AB 2850: Nurse assistant training programs: online or distance learning.
- Session Year: 2017-2018
- House: Assembly
- Latest Version Date: 2018-09-26
(1)Existing law establishes the State Department of Public Health and sets forth its powers and duties to license and administer health facilities, as defined, including skilled nursing facilities and intermediate care facilities.
Existing law requires skilled nursing facilities and intermediate care facilities to adopt certified nurse assistant training programs approved by the department. Existing law requires a training program to include 60 hours of classroom training, composed of specified topics, which may be conducted within a facility or at an educational institution.
This bill would authorize the required classroom training to be offered through online or distance learning classes approved by the department. The bill would require an online or distance learning nurse assistant training program to comply with specified requirements, including, among others, having trainees sign an affidavit attesting under penalty of perjury to their identity while completing the program. By expanding the crime of perjury, this bill would impose a state-mandated local program.
This bill would also authorize an experienced licensed or registered nurse, as specified, to provide instruction as part of a certified nurse assistant training program at a skilled nursing or intermediate care facility or in an educational institution, regardless of whether he or she holds a teaching credential to provide that instruction.
(2)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
(1)Existing law establishes the State Department of Public Health and sets forth its powers and duties to license and administer health facilities, as defined, including skilled nursing facilities and intermediate care facilities.
Existing law requires skilled nursing facilities and intermediate care facilities to adopt certified nurse assistant training programs approved by the department. Existing law requires a training program to include 60 hours of classroom training, composed of specified topics, which may be conducted within a facility or at an educational institution.
This bill would authorize the required classroom training to be offered through online or distance learning classes approved by the department. The bill would require an online or distance learning nurse assistant training program to comply with specified requirements, including, among others, having trainees sign an affidavit attesting under penalty of perjury to their identity while completing the program. By expanding the crime of perjury, this bill would impose a state-mandated local program.
This bill would also authorize an experienced licensed or registered nurse, as specified, to provide instruction as part of a certified nurse assistant training program at a skilled nursing or intermediate care facility or in an educational institution, regardless of whether he or she holds a teaching credential to provide that instruction.
(2)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
(1)Existing law establishes the State Department of Public Health and sets forth its powers and duties to license and administer health facilities, as defined, including skilled nursing facilities and intermediate care facilities.
Existing law requires skilled nursing facilities and intermediate care facilities to adopt certified nurse assistant training programs approved by the department. Existing law requires a training program to include 60 hours of classroom training, composed of specified topics, which may be conducted within a facility or at an educational institution.
This bill would authorize the required classroom training to be offered through online or distance learning classes approved by the department. The bill would require an online or distance learning nurse assistant training program to comply with specified requirements, including, among others, having trainees sign an affidavit attesting under penalty of perjury to their identity while completing the program. By expanding the crime of perjury, this bill would impose a state-mandated local program.
This bill would also authorize an experienced licensed or registered nurse, as specified, to provide instruction as part of a certified nurse assistant training program at a skilled nursing or intermediate care facility or in an educational institution, regardless of whether he or she holds a teaching credential to provide that instruction.
(2)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
(1)Existing law establishes the State Department of Public Health and sets forth its powers and duties, including the licensing and administration of duties to license and administer health facilities, as defined, including skilled nursing facilities and intermediate care facilities.
Existing law requires skilled nursing facilities and intermediate care facilities to adopt certified nurse assistant training programs approved by the department. Existing law requires a training program to include 60 hours of classroom training, as specified, composed of specified topics, which may be conducted within a facility or at an educational institution.
This bill would authorize the required classroom training to be offered through online or distance learning classes approved by the department. The bill would require an online or distance learning nurse assistant training program to comply with specified requirements, including, among others, having trainees sign an affidavit attesting under penalty of perjury to their identity while completing the program. By expanding the crime of perjury, this bill would impose a state-mandated local program.
This bill would also authorize an experienced licensed or registered nurse, as specified, to provide instruction as part of a certified nurse assistant training program at a skilled nursing or intermediate care facility or in an educational institution, regardless of whether he or she holds a teaching credential to provide that instruction.
(2)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Existing law establishes the State Department of Public Health and sets forth its powers and duties, including the licensing and administration of health facilities, as defined, including skilled nursing facilities and intermediate care facilities.
Existing law requires skilled nursing facilities and intermediate care facilities to adopt certified nurse assistant training programs approved by the department. Existing law requires a training program to include 60 hours of classroom training, as specified, which may be conducted within a facility or at an educational institution.
This bill would authorize the required classroom training to be offered through online or distance learning classes approved by the department.
This bill would also authorize a presently employed an experienced licensed or registered nurse, as specified, to provide instruction as part of a certified nurse assistant training program at a skilled nursing or intermediate care facility or in an educational institution, regardless of whether he or she holds a teaching credential to provide that instruction.
Existing law establishes the State Department of Public Health and sets forth its powers and duties, including the licensing and administration of health facilities, as defined, including skilled nursing facilities and intermediate care facilities.
Existing law requires skilled nursing facilities and intermediate care facilities to adopt certified nurse assistant training programs approved by the department. Existing law requires a training program to include 60 hours of classroom training, as specified, which may be conducted within a facility or at an educational institution.
This bill would authorize the required classroom training to be offered through online or distance learning classes approved by the department.
This bill would also authorize a presently employed nurse, as specified, to provide instruction as part of a certified nurse assistant training program at a skilled nursing or intermediate care facility or in an educational institution, regardless of whether he or she holds a teaching credential to provide that instruction.
Existing law establishes the State Department of Public Health and sets forth its powers and duties, including the licensing and administration of health facilities, as defined, including skilled nursing facilities and intermediate care facilities. Violation of these provisions is a crime.
Existing law requires skilled nursing facilities and intermediate care facilities to adopt certified nurse assistant training programs approved by the department. Existing law requires a training program to include 60 hours of classroom training, as specified, which may be conducted within a facility or at an educational institution.
This bill would authorize the required classroom training to be offered through online or distance learning classes approved by the department.
This bill would include a geriatric medication technician, as defined, within the category of certified nurse assistant for these purposes. Because a violation of these provisions would be a crime, this bill would impose a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.Existing law establishes the State Department of Public Health and sets forth its powers and duties, including the licensing and administration of health facilities, as defined, including skilled nursing facilities and intermediate care facilities. Violation of these provisions is a crime.
Existing law requires skilled nursing facilities and intermediate care facilities to adopt certified nurse assistant training programs approved by the department.
This bill would include a geriatric medication technician, as defined, within the category of certified nurse assistant for these purposes. Because a violation of these provisions would be a crime, this bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
The Legislature finds and declares all of the following:
(a)Over 1,100 people turn 65 years of age every day in California, and there are approximately 110,000 licensed skilled nursing beds in the state.
(b)About 25 percent of older adults will need nursing home care at some time in their lives.
(c)There is a shortage of qualified nurses available to meet the needs of patients in California health care facilities, particularly those patients in the states 1,200 skilled nursing facilities.
(d)Californias skilled nursing facilities currently face a challenge not only in recruiting qualified nursing staff, but also in retaining quality nursing staff.
(e)With over 65 percent of our residents on Medi-Cal, Californias skilled nursing facilities are an integral part of the health care continuum, with over 13.5 million Californians on Medi-Cal.
(f)The occupancy rate of Californias skilled nursing facilities is above the national average and is currently at 88 percent.
(g)Certified nurse assistants are an important component of skilled nursing facilities, but unfortunately the workforce in that area is stagnant and extremely limited in various counties.
(h)Over 1,600 additional certified nurse assistants in skilled nursing facilities will be needed to meet the increased minimum staffing level mandate by July 1, 2018.
(i)According to the Office of Statewide Health Planning and Development, in 2016, over 63 percent of skilled nursing facility direct care staff are certified nurse assistants, over 23 percent are licensed vocational nurses (LVNs), and over 9 percent are registered nurses (RNs).
(j)The California HealthCare Foundation has determined that: ... California may not have adequate numbers of nurses with appropriate skills. The result could be decreased patient access, higher health care costs, and lower quality of service.
(k)The quality of patient care in California long-term care facilities is directly dependent upon the availability of an adequate supply of appropriately trained workers.
SEC. 2.Section 1337.1 of the Health and Safety Code is amended to read:1337.1.A skilled nursing facility or intermediate care facility shall adopt an approved training program that meets standards established by the department. The approved training program shall consist of at least all of the following:
(a)An orientation program to be given to newly employed nurse assistants prior to providing direct patient care in skilled nursing facility or intermediate care facilities.
(b)(1)A precertification training program consisting of at least 60 classroom hours of training on basic nursing skills, patient safety and rights, the social and psychological problems of patients, and resident abuse prevention, recognition, and reporting pursuant to subdivision (e). The 60 classroom hours of training may be conducted within a skilled nursing facility or intermediate care facility or in an educational institution or agency. A skilled nursing facility or intermediate care facility may conduct the 60 classroom hours of training in an online or distance learning course format, as approved by the department.
(2)In addition to the 60 classroom hours of training required under paragraph (1), the precertification training program shall consist of at least 100 hours of supervised and on-the-job training clinical practice. The 100 hours may consist of normal employment as a nurse assistant under the supervision of either the director of nurse training or a licensed nurse qualified to provide nurse assistant training who has no other assigned duties while providing the training.
(3)At least two hours of the 60 hours of classroom training shall address the special needs of persons with developmental and mental disorders, including intellectual disability, cerebral palsy, epilepsy, dementia, Parkinsons disease, and mental illness. At least two hours of the 60 hours of classroom training shall address the special needs of persons with Alzheimers disease and related dementias.
(4)At least four hours of the 100 hours of supervised clinical training shall address the special needs of persons with developmental and mental disorders, including intellectual disability, cerebral palsy, epilepsy, Alzheimers disease and related dementias, and Parkinsons disease.
(5)In a precertification training program subject to this subdivision, credit shall be given for the training received in an approved precertification training program adopted by another skilled nursing facility or intermediate care facility.
(6)This subdivision shall not apply to a skilled nursing facility or intermediate care facility that demonstrates to the department that it employs only nurse assistants with a valid certification.
(c)Continuing in-service training to ensure continuing competency in existing and new nursing skills.
(d)Each facility shall consider including training regarding the characteristics and method of assessment and treatment of acquired immune deficiency syndrome (AIDS).
(e)(1)The approved training program shall include, within the 60 hours of classroom training, a minimum of six hours of instruction on preventing, recognizing, and reporting instances of resident abuse utilizing those courses developed pursuant to Section 13823.93 of the Penal Code, and a minimum of one hour of instruction on preventing, recognizing, and reporting residents rights violations.
(2)A minimum of four hours of instruction on preventing, recognizing, and reporting instances of resident abuse, including instruction on preventing, recognizing, and reporting residents rights violations, shall be included within the total minimum hours of continuing education or in-service training required and in effect for certified nurse assistants.
SEC. 3.Section 1337.15 is added to the Health and Safety Code, immediately following Section 1337.1, to read:1337.15.(a)A person who provides instruction or training, at a skilled nursing facility or intermediate care facility or in an educational institution, as part of a certified nurse assistant precertification training program described in Section 1337.1 or 1337.3 may be any licensed vocational nurse or registered nurse with no less than two years of nursing experience, of which no less than one year is in providing care and services to chronically ill or elderly patients in an acute care hospital, skilled nursing facility, intermediate care facility, home care, hospice care, or other long-term care setting.
(b)Notwithstanding any other law, a person described in subdivision (a) shall not be required to hold a teaching credential to provide instruction as part of a certified nurse assistant precertification training program described in Section 1337.1 or 1337.3.
SEC. 4.Section 1337.16 is added to the Health and Safety Code, immediately following Section 1337.15, to read:1337.16.(a)An online or distance learning nurse assistant training program shall comply with all of the following requirements:
(1)Provide online instruction in which the trainees and the approved instructor are online at the same or similar times and which allows them to use real-time collaborative software that combines audio, video, file sharing, or any other forms of approved interaction and communication.
(2)Require the use of a personal identification number or personal identification information that confirms the identity of the trainees and instructors, including, but not limited to, having trainees sign an affidavit attesting under penalty of perjury to their identity while completing the program.
(3)Provide safeguards to protect personal information.
(4)Include policies and procedures to ensure that instructors are accessible to trainees outside of the normal instruction times.
(5)Include policies and procedures for equipment failures, student absences, and completing assignments past original deadlines.
(6)Provide a clear explanation on its Internet Web site of all technology requirements to participate and complete the program.
(7)Provide the department with statistics about the performance of trainees in the program, including, but not limited to, exam pass rate and the rate at which trainees repeat each module of the program, and any other information requested by the department regarding trainee participation in and completion of the program.
(b)In addition to the requirements set forth in subdivision (a), an online or distance learning nurse assistant training program shall meet the same standards as a traditional, classroom-based program, and comply with any other standard established by the department for online or distance learning nurse assistant training programs. Notwithstanding any other law, the department may, without taking any regulatory actions pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, implement, interpret, or make specific this section by means of an All Facilities Letter (AFL) or similar instruction.
(c)As a condition of approval by the department, an online or distance learning nurse assistant training program shall provide the department with access rights to the program for the purposes of verifying that program complies with all requirements and allowing the department to monitor online or distance learning sessions.
SEC. 5.Section 1337.3 of the Health and Safety Code is amended to read:1337.3.(a)The department shall prepare and maintain a list of approved training programs for nurse assistant certification. The list shall include training programs conducted by skilled nursing facilities or intermediate care facilities, as well as local agencies and education programs. In addition, the list shall include information on whether a training center is currently training nurse assistants, their competency test pass rates, and the number of nurse assistants they have trained. Clinical portions of the training programs may be obtained as on-the-job training, supervised by a qualified director of staff development or licensed nurse.
(b)It shall be the duty of the department to inspect a representative sample of training programs. The department shall protect consumers and students in any training program against fraud, misrepresentation, or other practices that may result in improper or excessive payment of funds paid for training programs. In evaluating a training centers training program, the department shall examine each training centers trainees competency test passage rate, and require each program to maintain an average 60 percent test score passage rate to maintain its participation in the program. The average test score passage rate shall be calculated over a two-year period. If the department determines that a training program is not complying with regulations or is not meeting the competency passage rate requirements, notice thereof in writing shall be immediately given to the program. If the program has not been brought into compliance within a reasonable time, the program may be removed from the approved list and notice thereof in writing given to it. Programs removed under this article shall be afforded an opportunity to request reinstatement of program approval at any time. The departments district offices shall inspect facility-based centers as part of their annual survey.
(c)Notwithstanding Section 1337.1, the approved training program shall consist of at least the following:
(1)A 16-hour orientation program to be given to newly employed nurse assistants prior to providing direct patient care, and consistent with federal training requirements for facilities participating in the Medicare or Medicaid programs.
(2)(A)A precertification training program consisting of at least 60 classroom hours of training on basic nursing skills, patient safety and rights, the social and psychological problems of patients, and elder abuse recognition and reporting pursuant to subdivision (e) of Section 1337.1. The 60 classroom hours of training may be conducted within a skilled nursing facility, an intermediate care facility, or an educational institution or agency. A health facility, educational institution, or local agency may conduct the 60 classroom hours of training in an online or distance learning course format, as approved by the department.
(B)In addition to the 60 classroom hours of training required under subparagraph (A), the precertification program shall also consist of 100 hours of supervised and on-the-job training clinical practice. The 100 hours may consist of normal employment as a nurse assistant under the supervision of either the director of staff development or a licensed nurse qualified to provide nurse assistant training who has no other assigned duties while providing the training.
(3)At least two hours of the 60 hours of classroom training and at least four hours of the 100 hours of the supervised clinical training shall address the special needs of persons with developmental and mental disorders, including intellectual disability, Alzheimers disease, cerebral palsy, epilepsy, dementia, Parkinsons disease, and mental illness.
(d)The department, in consultation with the State Department of Education and other appropriate organizations, shall develop criteria for approving training programs, that includes program content for orientation, training, inservice and the examination for testing knowledge and skills related to basic patient care services and shall develop a plan that identifies and encourages career ladder opportunities for certified nurse assistants. This group shall also recommend, and the department shall adopt, regulation changes necessary to provide for patient care when facilities utilize noncertified nurse assistants who are performing direct patient care. The requirements of this subdivision shall be established by January 1, 1989.
(e)On or before January 1, 2004, the department, in consultation with the State Department of Education, the American Red Cross, and other appropriate organizations, shall do the following:
(1)Review the current examination for approved training programs for certified nurse assistants to ensure the accurate assessment of whether a nurse assistant has obtained the required knowledge and skills related to basic patient care services.
(2)Develop a plan that identifies and encourages career ladder opportunities for certified nurse assistants, including the application of on-the-job postcertification hours to educational credits.
(f)A skilled nursing facility or intermediate care facility shall determine the number of specific clinical hours within each module identified by the department required to meet the requirements of subdivision (d), subject to subdivisions (b) and (c). The facility shall consider the specific hours recommended by the state department when adopting the precertification training program required by this chapter.
(g)This article shall not apply to a program conducted by any church or denomination for the purpose of training the adherents of the church or denomination in the care of the sick in accordance with its religious tenets.
(h)The Chancellor of the California Community Colleges shall provide to the department a standard process for approval of college credit. The department shall make this information available to all training programs in the state.
(i)An online or distance learning nurse assistant training program shall meet the same standards as a traditional, classroom-based program.
(j)An online nurse assistant training program shall contract with a licensed skilled nursing facility or intermediate care facility for the purpose of coordinating and completing the clinical portion of the nurse assistant training program.
SEC. 6.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
The Legislature finds and declares all of the following:
(a)Over 1,100 people turn 65 years of age every day in California, and there are approximately 110,000 licensed skilled nursing beds in the state.
(b)About 25 percent of older adults will need nursing home care at some time in their lives.
(c)There is a shortage of qualified nurses available to meet the needs of patients in California health care facilities, particularly those patients in the states 1,200 skilled nursing facilities.
(d)Californias skilled nursing facilities currently face a challenge not only in recruiting qualified nursing staff, but also in retaining quality nursing staff.
(e)With over 65 percent of our residents on Medi-Cal, Californias skilled nursing facilities are an integral part of the health care continuum, with over 13.5 million Californians on Medi-Cal.
(f)The occupancy rate of Californias skilled nursing facilities is above the national average and is currently at 88 percent.
(g)Certified nurse assistants are an important component of skilled nursing facilities, but unfortunately the workforce in that area is stagnant and extremely limited in various counties.
(h)Over 1,600 additional certified nurse assistants in skilled nursing facilities will be needed to meet the increased minimum staffing level mandate by July 1, 2018.
