date of this section and who have not received equivalent training within the prior 24 months shall complete the initial training requirements within one year following publication by the Department of Health of acceptable trainings regulations.
"(2) Each facility or program shall establish procedures for ongoing staff support regarding the treatment and care of persons with dementia, which shall include on-site mentoring programs and other support mechanisms developed by the Department.
"(3) For covered direct service staff members and covered administrative staff members, the curriculum used for the initial training shall cover:
"(A) Alzheimer's disease, and related dementia;
"(B) Person-centered care;
"(C) Assessment and care planning;
"(D) Activities of daily living; and
"(E) Dementia-related behaviors and communication.
"(4) For covered administrative staff members, the curriculum used for the initial training shall also cover:
"(A) Medical management information education and support;
"(B) Staffing;
"(C) Supportive and therapeutic environments; and
"(D) Transitions and coordination of services.
"(5) For other covered staff members, training shall include, at a minimum, an overview of dementia, principles of person-centered care, and communication issues.
"(6) Initial dementia training shall be considered complete only after the staff member has taken and passed an evaluation.
"(c)(1) Within 120 days after the applicability date of this section, the Department shall identify and designate standardized trainings, including online trainings, and trainings currently used by providers that meet the requirements of subsection (b)(3) through (5) and shall also establish a process whereby other non-standardized training programs will be determined to meet the requirements for dementia training.
"(2) To receive approval by the Department, whether online or in-person, all training modules, presentations, materials, and evaluations must reflect current standards and best practices in the care and treatment of persons with dementia.
"(3) The Department may also approve independent evaluation instruments currently used by providers that meet the Department's criterion for dementia training or develop an evaluation instrument or instruments that relate to the demonstration of competency.
"(d)(1) The facility shall issue a certificate, which shall be notarized and provided to covered staff members upon completion of dementia training, which certification shall be portable between settings within the District.
"(2) Provided that the covered staff member does not have a lapse of dementia-related direct service or administration employment for 24 consecutive months or more, the covered staff member shall not be required to repeat the initial dementia training.
"(3) Covered staff members shall be responsible for maintaining documentation regarding completed dementia trainings and evaluations.
"(e)(1) A minimum of 4 hours of continuing education in each calendar year shall be required for covered administrative staff members and covered direct service staff members.
"(2) A minimum of 2 hours of continuing education in each calendar year shall be required for other covered staff members.
"(3) Such continuing education shall include new information on best practices in the treatment and care of persons with dementia.
"(f)(1) Persons responsible for conducting in-person dementia trainings shall have, at a minimum:
"(A) Two years of work experience related to Alzheimer's disease or other related dementias in health care, gerontology, or other related field; and
"(B) Completed training equivalent to the requirements provided in this section, including successful passage of any skills competency or knowledge test required by the District.
"(2) Covered staff members shall not be required to bear any of the cost of training offered by the facility or program and shall receive their normal compensation when attending required trainings.
"(g)(1) The Department shall exercise oversight of a facility's or program's dementia training program as part of its comprehensive regulatory responsibilities, which shall:
"(A) Ensure that the facility or program provides continuing education opportunities;
"(B) Ensure that the facility or program uses designated online training programs or facility-based training that meets the requirements for dementia training in the District;
"(C) Include a periodic review of the training evaluation, including the use of competency measures to demonstrate knowledge gained;
"(D) Involve observation and assessment of the proficiencies of direct care staff; and
"(E) Ensure compliance with any other requirements not specified above.
"(2) The Department may use all of its enforcement tools to ensure that facilities or programs comply with these provisions.
"(h) Where the training requirements established by this section differ or overlap with other District law or regulation, the more rigorous training requirements shall apply.".
Sec. 3. Rate Study for the cost of health care work.
(a) The Department of Health Care Finance ("DHCF"), in consultation with private and public entities that provide direct healthcare services to members in the community, shall have a rate study conducted through an independent third party to determine the existing wage structure and projected wage structure necessary to ensure a vital and adequately compensated class of direct support workers in the home health care, personal care assistance nursing home care, and assisted living industry.
(b) The rate study shall consider the following services:
(1) Personal care aides, including homemaker services and chore aide services;
(2) Certified nurse assistance;
(3) Skilled nursing;
(3) Physical therapy;
(4) Occupational therapy;
(5) Speech and language pathology; and
(6) Nutritional services.
(c) The rate study shall not include any services that are funded by the Department of Disability Services.
(d) The rate study shall evaluate:
(1) The cost of recruitment, training, and retention for quality staff;
(2) The projected need for workers within this class and in the health care industry;
(3) The direct support hourly wage rates, existing funding rates, projected minimum wage and living wage considerations in the District and metropolitan area; and
(4) The reimbursement rate to support and retain health care workers in the home health industry compared to health care workers in long-term care facilities and hospitals.
(e)(1) The rate study shall be completed within 180 days of the applicability date of this section.
(2) DHCF shall transmit the completed rate study to the Council within 15 days of its receipt from the independent third party.
(f) For the purposes of this section, the term "direct support worker" means a paid employee who performs at least 51% of their job duties providing direct support to persons in the home health care, personal care assistance nursing home care, and assisted living industry in the District.
Sec. 4. Rulemaking.
The Mayor, pursuant to title 1 of the District of Columbia Administrative Procedure Act, approved October 21, 1968 (82 Stat. 1204; D.C. Official Code § 2-501 et seq.), may issue rules to implement the provisions of this act.
Sec. 5. Applicability.
(a) This act shall apply upon the date of inclusion of its fiscal effect in an approved budget and financial plan.
(b) The Chief Financial Officer shall certify the date of the inclusion of the fiscal effect in an approved budget and financial plan and provide notice to the Budget Director of the Council of the certification.
(c)(1) The Budget Director shall cause the notice of the certification to be published in the District of Columbia Register.
(2) The date of publication of the notice of the certification shall not affect the applicability of this act.
Sec. 6. Fiscal impact statement.
The Council adopts the fiscal impact statement in the committee report as the fiscal impact a statement required by section 4a of the General Legislative Procedures Act of 1975, approved October 16,2006 (120 Stat. 2038; D.C. official Code Section 1-201.47a).
Sec. 7. Effective date.
This act shall take effect following approval by the Mayor (or in the event of veto by the Mayor, action by the Council to override the veto), a 30-day period of congressional review as provided in section 602(c)(1) of the District of Columbia Home Rule Act, approved December 24, 1973 (87 Stat. 813; D.C. Official Code § 1-206.02(c)(1)), and publication in the District of Columbia Register.