(i)According to the Office of Statewide Health Planning and Development, in 2016, over 63 percent of skilled nursing facility direct care staff are certified nurse assistants, over 23 percent are licensed vocational nurses (LVNs), and over 9 percent are registered nurses (RNs).
(j)The California HealthCare Foundation has determined that: ... California may not have adequate numbers of nurses with appropriate skills. The result could be decreased patient access, higher health care costs, and lower quality of service.
(k)The quality of patient care in California long-term care facilities is directly dependent upon the availability of an adequate supply of appropriately trained workers.
SEC. 2.Section 1337.1 of the Health and Safety Code is amended to read:1337.1.A skilled nursing facility or intermediate care facility shall adopt an approved training program that meets standards established by the department. The approved training program shall consist of at least all of the following:
(a)An orientation program to be given to newly employed nurse assistants prior to providing direct patient care in skilled nursing facility or intermediate care facilities.
(b)(1)A precertification training program consisting of at least 60 classroom hours of training on basic nursing skills, patient safety and rights, the social and psychological problems of patients, and resident abuse prevention, recognition, and reporting pursuant to subdivision (e). The 60 classroom hours of training may be conducted within a skilled nursing facility or intermediate care facility or in an educational institution or agency. A skilled nursing facility or intermediate care facility may conduct the 60 classroom hours of training in an online or distance learning course format, as approved by the department.
(2)In addition to the 60 classroom hours of training required under paragraph (1), the precertification training program shall consist of at least 100 hours of supervised and on-the-job training clinical practice. The 100 hours may consist of normal employment as a nurse assistant under the supervision of either the director of nurse training or a licensed nurse qualified to provide nurse assistant training who has no other assigned duties while providing the training.
(3)At least two hours of the 60 hours of classroom training shall address the special needs of persons with developmental and mental disorders, including intellectual disability, cerebral palsy, epilepsy, dementia, Parkinsons disease, and mental illness. At least two hours of the 60 hours of classroom training shall address the special needs of persons with Alzheimers disease and related dementias.
(4)At least four hours of the 100 hours of supervised clinical training shall address the special needs of persons with developmental and mental disorders, including intellectual disability, cerebral palsy, epilepsy, Alzheimers disease and related dementias, and Parkinsons disease.
(5)In a precertification training program subject to this subdivision, credit shall be given for the training received in an approved precertification training program adopted by another skilled nursing facility or intermediate care facility.
(6)This subdivision shall not apply to a skilled nursing facility or intermediate care facility that demonstrates to the department that it employs only nurse assistants with a valid certification.
(c)Continuing in-service training to ensure continuing competency in existing and new nursing skills.
(d)Each facility shall consider including training regarding the characteristics and method of assessment and treatment of acquired immune deficiency syndrome (AIDS).
(e)(1)The approved training program shall include, within the 60 hours of classroom training, a minimum of six hours of instruction on preventing, recognizing, and reporting instances of resident abuse utilizing those courses developed pursuant to Section 13823.93 of the Penal Code, and a minimum of one hour of instruction on preventing, recognizing, and reporting residents rights violations.
(2)A minimum of four hours of instruction on preventing, recognizing, and reporting instances of resident abuse, including instruction on preventing, recognizing, and reporting residents rights violations, shall be included within the total minimum hours of continuing education or in-service training required and in effect for certified nurse assistants.
SEC. 3.Section 1337.15 is added to the Health and Safety Code, immediately following Section 1337.1, to read:1337.15.(a)A person who provides instruction or training, at a skilled nursing facility or intermediate care facility or in an educational institution, as part of a certified nurse assistant precertification training program described in Section 1337.1 or 1337.3 may be any licensed vocational nurse or registered nurse with no less than two years of nursing experience, of which no less than one year is in providing care and services to chronically ill or elderly patients in an acute care hospital, skilled nursing facility, intermediate care facility, home care, hospice care, or other long-term care setting.
(b)Notwithstanding any other law, a person described in subdivision (a) shall not be required to hold a teaching credential to provide instruction as part of a certified nurse assistant precertification training program described in Section 1337.1 or 1337.3.
SEC. 4.Section 1337.16 is added to the Health and Safety Code, immediately following Section 1337.15, to read:1337.16.(a)An online or distance learning nurse assistant training program shall comply with all of the following requirements:
(1)Provide online instruction in which the trainees and the approved instructor are online at the same or similar times and which allows them to use real-time collaborative software that combines audio, video, file sharing, or any other forms of approved interaction and communication.
(2)Require the use of a personal identification number or personal identification information that confirms the identity of the trainees and instructors, including, but not limited to, having trainees sign an affidavit attesting under penalty of perjury to their identity while completing the program.
(3)Provide safeguards to protect personal information.
(4)Include policies and procedures to ensure that instructors are accessible to trainees outside of the normal instruction times.
(5)Include policies and procedures for equipment failures, student absences, and completing assignments past original deadlines.
(6)Provide a clear explanation on its Internet Web site of all technology requirements to participate and complete the program.
(7)Provide the department with statistics about the performance of trainees in the program, including, but not limited to, exam pass rate and the rate at which trainees repeat each module of the program, and any other information requested by the department regarding trainee participation in and completion of the program.
(b)In addition to the requirements set forth in subdivision (a), an online or distance learning nurse assistant training program shall meet the same standards as a traditional, classroom-based program, and comply with any other standard established by the department for online or distance learning nurse assistant training programs. Notwithstanding any other law, the department may, without taking any regulatory actions pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, implement, interpret, or make specific this section by means of an All Facilities Letter (AFL) or similar instruction.
(c)As a condition of approval by the department, an online or distance learning nurse assistant training program shall provide the department with access rights to the program for the purposes of verifying that program complies with all requirements and allowing the department to monitor online or distance learning sessions.
SEC. 5.Section 1337.3 of the Health and Safety Code is amended to read:1337.3.(a)The department shall prepare and maintain a list of approved training programs for nurse assistant certification. The list shall include training programs conducted by skilled nursing facilities or intermediate care facilities, as well as local agencies and education programs. In addition, the list shall include information on whether a training center is currently training nurse assistants, their competency test pass rates, and the number of nurse assistants they have trained. Clinical portions of the training programs may be obtained as on-the-job training, supervised by a qualified director of staff development or licensed nurse.
(b)It shall be the duty of the department to inspect a representative sample of training programs. The department shall protect consumers and students in any training program against fraud, misrepresentation, or other practices that may result in improper or excessive payment of funds paid for training programs. In evaluating a training centers training program, the department shall examine each training centers trainees competency test passage rate, and require each program to maintain an average 60 percent test score passage rate to maintain its participation in the program. The average test score passage rate shall be calculated over a two-year period. If the department determines that a training program is not complying with regulations or is not meeting the competency passage rate requirements, notice thereof in writing shall be immediately given to the program. If the program has not been brought into compliance within a reasonable time, the program may be removed from the approved list and notice thereof in writing given to it. Programs removed under this article shall be afforded an opportunity to request reinstatement of program approval at any time. The departments district offices shall inspect facility-based centers as part of their annual survey.
(c)Notwithstanding Section 1337.1, the approved training program shall consist of at least the following:
(1)A 16-hour orientation program to be given to newly employed nurse assistants prior to providing direct patient care, and consistent with federal training requirements for facilities participating in the Medicare or Medicaid programs.
(2)(A)A precertification training program consisting of at least 60 classroom hours of training on basic nursing skills, patient safety and rights, the social and psychological problems of patients, and elder abuse recognition and reporting pursuant to subdivision (e) of Section 1337.1. The 60 classroom hours of training may be conducted within a skilled nursing facility, an intermediate care facility, or an educational institution or agency. A health facility, educational institution, or local agency may conduct the 60 classroom hours of training in an online or distance learning course format, as approved by the department.
(B)In addition to the 60 classroom hours of training required under subparagraph (A), the precertification program shall also consist of 100 hours of supervised and on-the-job training clinical practice. The 100 hours may consist of normal employment as a nurse assistant under the supervision of either the director of staff development or a licensed nurse qualified to provide nurse assistant training who has no other assigned duties while providing the training.
(3)At least two hours of the 60 hours of classroom training and at least four hours of the 100 hours of the supervised clinical training shall address the special needs of persons with developmental and mental disorders, including intellectual disability, Alzheimers disease, cerebral palsy, epilepsy, dementia, Parkinsons disease, and mental illness.
(d)The department, in consultation with the State Department of Education and other appropriate organizations, shall develop criteria for approving training programs, that includes program content for orientation, training, inservice and the examination for testing knowledge and skills related to basic patient care services and shall develop a plan that identifies and encourages career ladder opportunities for certified nurse assistants. This group shall also recommend, and the department shall adopt, regulation changes necessary to provide for patient care when facilities utilize noncertified nurse assistants who are performing direct patient care. The requirements of this subdivision shall be established by January 1, 1989.
(e)On or before January 1, 2004, the department, in consultation with the State Department of Education, the American Red Cross, and other appropriate organizations, shall do the following:
(1)Review the current examination for approved training programs for certified nurse assistants to ensure the accurate assessment of whether a nurse assistant has obtained the required knowledge and skills related to basic patient care services.
(2)Develop a plan that identifies and encourages career ladder opportunities for certified nurse assistants, including the application of on-the-job postcertification hours to educational credits.
(f)A skilled nursing facility or intermediate care facility shall determine the number of specific clinical hours within each module identified by the department required to meet the requirements of subdivision (d), subject to subdivisions (b) and (c). The facility shall consider the specific hours recommended by the state department when adopting the precertification training program required by this chapter.
(g)This article shall not apply to a program conducted by any church or denomination for the purpose of training the adherents of the church or denomination in the care of the sick in accordance with its religious tenets.
(h)The Chancellor of the California Community Colleges shall provide to the department a standard process for approval of college credit. The department shall make this information available to all training programs in the state.
(i)An online or distance learning nurse assistant training program shall meet the same standards as a traditional, classroom-based program.
(j)An online nurse assistant training program shall contract with a licensed skilled nursing facility or intermediate care facility for the purpose of coordinating and completing the clinical portion of the nurse assistant training program.
SEC. 6.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
The Legislature finds and declares all of the following:
(a)Over 1,100 people turn 65 years of age every day in California, and there are approximately 110,000 licensed skilled nursing beds in the state.
(b)About 25 percent of older adults will need nursing home care at some time in their lives.
(c)There is a shortage of qualified nurses available to meet the needs of patients in California health care facilities, particularly those patients in the states 1,200 skilled nursing facilities.
(d)Californias skilled nursing facilities currently face a challenge not only in recruiting qualified nursing staff, but also in retaining quality nursing staff.
(e)With over 65 percent of our residents on Medi-Cal, Californias skilled nursing facilities are an integral part of the health care continuum, with over 13.5 million Californians on Medi-Cal.
(f)The occupancy rate of Californias skilled nursing facilities is above the national average and is currently at 88 percent.
(g)Certified nurse assistants are an important component of skilled nursing facilities, but unfortunately the workforce in that area is stagnant and extremely limited in various counties.
(h)Over 1,600 additional certified nurse assistants in skilled nursing facilities will be needed to meet the increased minimum staffing level mandate by July 1, 2018.
(i)According to the Office of Statewide Health Planning and Development, in 2016, over 63 percent of skilled nursing facility direct care staff are certified nurse assistants, over 23 percent are licensed vocational nurses (LVNs), and over 9 percent are registered nurses (RNs).
(j)The California HealthCare Foundation has determined that: ... California may not have adequate numbers of nurses with appropriate skills. The result could be decreased patient access, higher health care costs, and lower quality of service.
(k)The quality of patient care in California long-term care facilities is directly dependent upon the availability of an adequate supply of appropriately trained workers.
SEC. 2.Section 1337.1 of the Health and Safety Code is amended to read:1337.1.A skilled nursing facility or intermediate care facility shall adopt an approved training program that meets standards established by the department. The approved training program shall consist of at least all of the following:
(a)An orientation program to be given to newly employed nurse assistants prior to providing direct patient care in skilled nursing facility or intermediate care facilities.
(b)(1)A precertification training program consisting of at least 60 classroom hours of training on basic nursing skills, patient safety and rights, the social and psychological problems of patients, and resident abuse prevention, recognition, and reporting pursuant to subdivision (e). The 60 classroom hours of training may be conducted within a skilled nursing facility or intermediate care facility or in an educational institution or agency. A skilled nursing facility or intermediate care facility may conduct the 60 classroom hours of training in an online or distance learning course format, as approved by the department.
(2)In addition to the 60 classroom hours of training required under paragraph (1), the precertification training program shall consist of at least 100 hours of supervised and on-the-job training clinical practice. The 100 hours may consist of normal employment as a nurse assistant under the supervision of either the director of nurse training or a licensed nurse qualified to provide nurse assistant training who has no other assigned duties while providing the training.
(3)At least two hours of the 60 hours of classroom training shall address the special needs of persons with developmental and mental disorders, including intellectual disability, cerebral palsy, epilepsy, dementia, Parkinsons disease, and mental illness. At least two hours of the 60 hours of classroom training shall address the special needs of persons with Alzheimers disease and related dementias.
(4)At least four hours of the 100 hours of supervised clinical training shall address the special needs of persons with developmental and mental disorders, including intellectual disability, cerebral palsy, epilepsy, Alzheimers disease and related dementias, and Parkinsons disease.
(5)In a precertification training program subject to this subdivision, credit shall be given for the training received in an approved precertification training program adopted by another skilled nursing facility or intermediate care facility.
(6)This subdivision shall not apply to a skilled nursing facility or intermediate care facility that demonstrates to the department that it employs only nurse assistants with a valid certification.
(c)Continuing in-service training to ensure continuing competency in existing and new nursing skills.
(d)Each facility shall consider including training regarding the characteristics and method of assessment and treatment of acquired immune deficiency syndrome (AIDS).
(e)(1)The approved training program shall include, within the 60 hours of classroom training, a minimum of six hours of instruction on preventing, recognizing, and reporting instances of resident abuse utilizing those courses developed pursuant to Section 13823.93 of the Penal Code, and a minimum of one hour of instruction on preventing, recognizing, and reporting residents rights violations.
(2)A minimum of four hours of instruction on preventing, recognizing, and reporting instances of resident abuse, including instruction on preventing, recognizing, and reporting residents rights violations, shall be included within the total minimum hours of continuing education or in-service training required and in effect for certified nurse assistants.
SEC. 3.Section 1337.15 is added to the Health and Safety Code, immediately following Section 1337.1, to read:1337.15.(a)A person who provides instruction or training, at a skilled nursing facility or intermediate care facility or in an educational institution, as part of a certified nurse assistant precertification training program described in Section 1337.1 or 1337.3 may be any licensed vocational nurse or registered nurse with no less than two years of nursing experience, of which no less than one year is in providing care and services to chronically ill or elderly patients in an acute care hospital, skilled nursing facility, intermediate care facility, home care, hospice care, or other long-term care setting.
(b)Notwithstanding any other law, a person described in subdivision (a) shall not be required to hold a teaching credential to provide instruction as part of a certified nurse assistant precertification training program described in Section 1337.1 or 1337.3.
SEC. 4.Section 1337.16 is added to the Health and Safety Code, immediately following Section 1337.15, to read:1337.16.(a)An online or distance learning nurse assistant training program shall comply with all of the following requirements:
(1)Provide synchronous, online instruction that allows in which the trainees and the approved instructor to be are online at the same or similar times and which allows them to use real-time collaborative software that combines audio, video, file sharing, or any other forms of approved interaction and communication.
(2)Require the use of a personal identification number or personal identification information that confirms the identity of the trainees and instructors, including, but not limited to, having trainees sign an affidavit attesting under penalty of perjury to their identity while completing the program.
(3)Provide safeguards to protect personal information.
(4)Include policies and procedures to ensure that instructors are accessible to trainees outside of the normal instruction times.
(5)Include policies and procedures for equipment failures, student absences, and completing assignments past original deadlines.
(6)Provide a clear explanation on its Internet Web site of all technology requirements to participate and complete the program.
(7)Provide the department with statistics about the performance of trainees in the program, including, but not limited to, exam pass rate and the rate at which trainees repeat each module of the program, and any other information requested by the department regarding trainee participation in and completion of the program.
(b)In addition to the requirements set forth in subdivision (a), an online or distance learning nurse assistant training program shall meet the same standards as a traditional, classroom-based program, and comply with any other standard established by the department for online or distance learning nurse assistant training programs. Notwithstanding any other law, the department may, without taking any regulatory actions pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, implement, interpret, or make specific this section by means of an All Facilities Letter (AFL) or similar instruction.
(c)As a condition of approval by the department, an online or distance learning nurse assistant training program shall provide the department with access rights to the program for the purposes of verifying that program complies with all requirements and allowing the department to monitor online or distance learning sessions.
SEC. 5.Section 1337.3 of the Health and Safety Code is amended to read:1337.3.(a)The department shall prepare and maintain a list of approved training programs for nurse assistant certification. The list shall include training programs conducted by skilled nursing facilities or intermediate care facilities, as well as local agencies and education programs. In addition, the list shall include information on whether a training center is currently training nurse assistants, their competency test pass rates, and the number of nurse assistants they have trained. Clinical portions of the training programs may be obtained as on-the-job training, supervised by a qualified director of staff development or licensed nurse.
(b)It shall be the duty of the department to inspect a representative sample of training programs. The department shall protect consumers and students in any training program against fraud, misrepresentation, or other practices that may result in improper or excessive payment of funds paid for training programs. In evaluating a training centers training program, the department shall examine each training centers trainees competency test passage rate, and require each program to maintain an average 60 percent test score passage rate to maintain its participation in the program. The average test score passage rate shall be calculated over a two-year period. If the department determines that a training program is not complying with regulations or is not meeting the competency passage rate requirements, notice thereof in writing shall be immediately given to the program. If the program has not been brought into compliance within a reasonable time, the program may be removed from the approved list and notice thereof in writing given to it. Programs removed under this article shall be afforded an opportunity to request reinstatement of program approval at any time. The departments district offices shall inspect facility-based centers as part of their annual survey.
(c)Notwithstanding Section 1337.1, the approved training program shall consist of at least the following:
(1)A 16-hour orientation program to be given to newly employed nurse assistants prior to providing direct patient care, and consistent with federal training requirements for facilities participating in the Medicare or Medicaid programs.
(2)(A)A precertification training program consisting of at least 60 classroom hours of training on basic nursing skills, patient safety and rights, the social and psychological problems of patients, and elder abuse recognition and reporting pursuant to subdivision (e) of Section 1337.1. The 60 classroom hours of training may be conducted within a skilled nursing facility, an intermediate care facility, or an educational institution or agency. A health facility, educational institution, or local agency may conduct the 60 classroom hours of training in an online or distance learning course format, as approved by the department.
(B)In addition to the 60 classroom hours of training required under subparagraph (A), the precertification program shall also consist of 100 hours of supervised and on-the-job training clinical practice. The 100 hours may consist of normal employment as a nurse assistant under the supervision of either the director of staff development or a licensed nurse qualified to provide nurse assistant training who has no other assigned duties while providing the training.
(3)At least two hours of the 60 hours of classroom training and at least four hours of the 100 hours of the supervised clinical training shall address the special needs of persons with developmental and mental disorders, including intellectual disability, Alzheimers disease, cerebral palsy, epilepsy, dementia, Parkinsons disease, and mental illness.
(d)The department, in consultation with the State Department of Education and other appropriate organizations, shall develop criteria for approving training programs, that includes program content for orientation, training, inservice and the examination for testing knowledge and skills related to basic patient care services and shall develop a plan that identifies and encourages career ladder opportunities for certified nurse assistants. This group shall also recommend, and the department shall adopt, regulation changes necessary to provide for patient care when facilities utilize noncertified nurse assistants who are performing direct patient care. The requirements of this subdivision shall be established by January 1, 1989.
(e)On or before January 1, 2004, the department, in consultation with the State Department of Education, the American Red Cross, and other appropriate organizations, shall do the following:
(1)Review the current examination for approved training programs for certified nurse assistants to ensure the accurate assessment of whether a nurse assistant has obtained the required knowledge and skills related to basic patient care services.
(2)Develop a plan that identifies and encourages career ladder opportunities for certified nurse assistants, including the application of on-the-job postcertification hours to educational credits.
(f)A skilled nursing facility or intermediate care facility shall determine the number of specific clinical hours within each module identified by the department required to meet the requirements of subdivision (d), subject to subdivisions (b) and (c). The facility shall consider the specific hours recommended by the state department when adopting the precertification training program required by this chapter.
(g)This article shall not apply to a program conducted by any church or denomination for the purpose of training the adherents of the church or denomination in the care of the sick in accordance with its religious tenets.
(h)The Chancellor of the California Community Colleges shall provide to the department a standard process for approval of college credit. The department shall make this information available to all training programs in the state.
(i)An online or distance learning nurse assistant training program shall meet the same standards as a traditional, classroom-based program.
(j)An online nurse assistant training program shall contract with a licensed skilled nursing facility or intermediate care facility for the purpose of coordinating and completing the clinical portion of the nurse assistant training program.
SEC. 6.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
The Legislature finds and declares all of the following:
(a)Over 1,100 people turn 65 years of age every day in California, and there are approximately 110,000 licensed skilled nursing beds in the state.
(b)About 25 percent of older adults will need nursing home care at some time in their lives.
(c)There is a shortage of qualified nurses available to meet the needs of patients in California health care facilities, particularly those patients in the states 1,200 skilled nursing facilities.
(d)Californias skilled nursing facilities currently face a challenge not only in recruiting qualified nursing staff, but also in retaining quality nursing staff.
(e)With over 65 percent of our residents on Medi-Cal, Californias skilled nursing facilities are an integral part of the health care continuum, with over 13.5 million Californians on Medi-Cal.
(f)The occupancy rate of Californias skilled nursing facilities is above the national average and is currently at 88 percent.
(g)Certified nurse assistants are an important component of skilled nursing facilities, but unfortunately the workforce in that area is stagnant and extremely limited in various counties.
(h)Over 1,600 additional certified nurse assistants in skilled nursing facilities will be needed to meet the increased minimum staffing level mandate by July 1, 2018.
(i)According to the Office of Statewide Health Planning and Development, in 2016, over 63 percent of skilled nursing facility direct care staff are certified nurse assistants, over 23 percent are licensed vocational nurses (LVNs), and over 9 percent are registered nurses (RNs).
(j)The California HealthCare Foundation has determined that: ... California may not have adequate numbers of nurses with appropriate skills. The result could be decreased patient access, higher health care costs, and lower quality of service.
(k)The quality of patient care in California long-term care facilities is directly dependent upon the availability of an adequate supply of appropriately trained workers.
SEC. 2.Section 1337.1 of the Health and Safety Code is amended to read:1337.1.A skilled nursing facility or intermediate care facility shall adopt an approved training program that meets standards established by the department. The approved training program shall consist of at least all of the following:
(a)An orientation program to be given to newly employed nurse assistants prior to providing direct patient care in skilled nursing facility or intermediate care facilities.
(b)(1)A precertification training program consisting of at least 60 classroom hours of training on basic nursing skills, patient safety and rights, the social and psychological problems of patients, and resident abuse prevention, recognition, and reporting pursuant to subdivision (e). The 60 classroom hours of training may be conducted within a skilled nursing facility or intermediate care facility or in an educational institution. institution or agency. A skilled nursing facility or intermediate care facility or an educational institution may conduct the 60 classroom hours of training in an online or distance learning course format, as approved by the department.
(2)In addition to the 60 classroom hours of training required under paragraph (1), the precertification training program shall consist of at least 100 hours of supervised and on-the-job training clinical practice. The 100 hours may consist of normal employment as a nurse assistant under the supervision of either the director of nurse training or a licensed nurse qualified to provide nurse assistant training who has no other assigned duties while providing the training.
(3)At least two hours of the 60 hours of classroom training shall address the special needs of persons with developmental and mental disorders, including intellectual disability, cerebral palsy, epilepsy, dementia, Parkinsons disease, and mental illness. At least two hours of the 60 hours of classroom training shall address the special needs of persons with Alzheimers disease and related dementias.
(4)At least four hours of the 100 hours of supervised clinical training shall address the special needs of persons with developmental and mental disorders, including intellectual disability, cerebral palsy, epilepsy, Alzheimers disease and related dementias, and Parkinsons disease.
(5)In a precertification training program subject to this subdivision, credit shall be given for the training received in an approved precertification training program adopted by another skilled nursing facility or intermediate care facility.
(6)This subdivision shall not apply to a skilled nursing facility or intermediate care facility that demonstrates to the department that it employs only nurse assistants with a valid certification.
(c)Continuing in-service training to ensure continuing competency in existing and new nursing skills.
(d)Each facility shall consider including training regarding the characteristics and method of assessment and treatment of acquired immune deficiency syndrome (AIDS).
(e)(1)The approved training program shall include, within the 60 hours of classroom training, a minimum of six hours of instruction on preventing, recognizing, and reporting instances of resident abuse utilizing those courses developed pursuant to Section 13823.93 of the Penal Code, and a minimum of one hour of instruction on preventing, recognizing, and reporting residents rights violations.
(2)A minimum of four hours of instruction on preventing, recognizing, and reporting instances of resident abuse, including instruction on preventing, recognizing, and reporting residents rights violations, shall be included within the total minimum hours of continuing education or in-service training required and in effect for certified nurse assistants.
SEC. 3.Section 1337.15 is added to the Health and Safety Code, immediately following Section 1337.1, to read:1337.15.(a)A person who provides instruction or training, at a skilled nursing facility or intermediate care facility or in an educational institution, as part of a certified nurse assistant precertification training program described in Section 1337.1 or 1337.3 may be any licensed vocational nurse or registered nurse with no less than two years of nursing experience, of which no less than one year is in providing care and services to chronically ill or elderly patients in an acute care hospital, skilled nursing facility, intermediate care facility, home care, hospice care, or other long-term care setting.
(b)Notwithstanding any other law, a person described in subdivision (a) shall not be required to hold a teaching credential to provide instruction as part of a certified nurse assistant precertification training program described in Section 1337.1. 1337.1 or 1337.3.
SEC. 4.Section 1337.16 is added to the Health and Safety Code, immediately following Section 1337.15, to read:1337.16.(a)An online or distance learning nurse assistant training program shall comply with all of the following requirements:
(1)Provide synchronous, online instruction that allows the trainees and the approved instructor to be online at the same or similar times and use real-time collaborative software that combines audio, video, file sharing, or any other forms of approved interaction and communication.
(2)Require the use of a personal identification number or personal identification information that confirms the identity of the trainees and instructors, including, but not limited to, having trainees sign an affidavit attesting under penalty of perjury to their identity while completing the program.
(3)Provide safeguards to protect personal information.
(4)Include policies and procedures to ensure that instructors are accessible to trainees outside of the normal instruction times.
(5)Include policies and procedures for equipment failures, student absences, and completing assignments past original deadlines.
(6)Provide a clear explanation on its Internet Web site of all technology requirements to participate and complete the program.
(7)Provide the department with statistics about the performance of trainees in the program, including, but not limited to, exam pass rate and the rate at which trainees repeat each module of the program, and any other information requested by the department regarding trainee participation in and completion of the program.
(b)In addition to the requirements set forth in subdivision (a), an online or distance learning nurse assistant training program shall meet the same standards as a traditional, classroom-based program, and comply with any other standard established by the department for online or distance learning nurse assistant training programs. Notwithstanding any other law, the department may, without taking any regulatory actions pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, implement, interpret, or make specific this section by means of an All Facilities Letter (AFL) or similar instruction.
(c)As a condition of approval by the department, an online or distance learning nurse assistant training program shall provide the department with access rights to the program for the purposes of verifying that program complies with all requirements and allowing the department to monitor online or distance learning sessions.
SEC. 5.Section 1337.3 of the Health and Safety Code is amended to read:1337.3.(a)The department shall prepare and maintain a list of approved training programs for nurse assistant certification. The list shall include training programs conducted by skilled nursing facilities or intermediate care facilities, as well as local agencies and education programs. In addition, the list shall include information on whether a training center is currently training nurse assistants, their competency test pass rates, and the number of nurse assistants they have trained. Clinical portions of the training programs may be obtained as on-the-job training, supervised by a qualified director of staff development or licensed nurse.
(b)It shall be the duty of the department to inspect a representative sample of training programs. The department shall protect consumers and students in any training program against fraud, misrepresentation, or other practices that may result in improper or excessive payment of funds paid for training programs. In evaluating a training centers training program, the department shall examine each training centers trainees competency test passage rate, and require each program to maintain an average 60 percent test score passage rate to maintain its participation in the program. The average test score passage rate shall be calculated over a two-year period. If the department determines that a training program is not complying with regulations or is not meeting the competency passage rate requirements, notice thereof in writing shall be immediately given to the program. If the program has not been brought into compliance within a reasonable time, the program may be removed from the approved list and notice thereof in writing given to it. Programs removed under this article shall be afforded an opportunity to request reinstatement of program approval at any time. The departments district offices shall inspect facility-based centers as part of their annual survey.
(c)Notwithstanding Section 1337.1, the approved training program shall consist of at least the following:
(1)A 16-hour orientation program to be given to newly employed nurse assistants prior to providing direct patient care, and consistent with federal training requirements for facilities participating in the Medicare or Medicaid programs.
(2)(A)A certification precertification training program consisting of at least 60 classroom hours of training on basic nursing skills, patient safety and rights, the social and psychological problems of patients, and elder abuse recognition and reporting pursuant to subdivision (e) of Section 1337.1. The 60 classroom hours of training may be conducted within a skilled nursing facility, an intermediate care facility, or an educational institution. institution or agency. A health facility, educational institution, or local agency may conduct the 60 classroom hours of training in an online or distance learning course format, as approved by the department.
(B)In addition to the 60 classroom hours of training required under subparagraph (A), the certification precertification program shall also consist of 100 hours of supervised and on-the-job training clinical practice. The 100 hours may consist of normal employment as a nurse assistant under the supervision of either the director of staff development or a licensed nurse qualified to provide nurse assistant training who has no other assigned duties while providing the training.
(3)At least two hours of the 60 hours of classroom training and at least four hours of the 100 hours of the supervised clinical training shall address the special needs of persons with developmental and mental disorders, including intellectual disability, Alzheimers disease, cerebral palsy, epilepsy, dementia, Parkinsons disease, and mental illness.
(d)The department, in consultation with the State Department of Education and other appropriate organizations, shall develop criteria for approving training programs, that includes program content for orientation, training, inservice and the examination for testing knowledge and skills related to basic patient care services and shall develop a plan that identifies and encourages career ladder opportunities for certified nurse assistants. This group shall also recommend, and the department shall adopt, regulation changes necessary to provide for patient care when facilities utilize noncertified nurse assistants who are performing direct patient care. The requirements of this subdivision shall be established by January 1, 1989.
(e)On or before January 1, 2004, the department, in consultation with the State Department of Education, the American Red Cross, and other appropriate organizations, shall do the following:
(1)Review the current examination for approved training programs for certified nurse assistants to ensure the accurate assessment of whether a nurse assistant has obtained the required knowledge and skills related to basic patient care services.
(2)Develop a plan that identifies and encourages career ladder opportunities for certified nurse assistants, including the application of on-the-job postcertification hours to educational credits.
(f)A skilled nursing facility or intermediate care facility shall determine the number of specific clinical hours within each module identified by the department required to meet the requirements of subdivision (d), subject to subdivisions (b) and (c). The facility shall consider the specific hours recommended by the state department when adopting the certification precertification training program required by this chapter.
(g)This article shall not apply to a program conducted by any church or denomination for the purpose of training the adherents of the church or denomination in the care of the sick in accordance with its religious tenets.
(h)The Chancellor of the California Community Colleges shall provide to the department a standard process for approval of college credit. The department shall make this information available to all training programs in the state.
(i)An online or distance learning nurse assistant training program shall meet the same standards as a traditional, classroom-based program.
(j)An online nurse assistant training program shall contract with a licensed skilled nursing facility or intermediate care facility for the purpose of coordinating and completing the clinical portion of the nurse assistant training program.
SEC. 6.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
The Legislature finds and declares all of the following:
(a)Over 1,100 people turn 65 years of age every day in California, and there are approximately 110,000 licensed skilled nursing beds in the state.
(b)About 25 percent of older adults will need nursing home care at some time in their lives.
(c)There is a shortage of qualified nurses available to meet the needs of patients in California health care facilities, particularly those patients in the states 1,200 skilled nursing facilities.
(d)Californias skilled nursing facilities currently face a challenge not only in recruiting qualified nursing staff, but also in retaining quality nursing staff.
(e)With over 65 percent of our residents on Medi-Cal, Californias skilled nursing facilities are an integral part of the health care continuum, with over 13.5 million Californians on Medi-Cal.
(f)The occupancy rate of Californias skilled nursing facilities is above the national average and is currently at 88 percent.
(g)Certified nurse assistants are an important component of skilled nursing facilities, but unfortunately the workforce in that area is stagnant and extremely limited in various counties.
(h)Over 1,600 additional certified nurse assistants in skilled nursing facilities will be needed to meet the increased minimum staffing level mandate by July 1, 2018.
(i)According to the Office of Statewide Health Planning and Development, in 2016, over 63 percent of skilled nursing facility direct care staff are certified nurse assistants, over 23 percent are licensed vocational nurses (LVNs), and over 9 percent are registered nurses (RNs).
(j)The California HealthCare Foundation has determined that: ... California may not have adequate numbers of nurses with appropriate skills. The result could be decreased patient access, higher health care costs, and lower quality of service.
(k)The quality of patient care in California long-term care facilities is directly dependent upon the availability of an adequate supply of appropriately trained workers.
SEC. 2.Section 1337.1 of the Health and Safety Code is amended to read:1337.1.A skilled nursing or intermediate care facility shall adopt an approved training program that meets standards established by the department. The approved training program shall consist of at least all of the following:
(a)An orientation program to be given to newly employed nurse assistants prior to providing direct patient care in skilled nursing or intermediate care facilities.
(b)(1)A precertification training program consisting of at least 60 classroom hours of training on basic nursing skills, patient safety and rights, the social and psychological problems of patients, and resident abuse prevention, recognition, and reporting pursuant to subdivision (e). The 60 classroom hours of training may be conducted within a skilled nursing or intermediate care facility or in an educational institution. A skilled nursing or intermediate care facility or an educational institution may conduct the 60 classroom hours of training in an online or distance learning course format, as approved by the department.
(2)In addition to the 60 classroom hours of training required under paragraph (1), the precertification training program shall consist of at least 100 hours of supervised and on-the-job training clinical practice. The 100 hours may consist of normal employment as a nurse assistant under the supervision of either the director of nurse training or a licensed nurse qualified to provide nurse assistant training who has no other assigned duties while providing the training.
(3)At least two hours of the 60 hours of classroom training shall address the special needs of persons with developmental and mental disorders, including intellectual disability, cerebral palsy, epilepsy, dementia, Parkinsons disease, and mental illness. At least two hours of the 60 hours of classroom training shall address the special needs of persons with Alzheimers disease and related dementias.
(4)At least four hours of the 100 hours of supervised clinical training shall address the special needs of persons with developmental and mental disorders, including intellectual disability, cerebral palsy, epilepsy, Alzheimers disease and related dementias, and Parkinsons disease.
(5)In a precertification training program subject to this subdivision, credit shall be given for the training received in an approved precertification training program adopted by another skilled nursing or intermediate care facility.
(6)This subdivision shall not apply to a skilled nursing or intermediate care facility that demonstrates to the department that it employs only nurse assistants with a valid certification.
(c)Continuing in-service training to ensure continuing competency in existing and new nursing skills.
(d)Each facility shall consider including training regarding the characteristics and method of assessment and treatment of acquired immune deficiency syndrome (AIDS).
(e)(1)The approved training program shall include, within the 60 hours of classroom training, a minimum of six hours of instruction on preventing, recognizing, and reporting instances of resident abuse utilizing those courses developed pursuant to Section 13823.93 of the Penal Code, and a minimum of one hour of instruction on preventing, recognizing, and reporting residents rights violations.
(2)A minimum of four hours of instruction on preventing, recognizing, and reporting instances of resident abuse, including instruction on preventing, recognizing, and reporting residents rights violations, shall be included within the total minimum hours of continuing education or in-service training required and in effect for certified nursing nurse assistants.
SEC. 3.Section 1337.15 is added to the Health and Safety Code, immediately following Section 1337.1, to read:1337.15.(a)A person who provides instruction or training, at a skilled nursing or intermediate care facility or in an educational institution, as part of a certified nurse assistant precertification training program described in Section 1337.1 may be any licensed vocational nurse or registered nurse presently employed at a skilled nursing facility, acute care hospital, or other facility that primarily provides care for older adults, including a nurse working in a supervisory capacity that does not directly involve patient care. with no less than two years of nursing experience, of which no less than one year is in providing care and services to chronically ill or elderly patients in an acute care hospital, skilled nursing facility, intermediate care facility, home care, hospice care, or other long-term care setting.
(b)Notwithstanding any other law, a person described in subdivision (a) shall not be required to hold a teaching credential to provide instruction as part of a certified nurse assistant precertification training program described in Section 1337.1.
The Legislature finds and declares all of the following:
(a)Over 1,100 people turn 65 years of age every day in California, and there are approximately 110,000 licensed skilled nursing beds in the state.
(b)About 25 percent of older adults will need nursing home care at some time in their lives.
(c)There is a shortage of qualified nurses available to meet the needs of patients in California health care facilities, particularly those patients in the states 1,200 skilled nursing facilities.
(d)Californias skilled nursing facilities currently face a challenge not only in recruiting qualified nursing staff, but also in retaining quality nursing staff.
(e)With over 65 percent of our residents on Medi-Cal, Californias skilled nursing facilities are an integral part of the health care continuum, with over 13.5 million Californians on Medi-Cal.
(f)The occupancy rate of Californias skilled nursing facilities is above the national average and is currently at 88 percent.
(g)Certified nurse assistants are an important component of skilled nursing facilities, but unfortunately the workforce in that area is stagnant and extremely limited in various counties.
(h)Over 1,600 additional certified nurse assistants in skilled nursing facilities will be needed to meet the increased minimum staffing level mandate by July 1, 2018.
(i)According to the Office of Statewide Health Planning and Development, in 2016, over 63 percent of skilled nursing facility direct care staff are certified nurse assistants, over 23 percent are licensed vocational nurses (LVNs), and over 9 percent are registered nurses (RNs).
(j)The California HealthCare Foundation has determined that: ... California may not have adequate numbers of nurses with appropriate skills. The result could be decreased patient access, higher health care costs, and lower quality of service.
(k)The quality of patient care in California long-term care facilities is directly dependent upon the availability of an adequate supply of appropriately trained workers.
SEC. 2.Section 1337.1 of the Health and Safety Code is amended to read:1337.1.A skilled nursing or intermediate care facility shall adopt an approved training program that meets standards established by the department. The approved training program shall consist of at least all of the following:
(a)An orientation program to be given to newly employed nurse assistants prior to providing direct patient care in skilled nursing or intermediate care facilities.
(b)(1)A precertification training program consisting of at least 60 classroom hours of training on basic nursing skills, patient safety and rights, the social and psychological problems of patients, and resident abuse prevention, recognition, and reporting pursuant to subdivision (e). The 60 classroom hours of training may be conducted within a skilled nursing or intermediate care facility or in an educational institution. A skilled nursing or intermediate care facility or an educational institution may conduct the 60 classroom hours of training in an online or distance learning course format, as approved by the department.
(2)In addition to the 60 classroom hours of training required under paragraph (1), the precertification training program shall consist of at least 100 hours of supervised and on-the-job training clinical practice. The 100 hours may consist of normal employment as a nurse assistant under the supervision of either the director of nurse training or a licensed nurse qualified to provide nurse assistant training who has no other assigned duties while providing the training.
(3)At least two hours of the 60 hours of classroom training shall address the special needs of persons with developmental and mental disorders, including intellectual disability, cerebral palsy, epilepsy, dementia, Parkinsons disease, and mental illness. At least two hours of the 60 hours of classroom training shall address the special needs of persons with Alzheimers disease and related dementias.
(4)At least four hours of the 100 hours of supervised clinical training shall address the special needs of persons with developmental and mental disorders, including intellectual disability, cerebral palsy, epilepsy, Alzheimers disease and related dementias, and Parkinsons disease.
(5)In a precertification training program subject to this subdivision, credit shall be given for the training received in an approved precertification training program adopted by another skilled nursing or intermediate care facility.
(6)This subdivision shall not apply to a skilled nursing or intermediate care facility that demonstrates to the department that it employs only nurse assistants with a valid certification.
(c)Continuing in-service training to ensure continuing competency in existing and new nursing skills.
(d)Each facility shall consider including training regarding the characteristics and method of assessment and treatment of acquired immune deficiency syndrome (AIDS).
(e)(1)The approved training program shall include, within the 60 hours of classroom training, a minimum of six hours of instruction on preventing, recognizing, and reporting instances of resident abuse utilizing those courses developed pursuant to Section 13823.93 of the Penal Code, and a minimum of one hour of instruction on preventing, recognizing, and reporting residents rights violations.
(2)A minimum of four hours of instruction on preventing, recognizing, and reporting instances of resident abuse, including instruction on preventing, recognizing, and reporting residents rights violations, shall be included within the total minimum hours of continuing education or in-service training required and in effect for certified nursing assistants.
SEC. 3.Section 1337.15 is added to the Health and Safety Code, immediately following Section 1337.1, to read:1337.15.(a)A person who provides instruction or training, at a skilled nursing or intermediate care facility or in an educational institution, as part of a certified nurse assistant precertification training program described in Section 1337.1 may be any licensed or registered nurse presently employed at a skilled nursing facility, acute care hospital, or other facility that primarily provides care for older adults, including a nurse working in a supervisory capacity that does not directly involve patient care.
(b)Notwithstanding any other law, a person described in subdivision (a) shall not be required to hold a teaching credential to provide instruction as part of a certified nurse assistant precertification training program described in Section 1337.1.
The Legislature finds and declares all of the following:
(a)Over 1,100 people turn 65 years of age every day in California, and there are approximately 110,000 licensed skilled nursing beds in the state.
(b)About 25 percent of older adults will need nursing home care at some time in their lives.
(c)There is a shortage of qualified nurses available to meet the needs of patients in California health care facilities, particularly those patients in the states 1,200 skilled nursing facilities.
(d)Californias skilled nursing facilities currently face a challenge not only in recruiting qualified nursing staff, but also in retaining quality nursing staff.
(e)With over 65 percent of our residents on Medi-Cal, Californias skilled nursing facilities are an integral part of the health care continuum, with over 13.5 million Californians on Medi-Cal.
(f)The occupancy rate of Californias skilled nursing facilities is above the national average and is currently at 88 percent.
(g)Certified nurse assistants are an important component of skilled nursing facilities, but unfortunately the workforce in that area is stagnant and extremely limited in various counties.
(h)Over 1,600 additional certified nurse assistants in skilled nursing facilities will be needed to meet the increased minimum staffing level mandate by July 1, 2018.
(i)According to the Office of Statewide Health Planning and Development, in 2016, over 63 percent of skilled nursing facility direct care staff are certified nurse assistants, over 23 percent are licensed vocational nurses (LVNs), and over 9 percent are registered nurses (RNs).
(j)The California HealthCare Foundation has determined that: ... California may not have adequate numbers of nurses with appropriate skills. The result could be decreased patient access, higher health care costs, and lower quality of service.
(k)The quality of patient care in California long-term care facilities is directly dependent upon the availability of an adequate supply of appropriately trained workers.
(l)Expanding the long-term care workforce requires coordinated strategies that address wages, working conditions, educational opportunities, career advancement opportunities, and personal preferences.(m)A survey done by the Office of Statewide Health Planning and Development found overwhelming support among facility nursing staff, residents and their families, physicians, and other members of the health care team for a new category of paraprofessional health care worker authorized to provide medication assistance under the seven-year Health Manpower Pilot Project No. 152 conducted in the County of Sonoma from 1988 to 1995.(n)At least 18 other states allow appropriately trained paraprofessional staff to give medicines and administer certain treatments to nursing home residents, if they have been trained and certified, and are supervised by licensed nursing staff.(o)The other states that allow the paraprofessional staff in nursing homes have reported quality outcomes, increased resident and staff satisfaction, no increase in medication errors, no decrease in licensed nursing staff levels, and have offered effective career ladder opportunities for certified nursing assistants.(p)The creation of additional training and certification programs necessary to establish a new permanent category of paraprofessional health care worker who can provide medication assistance to patients in skilled nursing facilities should be included in the range of solutions implemented to address the workforce shortage.SEC. 2.Section 1337 of the Health and Safety Code is amended to read:1337.(a)The Legislature finds that the quality of patient care in skilled nursing and intermediate care facilities is dependent upon the competence of the personnel who staff its facilities. The Legislature further finds that direct patient care in skilled nursing and intermediate care facilities is currently rendered largely by certified nurse assistants. To assure the availability of trained personnel in skilled nursing and intermediate care facilities, the Legislature intends that all such facilities in this state participate in approved training programs established under this article. This article shall not apply to intermediate care facilities/developmentally disabled habilitative, intermediate care facility/developmentally disabled-nursing, and intermediate care facility/developmentally disabled-continuous nursing which have staff training programs approved by the State Department of Developmental Services, general acute care hospitals, acute psychiatric hospitals, or special hospitals.(b)The requirement that certified nurse assistants obtain a criminal record clearance upon certification and biannually thereafter shall apply regardless of the setting in which the certified nurse assistant is employed.(c)The department shall develop procedures to ensure that certified nurse assistants, including, but not limited to, those certified as geriatric medication technicians, employed by intermediate care facilities for the developmentally disabled/habilitative and intermediate care facilities for the developmentally disabled/nursing shall not be required to obtain multiple criminal record clearances.(d)For the purpose of this article:(1)Nurse assistant means any unlicensed aide, assistant, or orderly, who performs nursing services directed at the safety, comfort, personal hygiene, or protection of patients in a skilled nursing or intermediate care facility.(2)Approved training program means a program for the training of nurse assistants that meets the criteria established and approved under this chapter.(3)(A)Certified nurse assistant means any person who holds himself or herself out as a certified nurse assistant and who, for compensation, performs basic patient care services directed at the safety, comfort, personal hygiene, and protection of patients, and is certified as having completed the requirements of this article. These services shall not include any services which may only be performed by a licensed person and otherwise shall be performed under the supervision of a registered nurse, as defined in Section 2725 of the Business and Professions Code, or a licensed vocational nurse, as defined in Section 2859 of the Business and Professions Code.(B)Geriatric medication technician means a certified nurse assistant who has been certified as successfully completing medication administration training with a geriatric focus pursuant to this article.(4)State department means the State Department of Public Health.SEC. 2.Section 1337.1 of the Health and Safety Code is amended to read:1337.1.A skilled nursing or intermediate care facility shall adopt an approved training program that meets standards established by the department. The approved training program shall consist of at least all of the following:
(a)An orientation program to be given to newly employed nurse assistants prior to providing direct patient care in skilled nursing or intermediate care facilities.
(b)(1)A precertification training program consisting of at least 60 classroom hours of training on basic nursing skills, patient safety and rights, the social and psychological problems of patients, and resident abuse prevention, recognition, and reporting pursuant to subdivision (e). The 60 classroom hours of training may be conducted within a skilled nursing or intermediate care facility or in an educational institution. A skilled nursing or intermediate care facility or an educational institution may conduct the 60 classroom hours of training in an online or distance learning course format, as approved by the department.
(2)In addition to the 60 classroom hours of training required under paragraph (1), the precertification training program shall consist of at least 100 hours of supervised and on-the-job training clinical practice. The 100 hours may consist of normal employment as a nurse assistant under the supervision of either the director of nurse training or a licensed nurse qualified to provide nurse assistant training who has no other assigned duties while providing the training.
(3)At least two hours of the 60 hours of classroom training shall address the special needs of persons with developmental and mental disorders, including intellectual disability, cerebral palsy, epilepsy, dementia, Parkinsons disease, and mental illness. At least two hours of the 60 hours of classroom training shall address the special needs of persons with Alzheimers disease and related dementias.
(4)At least four hours of the 100 hours of supervised clinical training shall address the special needs of persons with developmental and mental disorders, including intellectual disability, cerebral palsy, epilepsy, Alzheimers disease and related dementias, and Parkinsons disease.
(5)In a precertification training program subject to this subdivision, credit shall be given for the training received in an approved precertification training program adopted by another skilled nursing or intermediate care facility.
(6)This subdivision shall not apply to a skilled nursing or intermediate care facility that demonstrates to the department that it employs only nurse assistants with a valid certification.
(c)Continuing in-service training to ensure continuing competency in existing and new nursing skills.
(d)Each facility shall consider including training regarding the characteristics and method of assessment and treatment of acquired immune deficiency syndrome (AIDS).
(e)(1)The approved training program shall include, within the 60 hours of classroom training, a minimum of six hours of instruction on preventing, recognizing, and reporting instances of resident abuse utilizing those courses developed pursuant to Section 13823.93 of the Penal Code, and a minimum of one hour of instruction on preventing, recognizing, and reporting residents rights violations.
(2)A minimum of four hours of instruction on preventing, recognizing, and reporting instances of resident abuse, including instruction on preventing, recognizing, and reporting residents rights violations, shall be included within the total minimum hours of continuing education or in-service training required and in effect for certified nursing assistants.
SEC. 3.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.The Legislature finds and declares all of the following:
(a)Over 1,100 people turn 65 years of age every day in California, and there are approximately 110,000 licensed skilled nursing beds in the state.
(b)About 25 percent of older adults will need nursing home care at some time in their lives.
(c)There is a shortage of qualified nurses available to meet the needs of patients in California health care facilities, particularly those patients in the states 1,200 skilled nursing facilities.
(d)Californias skilled nursing facilities currently face a challenge not only in recruiting qualified nursing staff, but also in retaining quality nursing staff.
(e)With over 65 percent of our residents on Medi-Cal, Californias skilled nursing facilities are an integral part of the health care continuum, with over 13.5 million Californians on Medi-Cal.
(f)The occupancy rate of Californias skilled nursing facilities is above the national average and is currently at 88 percent.
(g)Certified nurse assistants are an important component of skilled nursing facilities, but unfortunately the workforce in that area is stagnant and extremely limited in various counties.
(h)Over 1,600 additional certified nurse assistants in skilled nursing facilities will be needed to meet the increased minimum staffing level mandate by July 1, 2018.
(i)According to the Office of Statewide Health Planning and Development, in 2016, over 63 percent of skilled nursing facility direct care staff are certified nurse assistants, over 23 percent are licensed vocational nurses (LVNs), and over 9 percent are registered nurses (RNs).
(j)The California HealthCare Foundation has determined that: ... California may not have adequate numbers of nurses with appropriate skills. The result could be decreased patient access, higher health care costs, and lower quality of service.
(k)The quality of patient care in California long-term care facilities is directly dependent upon the availability of an adequate supply of appropriately trained workers.
(l)Expanding the long-term care workforce requires coordinated strategies that address wages, working conditions, educational opportunities, career advancement opportunities, and personal preferences.
(m)A survey done by the Office of Statewide Health Planning and Development found overwhelming support among facility nursing staff, residents and their families, physicians, and other members of the health care team for a new category of paraprofessional health care worker authorized to provide medication assistance under the seven-year Health Manpower Pilot Project No. 152 conducted in the County of Sonoma from 1988 to 1995.
(n)At least 18 other states allow appropriately trained paraprofessional staff to give medicines and administer certain treatments to nursing home residents, if they have been trained and certified, and are supervised by licensed nursing staff.
(o)The other states that allow the paraprofessional staff in nursing homes have reported quality outcomes, increased resident and staff satisfaction, no increase in medication errors, no decrease in licensed nursing staff levels, and have offered effective career ladder opportunities for certified nursing assistants.
(p)The creation of additional training and certification programs necessary to establish a new permanent category of paraprofessional health care worker who can provide medication assistance to patients in skilled nursing facilities should be included in the range of solutions implemented to address the workforce shortage.
SEC. 2.Section 1337 of the Health and Safety Code is amended to read:1337.(a)The Legislature finds that the quality of patient care in skilled nursing and intermediate care facilities is dependent upon the competence of the personnel who staff its facilities. The Legislature further finds that direct patient care in skilled nursing and intermediate care facilities is currently rendered largely by certified nurse assistants. To assure the availability of trained personnel in skilled nursing and intermediate care facilities, the Legislature intends that all such facilities in this state participate in approved training programs established under this article. This article shall not apply to intermediate care facilities/developmentally disabled habilitative, intermediate care facility/developmentally disabled-nursing, and intermediate care facility/developmentally disabled-continuous nursing which have staff training programs approved by the State Department of Developmental Services, general acute care hospitals, acute psychiatric hospitals, or special hospitals.
(b)The requirement that certified nurse assistants obtain a criminal record clearance upon certification and biannually thereafter shall apply regardless of the setting in which the certified nurse assistant is employed.
(c)The department shall develop procedures to ensure that certified nurse assistants assistants, including, but not limited to, those certified as geriatric medication technicians, employed by intermediate care facilities for the developmentally disabled/habilitative and intermediate care facilities for the developmentally disabled/nursing shall not be required to obtain multiple criminal record clearances.
(d)For the purpose of this article:
(1)Nurse assistant means any unlicensed aide, assistant, or orderly, who performs nursing services directed at the safety, comfort, personal hygiene, or protection of patients in a skilled nursing or intermediate care facility.
(2)Approved training program means a program for the training of nurse assistants that meets the criteria established and approved under this chapter.
(3)(A)Certified nurse assistant means any person who holds himself or herself out as a certified nurse assistant and who, for compensation, performs basic patient care services directed at the safety, comfort, personal hygiene, and protection of patients, and is certified as having completed the requirements of this article. These services shall not include any services which may only be performed by a licensed person and otherwise shall be performed under the supervision of a registered nurse, as defined in Section 2725 of the Business and Professions Code, or a licensed vocational nurse, as defined in Section 2859 of the Business and Professions Code.
(B)Geriatric medication technician means a certified nurse assistant who has been certified as successfully completing medication administration training with a geriatric focus pursuant to this article.
(4)State department means the State Department of Public Health.
SEC. 3.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
|
Date
|
Status
|
|---|---|
| Sep 26, 2018 | Chaptered by Secretary of State - Chapter 769, Statutes of 2018. |
| Sep 26, 2018 | Approved by the Governor. |
| Sep 11, 2018 | Enrolled and presented to the Governor at 4:30 p.m. |
| Aug 30, 2018 | Senate amendments concurred in. To Engrossing and Enrolling. |
| Aug 29, 2018 | In Assembly. Concurrence in Senate amendments pending. |
| Aug 29, 2018 | Read third time. Passed. Ordered to the Assembly. |
| Aug 27, 2018 | Read second time. Ordered to third reading. |
| Aug 24, 2018 | Read third time and amended. Ordered to second reading. |
| Aug 20, 2018 | Read second time. Ordered to third reading. |
| Aug 17, 2018 | From committee: Amend, and do pass as amended. (Ayes 7. Noes 0.) (August 16). |
| Aug 6, 2018 | In committee: Referred to APPR. suspense file. |
| Jul 2, 2018 | Read second time and amended. Re-referred to Com. on APPR. |
| Jun 28, 2018 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 9. Noes 0.) (June 27). |
| Jun 18, 2018 | From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on HEALTH. |
| Jun 12, 2018 | In committee: Set, first hearing. Hearing canceled at the request of author. |
| Jun 7, 2018 | Referred to Com. on HEALTH. |
| May 31, 2018 | In Senate. Read first time. To Com. on RLS. for assignment. |
| May 30, 2018 | Read third time. Passed. Ordered to the Senate. |
| May 25, 2018 | From committee: Do pass. (Ayes 16. Noes 0.) (May 25). |
| May 9, 2018 | In committee: Set, first hearing. Referred to APPR. suspense file. |
| Apr 25, 2018 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 15. Noes 0.) (April 24). Re-referred to Com. on APPR. |
| Apr 19, 2018 | Re-referred to Com. on HEALTH. |
| Apr 18, 2018 | From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended. |
| Apr 17, 2018 | In committee: Set, first hearing. Hearing canceled at the request of author. |
| Mar 15, 2018 | Referred to Com. on HEALTH. |
| Feb 17, 2018 | From printer. May be heard in committee March 19. |
| Feb 16, 2018 | Read first time. To print. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Aug 30, 2018 | AB 2850 RUBIO Concurrence in Senate Amendments | Assembly Floor |
Passed |
|
| Aug 29, 2018 | Assembly 3rd Reading AB2850 Rubio By Pan | Senate Floor |
Passed |
|
| Aug 16, 2018 | Do pass as amended | Senate Standing Committee on Appropriations |
Passed |
|
| Aug 6, 2018 | Placed on suspense file | Senate Standing Committee on Appropriations |
Passed |
|
| Jun 27, 2018 | Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations] | Senate Standing Committee on Health |
Passed |
|
| May 30, 2018 | AB 2850 RUBIO Assembly Third Reading | Assembly Floor |
Passed |
|
| May 25, 2018 | Do pass. | Assembly Standing Committee on Appropriations |
Passed |
|
| Apr 24, 2018 | Do pass and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Health |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| 319-2081 | ** Against | May 7, 2018 |
| Appr. | ** Against | May 7, 2018 |
| California Advocates for Nursing Home Reform | ** Against | Aug 27, 2018 |
| California Association Of Health Facilities | ** Support | Aug 27, 2018 |
| California Hospital Association | ** Support | Aug 27, 2018 |
| California Nurses Association | ** Against | Apr 20, 2018 |
CONCURRENCE IN SENATE AMENDMENTS
CSA1 Bill Id:AB 2850
Author:(Rubio)
As Amended Ver:August 24, 2018
Majority vote
ASSEMBLY: | 78-0 | (May 30, 2018) | SENATE: | 39-0 | (August 29, 2018) |
Original Committee Reference: HEALTH
SUMMARY: Authorizes the 60 hours of required classroom training for certified nurse assistants (CNAs) to be offered through online or distance learning classes. Requires that online or distance learning classes be approved by the Department of Public Health (DPH).
The Senate amendments:
- Allow for a person who provides instruction or training, at a skilled nursing facility (SNF), intermediate care facility (ICF) or in an educational institution as part of a CNA precertification training program to be any licensed vocational nurse or registered nurse with no less than two years of nursing experience of which no less than one year is in providing care and services to chronically ill or elderly patients in an acute care hospital, SNF, ICF, home care, hospice care, or other long term care setting. Provide that this person is not required to hold a teaching credential to provide instruction as part of a CNA precertification training program.
- Require an online or distance learning CNA program to comply with all of the following requirements:
- Provide online instruction in which the trainees and the approved instructor are online at the same or similar times and which allows them to use real-time collaborative software that combines audio, video, file sharing, or any other forms of approved interaction and communication, as specified;
- Require the use of a personal identification number or information that confirms a trainee or instructor's identity;
- Provide safeguards to protect personal information;
- Include policies and procedures to ensure that instructors are accessible to trainees outside normal instruction times;
- Provide a clear explanation on its Website of all technology requirements to participate and complete; and,
- Provide DPH with statistics about a trainee's performance in the program.
- Require the online or distance learning CNA training program to meet the same standards as a traditional, classroom-based program, and comply with any other standard established by DPH for online or distance learning CNA training programs
- Require an online or distance learning CNA training program to provide DPH with access rights to the program to verify that program complies with all requirements, and to allow DPH to monitor online or distance learning sessions.
- Authorize a health facility, educational institution, or local agency to conduct a precertification training program, of at least 60 classroom hours of training in an online or distance learning course form, as approved by DPH.
- Provide that the Chancellor of the California Community Colleges must provide a standard process for approval of college credit and specifies:
- An online or distance learning CNA training program must meet the same standards as a traditional, classroom-based program; and,
- An online CNA training program must contract with a licensed SNF or ICF for the purposes of coordinating and completing the clinical portion of the CNA training program.
FISCAL EFFECT: According to the Senate Appropriations Committee:
- Costs of $137,544 Licensing and Certification Fund (L&C) in fiscal year (FY) 2018-19, and $265,087 (L&C Fund) in FYs 2019-20 and 2020-21 for one full-time associate governmental program analyst and one full-time information system analyst, and 0.5 health facility evaluation nurse to complete and develop regulations and establish the criteria for approving and denying applicants.
- Costs of $1.1 million (L&C Fund) in FY 2020-21, and ongoing, for:
- Six full-time staff to develop regulations; review initial and renewal training program documents; prepare correspondence related to deficiencies and approvals; and, provide clinical nursing consultation; and,
- One staff services manager, one program technician, and one information system analyst to prepare renewal notification, provide administrative support, exercise oversight over the approval process of the online training program, and enforce requirements related to online training courses.
COMMENTS: According to the author, this bill will help address California's skilled nursing facilities' workforce shortage by modernizing the classroom training requirement to become a CNA. Given the convenience and efficiency of online coursework, allowing potential CNA's the option of pursuing this portion of their certification online is a common-sense approach towards modernizing the certification process and encouraging more people to get into the field
CNAs are required to complete 60 classroom hours and 100 hours of supervised on-the-job training. According to DPH, current law, in statute and regulation, allocates 57 of the 60 classroom hours, with 50 of those hours allocated in regulation, and seven hours in statute. Of the seven hours specified in statute, six hours are on preventing, recognizing, and reporting resident abuse, and one hour on residents' rights violations.
Online and distance learning have been integrated into the educational community with all universities, colleges and community colleges conducting some of their coursework electronically. Likewise, within healthcare, the use of online or distance learning has been approved for some of the didactic (classroom) portion of training. For example, in dentistry where the supervision and scopes of practice of allied dental health professionals are parallel to nursing with registered dental hygienists, registered dental assistants and unlicensed dental assistants each with their own educational requirements and scopes of practice, electronic coursework is available for the didactic portion of their education requirements. These courses are offered as part of the Dental Board of California's approved educational programs. The American Health Care Association (AHCA) has developed an on-line CNA training program that is able to be tailored for state specificity. Currently there are eight states using the program for their CNA training. Twenty-three other states are engaged in the process of adopting the AHCA program.
Analysis Prepared by: Judith Babcock / HEALTH / (916) 319-2097 FN: 0005150
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB |
THIRD READING
Bill No: AB 2850
Amended: 8/24/18 in Senate
SENATE HEALTH COMMITTEE: 9-0, 6/27/18
AYES: Pan, Nguyen, Beall, Hernandez, Leyva, Mitchell, Monning, Nielsen, Roth
SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/16/18
AYES: Portantino, Bates, Beall, Bradford, Hill, Nielsen, Wiener
ASSEMBLY FLOOR: 78-0, 5/30/18 - See last page for vote
SUBJECT: Nurse assistant training programs: online or distance learning
SOURCE: California Association of Health Facilities
DIGEST:
This bill permits skilled nursing facilities or intermediate care facilities to conduct the 60 classroom hours of training for certified nurse assistants (CNAs) required under existing law in an online or distance learning course format, as approved by the Department of Public Health (DPH), as specified. Permits a person who provides instruction or training, as part of a CNA precertification training program, to be any licensed vocational nurse (LVN) or registered nurse (RN) with no less than two years of nursing experience, as specified.
Senate Floor Amendments of 8/24/18 make technical, clarifying changes.
Existing law:
- Requires certain health facilities, including skilled nursing facilities (SNFs) and intermediate care facilities (ICFs), to be licensed by DPH. [HSC §1250, et seq.]
- Defines a “CNA” as any person who holds him/herself out as a CNA and who, for compensation, performs basic patient care services directed at the safety, comfort, personal hygiene, and protection of patients, and is certified as having completed training requirements in existing law. Prohibits CNA services from including any services which may only be performed by a licensed person and requires those services to be performed under the supervision of an RN or LVN. [HSC §1337]
- Requires an SNF or ICF to adopt an approved training program that meets standards established by DPH. Requires the training program to consist of at least an orientation program to be given to newly employed nurse assistants prior to providing direct patient care in SNFs or ICFs and a precertification training program consisting of at least 60 classroom hours of training, as specified. Permits the 60 classroom hours of training to be conducted within a SNF, ICF, or in an educational institution. [HSC §1337.1]
- Places the following requirements on the 60 classroom hours of training:
- At least two hours of the 60 hours of classroom training to address the special needs of persons with developmental and mental disorders, including intellectual disability, cerebral palsy, epilepsy, dementia, Parkinson’s disease, and mental illness;
- At least two hours to address the special needs of persons with Alzheimer’s disease and related dementias;
- A minimum of six hours of instruction on preventing, recognizing, and reporting instances of resident abuse utilizing specified courses; and,
- A minimum of one hour of instruction on preventing, recognizing, and reporting residents’ rights violations. [HSC §1337.1]
- Requires the precertification training program, in addition to the 60 classroom hours of training, to consist of at least 100 hours of supervised and on-the-job training clinical practice. Permits the 100 hours to consist of normal employment as a nurse assistant under the supervision of either the director of nurse training or a licensed nurse qualified to provide nurse assistant training who has no other assigned duties while providing the training. Requires at least four of the 100 hours of supervised clinical training to address the special needs of persons with developmental and mental disorders, including intellectual disability, cerebral palsy, epilepsy, Alzheimer’s disease and related dementias, and Parkinson’s disease. [HSC §1337.1]
- Exempts SNFs and ICFs that demonstrate that it employs only nurse assistants with a valid certification from these training requirements. [HSC §1337.1]
This bill:
- Permits SNFs, ICFs, health facilities, educational institutions, or local agencies to conduct the 60 classroom hours of training required under existing law in an online or distance learning course format, as approved by DPH.
- Requires an online or distance learning training program to:
- Provide online instruction that allows the trainees and the approved instructor to be online at the same or similar times and use real-time collaborative software that combines audio, video, file sharing, or any other forms of approved interaction and communication;
- Require the use of a personal identification number or personal identification information that confirms the identity of the trainees and instructors, including, but not limited to, having trainees sign an affidavit attesting under penalty of perjury to their identity while completing the program;
- Provide safeguards to protect personal information;
- Include policies and procedures to ensure that instructors are accessible to trainees outside of the normal instruction times;
- Include policies and procedures for equipment failures, student absences, and completing assignments past original deadlines;
- Provide a clear explanation on its website of all technology requirements to participate and complete the program; and,
- Provide DPH with statistics about the performance of trainees in the program, including but not limited to, exam pass rate and the rate at which trainees repeat each module of the program, and any other information requested by DPH, as specified.
- Requires an online or distance learning training program, as a condition of DPH approval, to provide DPH with access rights to the program for the purposes of verifying that the program complies with all the requirements and allowing DPH to monitor online or distance learning sessions.
- Requires an online or distance learning training program to meet the same standards as a traditional, classroom-based program and to contract with a SNF or ICF for the purpose of coordinating and completing the clinical portion of the training program.
- Permits a person who provides instruction or training in a SNF, ICF, or an educational institution, as part of a CNA precertification training program, to be any licensed vocational nurse or RN with no less than two years of nursing experience, of which no less than one year is in providing care and services to chronically ill or elderly patients in an acute care hospital, SNF, ICF, home care, hospice care, or other long-term care setting. Prohibits this person from being required to hold a teaching credential to provide instruction as part of a CNA precertification training program.
Background
- CNAs. There are an estimated 160,000 CNAs working in California health facilities licensed by DPH. The majority of CNAs work in SNFs and perform a variety of basic duties for the patient’s comfort and recovery. A somewhat smaller number of CNAs work in other settings, such as hospitals, assisted living facilities, and private homes. Tasks vary depending on the employment setting but typically include: taking temperatures; pulse; respiration; blood pressure; helping patients with range-of-motion exercises; assisting patients with their daily living needs; serving meals; making beds; and, helping patients eat, dress and bathe. CNAs are paid $14 dollars per hour on average. The United States Bureau of Labor Statistics projects that, between 2008 and 2018, the demand for CNAs will increase by about 19%. As a growing occupation with low education and training requirements, the CNA profession has been a target for welfare-to-work and other training programs. To become a CNA, individuals must be at least 16 years old, pass a physical/health screening and criminal background check, Complete an approved training program consisting of at least 60 classroom hours and 100 hours of clinical practice, and pass a state CNA certification examination.
- CNA training requirements. Through statute and regulation, most, if not all, of the 60 classroom hours are allocated to various topics. Of the 11 hours specified in statute: six are on preventing, recognizing, and reporting resident abuse; two are on special needs of persons with developmental and mental disorders; two are on Alzheimer’s and dementia; and, one is on residents' rights violations. The 50 hours in regulations (CCR 71835 of Division 5, Title 22) are spread across 16 different modules. According to the California Association of Health Facilities, the length of time it takes to complete a CNA training program can run anywhere from four to 15 weeks but the average time for completion is eight weeks. The module topics and associated hours are:
Module | Topic | Requirement |
Module 1 | Introduction | 2 hours |
Module 2 | Patients’ Rights | 2 hours |
Module 3 | Interpersonal Skills | 2 hours |
Module 4 | Prevention and Management of Catastrophe and Unusual Occurrences | 1 hour |
Module 5 | Body Mechanics | 2 hours |
Module 6 | Medical and Surgical Asepsis | 2 hours |
Module 7 | Weights and Measures | 1 hour |
Module 8 | Patient Care Skill | 14 hours |
Module 9 | Patient Care Procedures | 7 hours |
Module 10 | Vital Signs | 3 hours |
Module 11 | Nutrition | 2 hours |
Module 12 | Emergency Procedures | 2 hours |
Module 13 | Long-Term Care Patient | 2 hours |
Module 14 | Rehabilitative Nursing | 2 hours |
Module 15 | Observation and Charting | 4 hours |
Module 16 | Death and Dying | 2 hours |
- Various training programs. According to DPH, California has a total of 673 CNA training programs. (DPH counts each cohort of students being trained by a given provider as a separate program, such that a provider can be associated with multiple programs.) Training providers include school district-run adult schools and Regional Occupational Centers and Programs, California Community Colleges, nonprofits (such as the American Red Cross), and for-profit schools (such as Coast Health Career College in Orange County). They also include some SNFs that provide their own training programs on site. Currently, SNFs operate 48 of the state’s 673 CNA training programs. Under the SNF training model, SNFs hire their own instructors (often employees of the SNF) and often pay students hourly wages while they receive training. In exchange, SNFs typically ask, but do not require, students to commit to working at the SNF for a specified amount of time (such as one year) after becoming a CNA. For-profit schools account for the largest share of CNA training providers, followed by adult schools.
- SNFs. According to an April 2018 Legislative Analyst’s Office (LAO) Budget and Policy Post, SNFs offer short-term rehabilitation services as well as long-term care for patients—primarily older adults—who have serious medical conditions and are unable to perform basic daily activities (such as bathing and eating) on their own. In 2016, approximately 1,100 SNFs in California served nearly 100,000 patients. The vast majority of these SNFs (90%) are operated by for-profit entities, while the remaining facilities are operated primarily by nonprofit organizations. SNFs receive the vast majority of their funding from federal and state sources through the Medi-Cal and Medicare programs.
- Patient staff ratios. State law defines nursing hours for SNFs as the number of hours of work performed by registered nurses, licensed vocational nurses, and CNAs. Prior to 2017‑18, the state required SNFs to provide each patient with a minimum of 3.2 nursing hours per day. The 2017‑18 budget package raised this requirement to 3.5 nursing hours per day, and added a new requirement that CNAs provide at least 2.4 of the minimum 3.5 nursing hours per day. Both of the new requirements become effective July 1, 2018. If a facility cannot comply with one or both of the requirements by July 1, 2018, it can request a “workforce shortage” waiver from DPH, who indicate that they are currently finalizing the application and evaluation process for this waiver. According to the 2018 LAO Budget and Policy Post, based on recent data from the Office of Statewide Health Planning and Development, a majority of SNFs currently meet both the higher minimum nursing hours requirement and the new minimum CNA nursing hours requirement. However, SNFs vary in the number of nursing hours they provide to each patient per day. Of the approximately 1,100 SNFs statewide, 465 SNFs (42%) do not meet the minimum CNA hours requirement. The LAO estimates that these SNFs will need to hire between 1,700 and 2,400 additional CNAs to meet the new staffing requirement.
Comments
- Author’s statement. According to the author, this bill will help address California’s SNF workforce shortage by modernizing the classroom training requirement to become a CNA. Given the convenience and efficiency of online coursework, allowing potential CNA’s the option of pursuing this portion of their certification online is a common-sense approach towards modernizing the certification process and encouraging more people to get into the field.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local: Yes
According to the Senate Appropriations Committee, staff notes the fiscal cost of the bill could include the following:
- $137,544 (Licensing and Certification Fund (L&C Fund)) in FY 2018-19, and $265,087 (L&C Fund) in 2019-20 and 2020-21 for 1.0 full-time associate governmental program analyst and 1.0 full-time information system analyst, and 0.5 health facility evaluation nurse to complete and develop regulations and establish the criteria for approving and denying applicants.
- $1.1 million (L&C Fund) in 2020-21, and ongoing, for:
- 3.0 AGPAs, 3.0 HFENs, to develop regulations; review initial and renewal training program documents; prepare correspondence related to deficiencies and approvals; provide clinical nursing consultation; and,
- 1.0 staff services manager, 1.0 program technician, and 1.0 information system analyst to prepare renewal notification, provide administrative support, exercise oversight over the approval process of the online training program, and enforce requirements related to online training courses.
California Association of Health Facilities (source)
California Hospital Association
OPPOSITION: (Verified 8/24/18)
California Advocates for Nursing Home Reform
ASSEMBLY FLOOR: 78-0, 5/30/18
AYES: Acosta, Aguiar-Curry, Travis Allen, Arambula, Baker, Berman, Bigelow, Bloom, Bonta, Brough, Burke, Caballero, Calderon, Carrillo, Cervantes, Chau, Chávez, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dahle, Daly, Eggman, Flora, Fong, Frazier, Friedman, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gonzalez Fletcher, Gray, Grayson, Harper, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Quirk, Quirk-Silva, Reyes, Rodriguez, Rubio, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon
8/27/18 20:39:44
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB |
THIRD READING
Bill No: AB 2850
Amended: 8/17/18 in Senate
SENATE HEALTH COMMITTEE: 9-0, 6/27/18
AYES: Pan, Nguyen, Beall, Hernandez, Leyva, Mitchell, Monning, Nielsen, Roth
SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/16/18
AYES: Portantino, Bates, Beall, Bradford, Hill, Nielsen, Wiener
ASSEMBLY FLOOR: 78-0, 5/30/18 - See last page for vote
SUBJECT: Nurse assistant training programs: online or distance learning
SOURCE: California Association of Health Facilities
DIGEST:
This bill permits skilled nursing facilities or intermediate care facilities to conduct the 60 classroom hours of training for certified nurse assistants (CNAs) required under existing law in an online or distance learning course format, as approved by the Department of Public Health (DPH), as specified. Permits a person who provides instruction or training, as part of a CNA precertification training program, to be any licensed vocational nurse (LVN) or registered nurse (RN) with no less than two years of nursing experience, as specified.
Existing law:
- Requires certain health facilities, including skilled nursing facilities (SNFs) and intermediate care facilities (ICFs), to be licensed by DPH. [HSC §1250, et seq.]
- Defines a “CNA” as any person who holds him/herself out as a CNA and who, for compensation, performs basic patient care services directed at the safety, comfort, personal hygiene, and protection of patients, and is certified as having completed training requirements in existing law. Prohibits CNA services from including any services which may only be performed by a licensed person and requires those services to be performed under the supervision of an RN or LVN. [HSC §1337]
- Requires an SNF or ICF to adopt an approved training program that meets standards established by DPH. Requires the training program to consist of at least an orientation program to be given to newly employed nurse assistants prior to providing direct patient care in SNFs or ICFs and a precertification training program consisting of at least 60 classroom hours of training, as specified. Permits the 60 classroom hours of training to be conducted within a SNF, ICF, or in an educational institution. [HSC §1337.1]
- Places the following requirements on the 60 classroom hours of training:
- At least two hours of the 60 hours of classroom training to address the special needs of persons with developmental and mental disorders, including intellectual disability, cerebral palsy, epilepsy, dementia, Parkinson’s disease, and mental illness;
- At least two hours to address the special needs of persons with Alzheimer’s disease and related dementias;
- A minimum of six hours of instruction on preventing, recognizing, and reporting instances of resident abuse utilizing specified courses; and,
- A minimum of one hour of instruction on preventing, recognizing, and reporting residents’ rights violations. [HSC §1337.1]
- Requires the precertification training program, in addition to the 60 classroom hours of training, to consist of at least 100 hours of supervised and on-the-job training clinical practice. Permits the 100 hours to consist of normal employment as a nurse assistant under the supervision of either the director of nurse training or a licensed nurse qualified to provide nurse assistant training who has no other assigned duties while providing the training. Requires at least four of the 100 hours of supervised clinical training to address the special needs of persons with developmental and mental disorders, including intellectual disability, cerebral palsy, epilepsy, Alzheimer’s disease and related dementias, and Parkinson’s disease. [HSC §1337.1]
- Exempts SNFs and ICFs that demonstrate that it employs only nurse assistants with a valid certification from these training requirements. [HSC §1337.1]
This bill:
- Permits SNFs, ICFs, health facilities, educational institutions, or local agencies to conduct the 60 classroom hours of training required under existing law in an online or distance learning course format, as approved by DPH.
- Requires an online or distance learning training program to:
- Provide online instruction that allows the trainees and the approved instructor to be online at the same or similar times and use real-time collaborative software that combines audio, video, file sharing, or any other forms of approved interaction and communication;
- Require the use of a personal identification number or personal identification information that confirms the identity of the trainees and instructors, including, but not limited to, having trainees sign an affidavit attesting under penalty of perjury to their identity while completing the program;
- Provide safeguards to protect personal information;
- Include policies and procedures to ensure that instructors are accessible to trainees outside of the normal instruction times;
- Include policies and procedures for equipment failures, student absences, and completing assignments past original deadlines;
- Provide a clear explanation on its website of all technology requirements to participate and complete the program; and,
- Provide DPH with statistics about the performance of trainees in the program, including but not limited to, exam pass rate and the rate at which trainees repeat each module of the program, and any other information requested by DPH, as specified.
- Requires an online or distance learning training program, as a condition of DPH approval, to provide DPH with access rights to the program for the purposes of verifying that the program complies with all the requirements and allowing DPH to monitor online or distance learning sessions.
- Requires an online or distance learning training program to meet the same standards as a traditional, classroom-based program and to contract with a SNF or ICF for the purpose of coordinating and completing the clinical portion of the training program.
- Permits a person who provides instruction or training in a SNF, ICF, or an educational institution, as part of a CNA precertification training program, to be any licensed vocational nurse or RN with no less than two years of nursing experience, of which no less than one year is in providing care and services to chronically ill or elderly patients in an acute care hospital, SNF, ICF, home care, hospice care, or other long-term care setting. Prohibits this person from being required to hold a teaching credential to provide instruction as part of a CNA precertification training program.
Background
- CNAs. There are an estimated 160,000 CNAs working in California health facilities licensed by DPH. The majority of CNAs work in SNFs and perform a variety of basic duties for the patient’s comfort and recovery. A somewhat smaller number of CNAs work in other settings, such as hospitals, assisted living facilities, and private homes. Tasks vary depending on the employment setting but typically include: taking temperatures; pulse; respiration; blood pressure; helping patients with range-of-motion exercises; assisting patients with their daily living needs; serving meals; making beds; and, helping patients eat, dress and bathe. CNAs are paid $14 dollars per hour on average. The United States Bureau of Labor Statistics projects that, between 2008 and 2018, the demand for CNAs will increase by about 19%. As a growing occupation with low education and training requirements, the CNA profession has been a target for welfare-to-work and other training programs. To become a CNA, individuals must be at least 16 years old, pass a physical/health screening and criminal background check, Complete an approved training program consisting of at least 60 classroom hours and 100 hours of clinical practice, and pass a state CNA certification examination.
- CNA training requirements. Through statute and regulation, most, if not all, of the 60 classroom hours are allocated to various topics. Of the 11 hours specified in statute: six are on preventing, recognizing, and reporting resident abuse; two are on special needs of persons with developmental and mental disorders; two are on Alzheimer’s and dementia; and, one is on residents' rights violations. The 50 hours in regulations (CCR 71835 of Division 5, Title 22) are spread across 16 different modules. According to the California Association of Health Facilities, the length of time it takes to complete a CNA training program can run anywhere from four to 15 weeks but the average time for completion is eight weeks. The module topics and associated hours are:
Module | Topic | Requirement |
Module 1 | Introduction | 2 hours |
Module 2 | Patients’ Rights | 2 hours |
Module 3 | Interpersonal Skills | 2 hours |
Module 4 | Prevention and Management of Catastrophe and Unusual Occurrences | 1 hour |
Module 5 | Body Mechanics | 2 hours |
Module 6 | Medical and Surgical Asepsis | 2 hours |
Module 7 | Weights and Measures | 1 hour |
Module 8 | Patient Care Skill | 14 hours |
Module 9 | Patient Care Procedures | 7 hours |
Module 10 | Vital Signs | 3 hours |
Module 11 | Nutrition | 2 hours |
Module 12 | Emergency Procedures | 2 hours |
Module 13 | Long-Term Care Patient | 2 hours |
Module 14 | Rehabilitative Nursing | 2 hours |
Module 15 | Observation and Charting | 4 hours |
Module 16 | Death and Dying | 2 hours |
- Various training programs. According to DPH, California has a total of 673 CNA training programs. (DPH counts each cohort of students being trained by a given provider as a separate program, such that a provider can be associated with multiple programs.) Training providers include school district-run adult schools and Regional Occupational Centers and Programs, California Community Colleges, nonprofits (such as the American Red Cross), and for-profit schools (such as Coast Health Career College in Orange County). They also include some SNFs that provide their own training programs on site. Currently, SNFs operate 48 of the state’s 673 CNA training programs. Under the SNF training model, SNFs hire their own instructors (often employees of the SNF) and often pay students hourly wages while they receive training. In exchange, SNFs typically ask, but do not require, students to commit to working at the SNF for a specified amount of time (such as one year) after becoming a CNA. For-profit schools account for the largest share of CNA training providers, followed by adult schools.
- SNFs. According to an April 2018 Legislative Analyst’s Office (LAO) Budget and Policy Post, SNFs offer short-term rehabilitation services as well as long-term care for patients—primarily older adults—who have serious medical conditions and are unable to perform basic daily activities (such as bathing and eating) on their own. In 2016, approximately 1,100 SNFs in California served nearly 100,000 patients. The vast majority of these SNFs (90%) are operated by for-profit entities, while the remaining facilities are operated primarily by nonprofit organizations. SNFs receive the vast majority of their funding from federal and state sources through the Medi-Cal and Medicare programs.
- Patient staff ratios. State law defines nursing hours for SNFs as the number of hours of work performed by registered nurses, licensed vocational nurses, and CNAs. Prior to 2017‑18, the state required SNFs to provide each patient with a minimum of 3.2 nursing hours per day. The 2017‑18 budget package raised this requirement to 3.5 nursing hours per day, and added a new requirement that CNAs provide at least 2.4 of the minimum 3.5 nursing hours per day. Both of the new requirements become effective July 1, 2018. If a facility cannot comply with one or both of the requirements by July 1, 2018, it can request a “workforce shortage” waiver from DPH, who indicate that they are currently finalizing the application and evaluation process for this waiver. According to the 2018 LAO Budget and Policy Post, based on recent data from the Office of Statewide Health Planning and Development, a majority of SNFs currently meet both the higher minimum nursing hours requirement and the new minimum CNA nursing hours requirement. However, SNFs vary in the number of nursing hours they provide to each patient per day. Of the approximately 1,100 SNFs statewide, 465 SNFs (42%) do not meet the minimum CNA hours requirement. The LAO estimates that these SNFs will need to hire between 1,700 and 2,400 additional CNAs to meet the new staffing requirement.
Comments
- Author’s statement. According to the author, this bill will help address California’s SNF workforce shortage by modernizing the classroom training requirement to become a CNA. Given the convenience and efficiency of online coursework, allowing potential CNA’s the option of pursuing this portion of their certification online is a common-sense approach towards modernizing the certification process and encouraging more people to get into the field.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: Yes
According to the Senate Appropriations Committee, staff notes the fiscal cost of the bill could include the following:
- $137,544 (Licensing and Certification Fund (L&C Fund)) in FY 2018-19, and $265,087 (L&C Fund) in 2019-20 and 2020-21 for 1.0 full-time associate governmental program analyst and 1.0 full-time information system analyst, and 0.5 health facility evaluation nurse to complete and develop regulations and establish the criteria for approving and denying applicants.
- $1.1 million (L&C Fund) in 2020-21, and ongoing, for:
- 3.0 AGPAs, 3.0 HFENs, to develop regulations; review initial and renewal training program documents; prepare correspondence related to deficiencies and approvals; provide clinical nursing consultation; and,
- 1.0 staff services manager, 1.0 program technician, and 1.0 information system analyst to prepare renewal notification, provide administrative support, exercise oversight over the approval process of the online training program, and enforce requirements related to online training courses.
California Association of Health Facilities (source)
California Hospital Association
OPPOSITION: (Verified 8/16/18)
California Advocates for Nursing Home Reform
ASSEMBLY FLOOR: 78-0, 5/30/18
AYES: Acosta, Aguiar-Curry, Travis Allen, Arambula, Baker, Berman, Bigelow, Bloom, Bonta, Brough, Burke, Caballero, Calderon, Carrillo, Cervantes, Chau, Chávez, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dahle, Daly, Eggman, Flora, Fong, Frazier, Friedman, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gonzalez Fletcher, Gray, Grayson, Harper, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Quirk, Quirk-Silva, Reyes, Rodriguez, Rubio, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon
8/19/18 13:34:21
SENATE COMMITTEE ON
Senator Anthony Portantino, Chair
2017 - 2018 Regular Session
AB 2850 (Rubio) - Nurse assistant training programs: online and distance learning
Version: | Policy Vote: |
Urgency: | Mandate: |
Hearing Date: | Consultant: |
Bill Summary:
Authorizes skilled nursing facilities, intermediate care facilities, or educational institutions to conduct the required 60 classroom hours of training for certified nurse assistants (CNAs) in an online or distance learning course format, as approved by the Department of Public Health (CDPH). Authorizes a person who provides instruction or training, as part of a CNA precertification training program, to be any licensed or registered nurse employed at a facility that primarily provides care for older adults.
*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********
The following information is revised to reflect amendments
adopted by the committee on August 16, 2018
Fiscal Impact:
Staff notes the fiscal cost of the bill could include the following:
- $137,544 (Licensing and Certification Fund) in FY 2018-19, and $265,087 (L&C Fund) in 2019-20 and 2020-21 for 1.0 full-time associate governmental program analyst and 1.0 full-time information system analyst, and 0.5 health facility evaluation nurse to complete and develop regulations and establish the criteria for approving and denying applicants.
- $1.1 million (L&C Fund) in 2020-21, and ongoing, for:
- 3.0 AGPAs, 3.0 HFENs, to develop regulations; review initial and renewal training program documents; prepare correspondence related to deficiencies and approvals; provide clinical nursing consultation; and,
- 1.0 staff services manager, 1.0 program technician, and 1.0 information system analyst to prepare renewal notification, provide administrative support, exercise oversight over the approval process of the online training program, and enforce requirements related to online training courses.
Author Amendments:
- Requires an online or distance learning nurse assistant program to comply with all of the following requirements:
- Provides synchronous, online instruction, as specified;
- Requires the use of a personal identification number or information that confirms a trainee or instructor’s identity;
- Provides safeguards to protect personal information;
- Includes policies and procedures to ensure that instructors are accessible to trainees outside normal instruction times;
- Provides a clear explanation on its website of all technology requirements to participate and complete; and,
- Provides the department with statistics about a trainee’s performance in the program.
- Requires the online or distance learning nurse assistant training program to meet the same standards as a traditional, classroom-based program, and comply with any other standard established by CDPH for online or distance learning nurse assistant training programs.
- Requires an online or distance learning nurse assistant training program to provide CDPH with access rights to the program to verify that program complies with all requirements, and to allow CDPH to monitor online or distance learning sessions.
- Authorizes a health facility, educational institution, or local agency to conduct a precertification training program, of at least 60 classroom hours of training in an online or distance learning course format, as approved by CDPH.
- Provides that the Chancellor of the California Community Colleges must provide a standard process for approval of college credit and specifies:
- An online or distance learning nurse assistant training program must meet the same standards as a traditional, classroom-based program
- An online nurse assistant training program must contract with a licensed skilled nursing facility or intermediate care facility for the purposes of coordinating and completing the clinical portion of the nurse assistant training program.
-- END --
SENATE COMMITTEE ON APPROPRIATIONS
Senator Anthony Portantino, Chair
2017 - 2018 Regular Session
AB 2850 (Rubio) - Nurse assistant training programs: online and distance learning
Version: July 2, 2018 | Policy Vote: HEALTH 9 - 0 |
Urgency: No | Mandate: No |
Hearing Date: August 6, 2018 | Consultant: Samantha Lui |
This bill meets the criteria for referral to the Suspense File.
Bill Summary:
Authorizes skilled nursing facilities, intermediate care facilities, or educational institutions to conduct the required 60 classroom hours of training for certified nurse assistants (CNAs) in an online or distance learning course format, as approved by the Department of Public Health (CDPH). Authorizes a person who provides instruction or training, as part of a CNA precertification training program, to be any licensed or registered nurse employed at a facility that primarily provides care for older adults.
Fiscal Impact:
Under the bill, the CDPH would be required to approve and regulate online CNA training programs. CDPH would need to develop regulations to provide necessary oversight for online CNA training courses, as well as establish standards for the programs. According to CDPH, fiscal costs to implement the bill include:
- $137,544 (Licensing and Certification Fund) in FY 2018-19, and $265,087 (L&C Fund) in 2019-20 and 2020-21 for 1.0 full-time associate governmental program analyst and 1.0 full-time information system analyst, and 0.5 health facility evaluation nurse to complete and develop regulations and establish the criteria for approving and denying applicants.
- $1.1 million (L&C Fund) in 2020-21, and ongoing, for:
- 3.0 AGPAs, 3.0 HFENs, to develop regulations; review initial and renewal training program documents; prepare correspondence related to deficiencies and approvals; provide clinical nursing consultation; and,
- 1.0 staff services manager, 1.0 program technician, and 1.0 information system analyst to prepare renewal notification, provide administrative support, exercise oversight over the approval process of the online CAN training program, and enforce requirements related to online training courses.
Background:
- There are an estimated 160,000 CNAs working in California health facilities licensed by DPH. The majority of CNAs work in SNFs and perform a variety of basic duties for the patient’s comfort and recovery. A somewhat smaller number of CNAs work in other settings, such as hospitals, assisted living facilities, and private homes. Tasks vary depending on the employment setting but typically include: taking temperatures; pulse; respiration; blood pressure; helping patients with range-of-motion exercises; assisting patients with their daily living needs; serving meals; making beds; and, helping patients eat, dress and bathe.
According to CDPH, California has a total of 673 CNA training programs. (DPH counts each cohort of students being trained by a given provider as a separate program, such that a provider can be associated with multiple programs.) Training providers include school district-run adult schools and Regional Occupational Centers and Programs, California Community Colleges (CCCs), nonprofits (such as the American Red Cross), and for-profit schools (such as Coast Health Career College in Orange County). They also include some SNFs that provide their own training programs on site. Currently, SNFs operate 48 of the state’s 673 CNA training programs.
Through statute and regulation, most, if not all of the 60 classroom hours are allocated to various topics. Of the 11 hours specified in statute: six are on preventing, recognizing, and reporting resident abuse; two are on special needs of persons with developmental and mental disorders; two are on Alzheimer’s and dementia; and, one is on residents' rights violations. The 50 hours in regulations (CCR 71835 of Division 5, Title 22) are spread across 16 different modules. The average length of time to complete a CNA training program is eight weeks. The module topics and associated hours are:
Module | Topic | Requirement |
Module 1 | Introduction | 2 hours |
Module 2 | Patients’ Rights | 2 hours |
Module 3 | Interpersonal Skills | 2 hours |
Module 4 | Prevention and Management of Catastrophe and Unusual Occurrences | 1 hour |
Module 5 | Body Mechanics | 2 hours |
Module 6 | Medical and Surgical Asepsis | 2 hours |
Module 7 | Weights and Measures | 1 hour |
Module 8 | Patient Care Skill | 14 hours |
Module 9 | Patient Care Procedures | 7 hours |
Module 10 | Vital Signs | 3 hours |
Module 11 | Nutrition | 2 hours |
Module 12 | Emergency Procedures | 2 hours |
Module 13 | Long-Term Care Patient | 2 hours |
Module 14 | Rehabilitative Nursing | 2 hours |
Module 15 | Observation and Charting | 4 hours |
Module 16 | Death and Dying | 2 hours |
Proposed Law:
Assembly Bill 2850 includes the following provisions, among others:
- Authorizes a skilled nursing or intermediate care facility or educational institution to conduct 60 classroom hours of training in an online or distance learning course format, as approved by CDPH, and be included as part of the approved precertification training program.
- Authorizes any licensed vocational nurse or registered nurse (with no less than two years of nursing experience, of which no less than one year is in providing care and services to chronically ill or elderly patients in an acute care hospital, skilled nursing facility, intermediate care facility, home care, hospice care, or other long-term care setting) to provide instruction or training, at a skilled nursing, intermediate care facility, or in an educational institution as part of a certified nurse assistant precertification training program.
- Exempts the instructor of the aforementioned course from being required to hold a teaching credential to provide instruction as part of a certified nurse assistant precertification training program
Related Legislation:
- AB 213 (Logue, 2013) would have required the DPH to accept upon application for licensure or certification, the education, training, and practical experience completed by an applicant in military service toward the qualifications and requirements to receive a license of certificate for specified professions including CNAs. AB 213 was held under submission on the Assembly Appropriations Committee suspense file.
- AB 2791 (Simitian, Chapter 270, Statutes of 2004) required the approved training program of a SNF and an ICF to include instruction on preventing, recognizing, and reporting residents’ rights violations as part of the training and instruction required under existing law.
-- END --
SENATE COMMITTEE ON HEALTH
Senator Dr. Richard Pan, Chair
BILL NO: AB 2850
AUTHOR: | Rubio | ||
VERSION: | June 18, 2018 | ||
HEARING DATE: | June 27, 2018 | ||
CONSULTANT: | Melanie Moreno | ||
SUBJECT: Nurse assistant training programs: online and distance learning
SUMMARY:
Permits skilled nursing facilities, intermediate care facilities, or educational institutions to conduct the 60 classroom hours of training for certified nurse assistants (CNAs) required under existing law in an online or distance learning course format, as approved by the Department of Public Health. Permits a person who provides instruction or training, as part of a CNA precertification training program, to be any licensed or registered nurse employed at a facility that primarily provides care for older adults.
Existing law:
- Requires certain health facilities, including skilled nursing facilities (SNFs) and intermediate care facilities (ICFs), to be licensed by the Department of Public Health (DPH). [HSC §1250, et. seq.]
- Defines a “certified nurse assistant” as any person who holds him/herself out as a CNA and who, for compensation, performs basic patient care services directed at the safety, comfort, personal hygiene, and protection of patients, and is certified as having completed training requirements in existing law. Prohibits CNA services from including any services which may only be performed by a licensed person and requires those services to be performed under the supervision of a registered nurse (RN) or a licensed vocational nurse (LVN). [HSC §1337]
- Requires a SNF or ICF to adopt an approved training program that meets standards established by DPH. Requires the training program to consist of at least an orientation program to be given to newly employed nurse assistants prior to providing direct patient care in SNFs or ICFs and a precertification training program consisting of at least 60 classroom hours of training, as specified. Permits the 60 classroom hours of training to be conducted within a SNF, ICF, or in an educational institution. [HSC §1337.1]
- Places the following requirements on the 60 classroom hours of training:
- At least two hours of the 60 hours of classroom training to address the special needs of persons with developmental and mental disorders, including intellectual disability, cerebral palsy, epilepsy, dementia, Parkinson’s disease, and mental illness;
- At least two hours to address the special needs of persons with Alzheimer’s disease and related dementias;
- A minimum of six hours of instruction on preventing, recognizing, and reporting instances of resident abuse utilizing specified courses; and,
- A minimum of one hour of instruction on preventing, recognizing, and reporting residents’ rights violations. [HSC §1337.1]
- Requires the precertification training program, in addition to the 60 classroom hours of training, to consist of at least 100 hours of supervised and on-the-job training clinical practice. Permits the 100 hours to consist of normal employment as a nurse assistant under the supervision of either the director of nurse training or a licensed nurse qualified to provide nurse assistant training who has no other assigned duties while providing the training. Requires at least four hours of the 100 hours of supervised clinical training to address the special needs of persons with developmental and mental disorders, including intellectual disability, cerebral palsy, epilepsy, Alzheimer’s disease and related dementias, and Parkinson’s disease. [HSC §1337.1]
- Exempts SNFs and ICFs that demonstrate that it employs only nurse assistants with a valid certification from these training requirements. [HSC §1337.1]
This bill:
- Permits SNFs, ICFs, or educational institutions to conduct the 60 classroom hours of training required under existing law in an online or distance learning course format, as approved by DPH.
- Permits a person who provides instruction or training in a SNF, ICF, or an educational institution, as part of a CNA precertification training program, to be any licensed nurse or RN presently employed at a SNF, acute care hospital, or other facility that primarily provides care for older adults, including a nurse working in a supervisory capacity that does not directly involve patient care. Prohibits this person from being required to hold a teaching credential to provide instruction as part of a CNA precertification training program.
FISCAL EFFECT:
According to the Assembly Appropriations Committee analysis of a previous version of this bill, all costs are from the Licensing and Certification Fund:
- Initial staff costs to DPH for the first two years in the range of $250,000 to promulgate regulations.
- Ongoing costs to DPH to approve, monitor, and investigate complaints related to the additional online training options are uncertain. They could range from negligible to quite high, depending on how programs respond. If all current programs submit an online option and maintain their current programs, costs could be significant, in the range of $1 million annually. If only some submit an online option, there would be a lower cost, in the hundreds of thousands annually. On the other hand, if online training opens the possibility of more consolidation in training programs and fewer individual programs, workload and costs could decrease as compared to the status quo. This would depend partially on how regulations are crafted.
PRIOR VOTES:
Assembly Floor: | 78 - 0 |
Assembly Appropriations Committee: | 16 - 0 |
Assembly Health Committee: | 15 - 0 |
COMMENTS:
- Author’s statement. According to the author, this bill will help address California’s SNF workforce shortage by modernizing the classroom training requirement to become a CNA. Given the convenience and efficiency of online coursework, allowing potential CNA’s the option of pursuing this portion of their certification online is a common-sense approach towards modernizing the certification process and encouraging more people to get into the field.
- Background on CNAs. There are an estimated 160,000 CNAs working in California health facilities licensed by DPH. The majority of CNAs work in SNFs and perform a variety of basic duties for the patient’s comfort and recovery. A somewhat smaller number of CNAs work in other settings, such as hospitals, assisted living facilities, and private homes. Tasks vary depending on the employment setting but typically include: taking temperatures; pulse; respiration; blood pressure; helping patients with range-of-motion exercises; assisting patients with their daily living needs; serving meals; making beds; and, helping patients eat, dress and bathe. CNAs are paid $14 dollars per hour on average. The United States Bureau of Labor Statistics projects that, between 2008 and 2018, the demand for CNAs will increase by about 19%. As a growing occupation with low education and training requirements, the CNA profession has been a target for welfare-to-work and other training programs. To become a CNA, individuals must be at least 16 years old, pass a physical/health screening and criminal background check, Complete an approved training program consisting of at least 60 classroom hours and 100 hours of clinical practice, and pass a state CNA certification examination.
- CNA training requirements. Through statute and regulation, most, if not all of the 60 classroom hours are allocated to various topics. Of the 11 hours specified in statute: six are on preventing, recognizing, and reporting resident abuse; two are on special needs of persons with developmental and mental disorders; two are on Alzheimer’s and dementia; and, one is on residents' rights violations. The 50 hours in regulations (CCR 71835 of Division 5, Title 22) are spread across 16 different modules. According to CAHF, the length of time it takes to complete a CNA training program can run anywhere from four to 15 weeks but the average time for completion is eight weeks. The module topics and associated hours are:
Module | Topic | Requirement |
Module 1 | Introduction | 2 hours |
Module 2 | Patients’ Rights | 2 hours |
Module 3 | Interpersonal Skills | 2 hours |
Module 4 | Prevention and Management of Catastrophe and Unusual Occurrences | 1 hour |
Module 5 | Body Mechanics | 2 hours |
Module 6 | Medical and Surgical Asepsis | 2 hours |
Module 7 | Weights and Measures | 1 hour |
Module 8 | Patient Care Skill | 14 hours |
Module 9 | Patient Care Procedures | 7 hours |
Module 10 | Vital Signs | 3 hours |
Module 11 | Nutrition | 2 hours |
Module 12 | Emergency Procedures | 2 hours |
Module 13 | Long-Term Care Patient | 2 hours |
Module 14 | Rehabilitative Nursing | 2 hours |
Module 15 | Observation and Charting | 4 hours |
Module 16 | Death and Dying | 2 hours |
- Various training programs. According to DPH, California has a total of 673 CNA training programs. (DPH counts each cohort of students being trained by a given provider as a separate program, such that a provider can be associated with multiple programs.) Training providers include school district-run adult schools and Regional Occupational Centers and Programs, California Community Colleges (CCCs), nonprofits (such as the American Red Cross), and for-profit schools (such as Coast Health Career College in Orange County). They also include some SNFs that provide their own training programs on site. Currently, SNFs operate 48 of the state’s 673 CNA training programs. Under the SNF training model, SNFs hire their own instructors (often employees of the SNF) and often pay students hourly wages while they receive training. In exchange, SNFs typically ask, but do not require, students to commit to working at the SNF for a specified amount of time (such as one year) after becoming a CNA. For-profit schools account for the largest share of CNA training providers, followed by adult schools.
- Background on SNFs. According to an April 2018 Legislative Analyst’s Office (LAO) Budget and Policy Post, SNFs offer short-term rehabilitation services as well as long-term care for patients—primarily older adults—who have serious medical conditions and are unable to perform basic daily activities (such as bathing and eating) on their own. In 2016, approximately 1,100 SNFs in California served nearly 100,000 patients. The vast majority of these SNFs (90%) are operated by for-profit entities, while the remaining facilities are operated primarily by nonprofit organizations. SNFs receive the vast majority of their funding from federal and state sources through the Medi-Cal and Medicare programs.
- Patient staff ratios. State law defines nursing hours for SNFs as the number of hours of work performed by registered nurses, licensed vocational nurses, and CNAs. Prior to 2017‑18, the state required SNFs to provide each patient with a minimum of 3.2 nursing hours per day. The 2017‑18 budget package raised this requirement to 3.5 nursing hours per day, and added a new requirement that CNAs provide at least 2.4 of the minimum 3.5 nursing hours per day. Both of the new requirements become effective July 1, 2018. If a facility cannot comply with one or both of the requirements by July 1, 2018, it can request a “workforce shortage” waiver from DPH, who indicate that they are currently finalizing the application and evaluation process for this waiver. According to the 2018 LAO Budget and Policy Post, based on recent data from the Office of Statewide Health Planning and Development (OSHPD), a majority of SNFs currently meet both the higher minimum nursing hours requirement and the new minimum CNA nursing hours requirement. However, SNFs vary in the number of nursing hours they provide to each patient per day. Of the approximately 1,100 SNFs statewide, 465 SNFs (42%) do not meet the minimum CNA hours requirement. The LAO estimates that these SNFs will need to hire between 1,700 and 2,400 additional CNAs to meet the new staffing requirement.
- LAO recommendations. The LAO’s April 2018 Budget and Policy Post offered a number of recommendations to address existing root problems affecting the supply of CNAs, including modifying credentialing requirements for CNA instructors so that individuals would no longer need a teaching credential to serve as CNA instructors at adult schools and modifying an Administration proposal on training slots and CCC grant program. The June 18, 2018 amendments to this bill seeks to implement an LAO recommendation to allow more types of nurses to qualify as CNA instructors. Specifically, the LAO suggested that nurses who have experience in an acute care hospital (or other facility in which a nurse would have provided a considerable amount of care for older adults even if not a SNF) and nurses who do not routinely provide direct patient care but may supervise CNAs be permitted to be instructors.
- Prior legislation. SB 219 (Wiener, Chapter 483, Statutes of 2017) established the Lesbian, Gay, Bisexual, and Transgender Long-Term Care Facility Residents’ Bill of Rights, that in addition to other requirements, required a SNF or ICF to provide existing employees and new hires access to the online learning tool, “Building Respect for LGBT Older Adults.”
SB 449 (Monning, Chapter 282, Statutes of 2017) requires at least two of the 60 hours of CNA classroom training to address the special needs of persons with Alzheimer’s disease and related dementias.
AB 1656 (Burke of 2017) would have required the Employment Training Panel to establish a grant award program to fund training programs for CNAs and would have appropriated $3 million from the General Fund to the Panel to implement the grant award program. AB 1656 was held on the Assembly Appropriations Committee suspense file.
SB 1384 (Mitchell, Chapter 847, Statutes of 2014) eliminated the requirement that DPH deny, suspend, or revoke a certificate of a CNA if the applicant or certificate holder has been convicted of a violation or attempted violation of one or more specified crimes.
AB 213 (Logue of 2013) would have required the DPH to accept upon application for licensure or certification, the education, training, and practical experience completed by an applicant in military service toward the qualifications and requirements to receive a license of certificate for specified professions including CNAs. AB 213 was held on the Assembly Appropriations Committee suspense file.
AB 2791 (Simitian, Chapter 270, Statutes of 2004) required the approved training program of a SNF and an ICF to include instruction on preventing, recognizing, and reporting residents’ rights violations as part of the training and instruction required under existing law.
- Support. CAHF writes that with over 14 million people on Medi-Cal and 1,100 Californians turning 65 years old every day, there must be an attractive and sustainable workforce in place in order to care for our aging population and because SNFs are a partner with California through the Medi-Cal program, it is imperative that the state and these facilities work together to train, attract and retain quality nursing staff. CAHF states that our nursing homes are at a crisis point in recruiting and retaining the current workforce need, let alone being able to address the increased needs of our baby boomers. It is hard to find a SNF that does not have a nursing vacancy, if not several, and CAHF reports that some facilities are not able to admit patients because they cannot staff safely without the necessary nursing care staff. CAHF asserts that this problem is more apparent than before with the new minimum staffing mandate and ratios enacted by the 2017-18 Budget. CAHF writes that by updating the classroom requirements to modern times for needed convenience and efficiency, and allowing more flexibility for the licensed nurse instructor and adult day schools, this bill will create a better process for instructing the needed workforce. This bill does not alter any of the required clinical components as quality of care is a number one priority for CAHF and a quality workforce is needed for quality outcomes.
- Oppose. California Advocates for Nursing Home Reform (CANHR) writes that on a daily basis, over 100,000 California nursing home residents rely on the skills and compassion of CNAs for their care, comfort and dignity. Yet CNAs, who may be as young as 16 years old, receive barely any training to prepare them for this challenging work. CANHR states that It is critical that this training not be diluted or rendered less effective, and they are alarmed that this bill leaves it completely up to DPH to determine qualifications for online and distance learning training programs, as DPH’s longstanding failures in nursing home oversight are thoroughly documented, such as the systematic failures described in the May 1, 2018 report by the California State Auditor: Absent Effective State Oversight, Substandard Quality of Care Has Continued. CANHR writes that removing interaction between trainees and instructors is certain to have a negative impact in the training of CNAs, and that this bill offers no assurances that online training would be conducted in an effective manner. CANHR further states that gutting the minimal instructor standards will weaken the quality of training CNAs receive and expose residents to poorer care. The care needs of nursing home residents have been intensifying for many years, yet this bill would undermine the little training their primary caregivers receive. CANHR states that with all due respect to the LAO, its recommendation is ill-advised and does not appear to have considered the impact on the quality of the training CNAs receive.
- Suggested amendments. To further refine Section 3 of this bill towards implementing the LAO recommendations, this bill should be amended consistent with federal regulations, but broadened, as follows:
On page 4, beginning on line 30:
(a) A person who provides instruction or training, at a skilled nursing or intermediate care facility or in an educational institution, as part of a certified nurse assistant precertification training program described in Section 1337.1 may be any licensed vocational or registered nurse who possess a minimum of 2 years of nursing experience, at least 1 year of which must be in the provision of services to chronically ill or elderly patients in an acute care hospital, a skilled nursing facility, an intermediate care facility, home care, hospice care, or other long term care setting. licensed or registered nurse presently employed at a skilled nursing facility, acute care hospital, or other facility that primarily provides care for older adults, including a nurse working in a supervisory capacity that does not directly involve patient care.
SUPPORT AND OPPOSITION:
Support: California Association of Health Facilities (sponsor)
California Hospital Association
Oppose: California Advocates for Nursing Home Reform
-- END --
ASSEMBLY THIRD READING
ATR Bill Id:AB 2850
Author:(Rubio)
As Amended Ver:April 18, 2018
Majority vote
Committee | Votes | Ayes | Noes |
Health | 15-0 | Wood, Mayes, Aguiar-Curry, Bigelow, Bonta, Burke, Carrillo, Flora, Limón, McCarty, Nazarian, Rodriguez, Santiago, Thurmond, Waldron | |
Appropriations | 16-0 | Gonzalez Fletcher, Bigelow, Bloom, Bonta, Calderon, Carrillo, Chau, Eggman, Fong, Friedman, Gallagher, Eduardo Garcia, Nazarian, Obernolte, Quirk, Reyes |
|
SUMMARY: Authorizes the 60 hours of required classroom training for certified nurse assistants (CNA) to be offered through online or distance learning classes. Requires that online or distance learning classes be approved by the Department of Public Health (DPH).
FISCAL EFFECT: According to the Assembly Appropriations Committee, all costs are from the Licensing and Certification Fund:
- Initial staff costs to DPH for the first two years in the range of $250,000 to promulgate regulations; and,
- Ongoing costs to the DPH to approve, monitor, and investigate complaints related to the additional online training options are uncertain. They could range from negligible to quite high, depending on how programs respond. If all current programs submit an online option and maintain their current programs, costs could be significant, in the range of $1 million annually. If only some submit an online option, there would be a lower cost, in the hundreds of thousands annually. On the other hand, if online training opens the possibility of more consolidation in training programs and fewer individual programs, workload and costs could decrease as compared to the status quo. This would depend partially on how regulations are crafted.
COMMENTS: According to the author, this bill will help address California’s skilled nursing facilities’ workforce shortage by modernizing the classroom training requirement to become a CNA. Given the convenience and efficiency of online coursework, allowing potential CNA's the option of pursuing this portion of their certification online is a common-sense approach towards modernizing the certification process and encouraging more people to get into the field
CNAs are required to complete 60 classroom hours and 100 hours of supervised on-the-job training. According to DPH, current law, in statute and regulation, allocates 57 of the 60 classroom hours, with 50 of those hours allocated in regulation, and seven hours in statute. Of the seven hours specified in statute, six hours are on preventing, recognizing, and reporting resident abuse, and one hour on residents' rights violations.
Online and distance learning have been integrated into the educational community with all universities, colleges and community colleges conducting some of their coursework electronically. Likewise, within healthcare, the use of online or distance learning has been approved for some of the didactic (classroom) portion of training. For example, in dentistry where the supervision and scopes of practice of allied dental health professionals are parallel to nursing with registered dental hygienists, registered dental assistants and unlicensed dental assistants each with their own educational requirements and scopes of practice, electronic coursework is available for the didactic portion of their education requirements. These courses are offered as part of the Dental Board of California's approved educational programs. The American Health Care Association (AHCA) has developed an on-line CNA training program that is able to be tailored for state specificity. Currently there are eight states using the program for their CNA training. Twenty-three other states are engaged in the process of adopting the AHCA program.
The California Association of Health Facilities (CAHF), sponsor of this bill states in support that the state’s nursing homes are at a crisis point in recruiting and retaining the current workforce let alone being able to address the increased needs of our baby boomers. It is hard to a find a skilled nursing facility that does not have a nursing vacancy, if not several. This problem is more apparent than before with the new minimum staffing mandate. If a facility does recruit a CNA for employment, many times these professionals move on to higher paying jobs. Most CNAs make very close to the minimum wage and with the minimum wage increase to $15 per hour; many CNAs will find an equal pay position with a restaurant or retail facility that is not as grueling work – mentally or physically. CAHF goes on to state that updating the classroom hours to modern times and needed convenience and efficiency will serve as a better process for people who want to enter the long-term care workforce.
The California Hospital Association also in support notes this bill will make CNA training easier to complete, particularly in rural areas with long travel distances and limited geographical access.
There is no known opposition to the current version of the bill.
Analysis Prepared by: Judith Babcock / HEALTH / (916) 319-2097 FN: 0003330
Date of Hearing: May 9, 2018
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez Fletcher, Chair
ABPCA Bill Id:AB 2850
Author:(Rubio) – As Amended Ver:April 18, 2018
Policy Committee: | Health | Vote: | 15 - 0 |
Urgency: No State Mandated Local Program: No Reimbursable: No
SUMMARY:
This bill allows a skilled nursing facility, intermediate care facility, or an educational institution to conduct the 60 hours of required certified nurse assistant (CNA) training in an online or distance learning format, as approved by the department.
FISCAL EFFECT:
All costs are from the Licensing and Certification Fund.
- Initial staff costs to the California Department of Public Health (CDPH) for the first two years in the range of $250,000 to promulgate regulations.
- Ongoing costs to the CDPH to approve, monitor, and investigate complaints related to the additional online training options are uncertain. They could range from negligible to quite high, depending on how programs respond. If all current programs submit an online option and maintain their current programs, costs could be significant, in the range of $1 million annually. If only some submit an online option, there would be a lower cost, in the hundreds of thousands annually. On the other hand, if online training opens the possibility of more consolidation in training programs and fewer individual programs, workload and costs could decrease as compared to the status quo. This would depend partially on how regulations are crafted.
COMMENTS:
- Purpose. According to the author, this bill will help address California’s skilled nursing facilities’ workforce shortage by modernizing the classroom training requirement to become a CNA.
- Background. Under physician or licensed nursing supervision, CNAs provide nursing care to patients and assist patients in performing daily living activities. CNAs are required to complete 60 classroom hours and 100 hours of supervised on-the-job training before certification. CDPH approves training programs operated by facilities or educational institutions.
Online education is now common within institutes of higher education and even in high schools. Likewise, it appears common for the didactic portion of other health-related training programs to be available online.
- Support and Opposition. California Association of Health Facilities (CAHF, representing skilled nursing facilities) is the bill's sponsor. The California Hospital Association also writes in support, noting this bill will make CNA training easier to complete, particularly in rural areas with long travel distances and limited geographical access. Two groups expressed opposition to a prior version of this bill that dealt with a different matter; no opposition is on file based on the current version.
Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081
Date of Hearing: April 24, 2018
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
ABPCA Bill Id:AB 2850
Author:(Rubio) – As Amended Ver:April 18, 2018
SUBJECT: Nurse assistant training programs: online and distance learning
SUMMARY: Authorizes the required 60 hours of classroom training for certified nurse assistants (CNA) to be offered through online or distance learning classes as approved by the Department of Public Health (DPH).
EXISTING LAW:
- Establishes DPH which, among other functions, includes the licensing and administration of specified health facilities including skilled nursing facilities (SNF) and intermediate care facilities (ICF).
- Defines a CNA as any person who holds themselves out as a CNA and who, for compensation, performs basic patient care services directed at the safety, comfort, personal hygiene and protection of patients and that does not include any services which may only be performed by a licensed person. Requires that a CNA has been certified as having completed the requirements to become a CNA and requires all services performed by a CNA to be provided under the supervision of a registered nurse, or a licensed vocational nurse.
- Requires a SNF or an ICF to adopt CNA training programs that have been approved by DPH that include:
- An orientation program to be given to newly employed nurse assistants prior to providing direct patient care;
- A precertification training program of at least 60 classroom hours of training on basic nursing skills, patient safety and rights, the social and psychological problems of patients, and resident abuse prevention, recognition and reporting;
- At least 100 hours of supervised and on-the-job training in clinical practice; and,
- Continuing in-service training to ensure continuing competency in existing and new nursing skills.
- Requires the approved training course, clinical practice or continuing education as specified to include the following:
- At least two hours of the 60 hours to address the special needs of persons with developmental and mental disorders, including intellectual disability, cerebral palsy, epilepsy, dementia, Parkinson’s disease, and mental illness;
- At least two hours of the 60 hours to address the special needs of persons with Alzheimer’s disease and related dementias;
- At least four of the 100 hours of supervised clinical training to address the special needs of persons with developmental and mental disorders, including intellectual disability, cerebral palsy, epilepsy, Alzheimer’s disease and related dementias, and Parkinson’s disease;
- At least six hours of the 60 hours to include instruction on preventing, recognizing, and reporting instances of resident abuse as specified, and at least one hour of instruction on preventing, recognizing and reporting residents’ rights violations; and,
- At least four hours of instruction on preventing, recognizing, and reporting instances of resident abuse, including instruction on preventing, recognizing and reporting residents’ rights violation to be included within the total minimum hours of continuing education or in-service training required for CNAs.
- Requires CNA applicants for certification to:
- Be at least 16 years old;
- Successfully complete a training program approved by DPH which includes an examination to test the applicant’s knowledge and skills related to basic patient care services; and,
c) Obtain a criminal record clearance.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.
COMMENTS:
- PURPOSE OF THIS BILL. According to the author, this bill will help address California’s skilled nursing facilities’ workforce shortage by modernizing the classroom training requirement to become a CNA. Given the convenience and efficiency of online coursework, allowing potential CNA’s the option of pursuing this portion of their certification online is a common-sense approach towards modernizing the certification process and encouraging more people to get into the field
- BACKGROUND.
- Registered Nurse (RN), Licensed Vocational Nurse (LVN), and CNA. California provides for various level of patient care to be performed by licensed or certified nursing personnel, almost always under the supervision of a physician and surgeon. Each level of nursing care has a specific scope of practice commensurate with the level of education and training. The highest level of care with the greatest level of autonomy is provided by RNs, with LVNs and CNAs following. Reimbursements for careers in nursing are also commensurate with the level of education, training, and responsibilities for each licensure/certification category. In California, the median salary for a RN is $94,000; for a LVN, $51,000; and, for a CNA, $35,000. Because of the entry level nature of the CNA position, retention of employees is difficult for SNFs and ICFs. Individuals leave the field or their current jobs for a variety of reasons including, educational opportunities, more lucrative or rewarding careers, and accepting a comparable position as a CNA at a different facility. The following represents a breakdown of the approved scope for each of the categories.
- RN. A broad definition of the scope for nursing means those functions including basic health care, which help people cope with difficulties in daily living which are associated with their actual or potential health or illness problems or the treatment of them which requires a substantial amount of scientific knowledge or technical skill. Nursing is generally divided into three types of functions:
- Independent functions relate to direct and indirect patient care services that insure the patient’s safety and comfort, personal hygiene and protection of patients and the performance of disease prevention and restorative measures. Indirect services include delegation and supervision of patient care activities performed by allied health professions (LVNs and CNAs);
- Dependent functions relate to direct and indirect patient care services including but not limited to the administration of medications and therapeutic agents or rehabilitative regimen ordered by a physician; and,
- Interdependent functions authorize the nurse to implement appropriate changes in treatment regimen in accordance with standardized procedures after observing signs and symptoms of illness, reactions to treatment, general behavior, or general physical condition, and determining that these exhibit abnormal characteristics. These activities overlap with the practice of medicine and may require adherence to standardized procedures when it is the nurse determining what activities are to be undertaken. Standardized procedures designate authority to perform medical function by a registered nurse and are developed through collaboration among RNs, physicians and administrators in the health care system in which they are to be used.
- LVN. Under the direction of a physician or an RN, a LVN applies scientific and technical expertise and manual skills to provide nursing care to assigned patients. Duties within the scope of practice of the LVN typically include, but are not limited to, the provision of basic hygienic and nursing care; measurement of temperature, pulse, respirations and blood pressure; basic assessment, documentation of data; performance of prescribed medical treatments; nursing interventions; observation and documentation of patient responses to treatments and interventions; participation in the development of nursing care plans; administration and documentation of prescribed medications; performance of skin testing; patient education; and, with further certification from the licensing board, performance of non-medicated intravenous therapy and blood withdrawal.
- CNA. Under physician or licensed nursing supervision, the CNA provides nursing care to patients that are physically ill, disabled, convalescent or geriatric; assists the physician or nurse with examination and treatments of patients; motivate and assist patients in developing and utilizing their maximum potential for self-care; and, other related work. CNAs provide physical support to assist patients in performing daily living activities, including rising out of bed, bathing, dressing, feeding, toileting, walking or exercising, social actions or rehabilitation programs; turns or re-positions bedridden patients; records vital signs, height and weight; measures and records dietary intake and urinary and fecal output; collects specimens; observes or examines patients to detect symptoms that may require medical attention; assists nurses or physicians in the operation of medical equipment or provision of care; transports patients to treatment units, operating rooms or other areas using wheelchairs, stretchers or movable beds; cleans and sanitizes patients clothing, rooms, bathrooms, examination rooms, or other patient areas; positions or holds patients for surgical preparations; performs immediate and temporary interventions in emergency situations; assists with admission, transfer, or discharge activities; sorts, counts and distributes linens and clothing; assists in serving meals and special diets; and, performs other tasks as required.
- RN. A broad definition of the scope for nursing means those functions including basic health care, which help people cope with difficulties in daily living which are associated with their actual or potential health or illness problems or the treatment of them which requires a substantial amount of scientific knowledge or technical skill. Nursing is generally divided into three types of functions:
- CNA training requirements. As noted in existing law above, CNAs are required to complete 60 classroom hours and 100 hours of supervised on-the-job training before licensure. According to DPH, current law, in statute and regulation, allocates 57 of the 60 classroom hours, with 50 of those hours allocated in regulation, and seven hours in statute. Of the seven hours specified in statute, six hours are on preventing, recognizing, and reporting resident abuse, and one hour on residents' rights violations.
- Registered Nurse (RN), Licensed Vocational Nurse (LVN), and CNA. California provides for various level of patient care to be performed by licensed or certified nursing personnel, almost always under the supervision of a physician and surgeon. Each level of nursing care has a specific scope of practice commensurate with the level of education and training. The highest level of care with the greatest level of autonomy is provided by RNs, with LVNs and CNAs following. Reimbursements for careers in nursing are also commensurate with the level of education, training, and responsibilities for each licensure/certification category. In California, the median salary for a RN is $94,000; for a LVN, $51,000; and, for a CNA, $35,000. Because of the entry level nature of the CNA position, retention of employees is difficult for SNFs and ICFs. Individuals leave the field or their current jobs for a variety of reasons including, educational opportunities, more lucrative or rewarding careers, and accepting a comparable position as a CNA at a different facility. The following represents a breakdown of the approved scope for each of the categories.
The 50 hours in regulations (CCR 71835 of Division 5, Title 22) are spread across 16 different modules. The module topics and associated hours are:
Module | Topic | Requirement |
Module 1 | Introduction | 2 hours |
Module 2 | Patients’ Rights | 2 hours |
Module 3 | Interpersonal Skills | 2 hours |
Module 4 | Prevention and Management of Catastrophe and Unusual Occurrences | 1 hour |
Module 5 | Body Mechanics | 2 hours |
Module 6 | Medical and Surgical Asepsis | 2 hours |
Module 7 | Weights and Measures | 1 hour |
Module 8 | Patient Care Skill | 14 hours |
Module 9 | Patient Care Procedures | 7 hours |
Module 10 | Vital Signs | 3 hours |
Module 11 | Nutrition | 2 hours |
Module 12 | Emergency Procedures | 2 hours |
Module 13 | Long-Term Care Patient | 2 hours |
Module 14 | Rehabilitative Nursing | 2 hours |
Module 15 | Observation and Charting | 4 hours |
Module 16 | Death and Dying | 2 hours |
The 100 clinical hours are recommended in various areas, but not mandated in statute. According to the California Association of Health Facilities (CAHF), a non-profit trade association representing SNFs and ICFs, the length of time it takes to complete a CNA training program can run anywhere from four to 15 weeks but the average time for completion is eight weeks.
- Patient Staff Ratios. Existing law provides for the licensure and regulation of health facilities, including SNFs, by the DPH. As part of their regulation DPH is required to establish staff-to-patient ratios for direct caregivers. A direct caregiver includes, among other persons, an RN and a CNA. SB 97 (Committee on Budget & Fiscal Review), Chapter 52, Statutes of 2017, updated the staff to patient ratios. The new ratio requires that effective July 1, 2018, SNFs, except those that are a distinct part of a general acute care facility or a state-owned hospital or developmental center, to have a minimum number of direct services hours of 3.5 hours per patient day (PPD) for RNs and a minimum of 2.4 hours PPD for CNAs. CAHF estimates these new staffing mandates will require SNFs to hire at least 1,600 new CNAs by the July 1, 2018, date in order to meet the requirement. CAHF reports that of the 1,039 SNFs in the state, 463 facilities do not currently meet the 2.4 hour PPD CNA requirements.
- Online and Distance Learning. Online and distance learning have been integrated into the educational community with all universities, colleges and community colleges conducting some of their coursework electronically. Likewise, within healthcare, the use of online or distance learning has been approved for some of the didactic (classroom) portion of training. For example, in dentistry where the supervision and scopes of practice of allied dental health professionals are parallel to nursing with registered dental hygienists, registered dental assistants and unlicensed dental assistants each have their own educational requirements and scopes of practice, electronic coursework is available for the didactic portion of their education requirements. These courses are offered as part of the Dental Board of California’s approved educational programs. The American Health Care Association (AHCA) has developed an on-line CNA training program that is able to be tailored for state specificity. Currently there are eight states using the program for their CNA training. Twenty-three other states are engaged in the process of adopting the AHCA program.
- SUPPORT. CAHF, sponsor of this bill states that our state’s nursing homes are at a crisis point in recruiting and retaining the current workforce let alone being able to address the increased needs of our baby boomers. It is hard to a find a SNF that does not have a nursing vacancy, if not several. This problem is more apparent than before with the new minimum staffing mandate. If a facility does recruit a CNA for employment, many times these professionals move on to higher paying jobs. Most CNAs make very close to the minimum wage and with the minimum wage increase to $15/hour, many CNAs will find an equal pay position with a restaurant or retail facility that is not as grueling work – mentally or physically. CAHF goes on to state that updating the classroom hours to modern times and needed convenience and efficiency will serve as a better process for people who want to enter the long-term care workforce.
- OPPOSITION. California Advocates for Nursing Home Reform, in opposition to a previous version of this bill, state that while the bill establishes a definition of geriatric medication technicians, it is silent on what training would be required, and who would provide it, how much it would cost and who would pay for it. CANHR goes on to state that this bill would reduce the qualifications of the personnel who administer medications to SNF residents at a time when their medical and nursing needs have never been greater.
- RELATED LEGISLATION.
- SB 219 (Wiener), Chapter 483, Statutes of 2017, established the Lesbian, Gay, Bisexual, and Transgender Long-Term Care Facility Residents’ Bill of Rights, that in addition to other requirements of the Act, required a SNF or ICF to provide existing employees and new hires access to the online learning tool, “Building Respect for LGBT Older Adults”.
- SB 449 (Monning), Chapter 282, Statutes of 2017, required that at least two hours of the 60 hours of CNA classroom training address the special needs of persons with Alzheimer’s disease and related dementias.
- AB 1656 (Burke) of 2017 would have required the Employment Training Panel to establish a grant award program to fund training programs for certified nurse assistant and would have appropriated $3 million from the General Fund to the Employment Training Panel to implement the grant award program. AB 1656 was held in the Assembly Appropriations Committee on the suspense file.
- PREVIOUS LEGISLATION.
- AB 213 (Logue) of 2013, would have required the DPH to accept upon application for licensure or certification, the education, training, and practical experience completed by an applicant in military service toward the qualifications and requirements to receive a license of certificate for specified professions including CNAs. AB 213 was held in the Assembly Appropriations Committee on the suspense file.
REGISTERED SUPPORT / OPPOSITION:
Support
California Association of Health Facilities (sponsor)
Opposition (previous version)
California Advocates for Nursing Home Reform
California Nurses Association
Analysis Prepared by: Judy Babcock and Lara Flynn / HEALTH / (916) 319-2097
Bill Author
Bill Co-Author(s):