Virtually all states have both orientation and initial and ongoing training requirements, but they are minimal. Some requirements are quite general, while others are specific regarding the type of training and the number of hours required. Most states require at least one staff trained in first aid and CPR on duty at all times. Examples of the wide range of requirements follow:
- Colorado. ADS centers providing medication administration as a service must have qualified staff who have been trained in accordance with state law regarding qualified medication administration. All staff must be trained in the use of universal precautions (infection control). The operator and staff must have training specific to the needs of the populations served (e.g., elderly, blind, or disabled). All staff and volunteers must be trained in the handling of emergencies including medical crises. Providers must have written procedures for dealing with medical crises.
- Delaware. Aide orientation and training must include at least 40 hours of instruction and supervised practicum and address the following topics: (1) the aide's role as a member of the adult day care team; (2) personal care services; (3) principles of good nutrition; (4) process of growth, development, and aging; (5) principles of infection control; (6) observation, reporting, and documentation of participant status; (7) maintaining a clean, safe, and healthy environment; (8) maintaining a least restrictive environment; (9) verbal/nonverbal communication skills; and (10) principles of body mechanics.
- Georgia. All adult day care staff who interact with participants and volunteers who are included as part of the staff-to-participant ratio, must complete an orientation within the first 2 weeks of employment. Content must include but not be limited to participant rights and program policies, including the client population served, medical and safety emergencies, health care delivery, universal precautions, and abuse. Within 90 days of employment, all employees who provide care to participants must receive a minimum of 18 hours of training in the areas relevant to their job, including participants' needs and abilities, physical and psychological aspects of participants' disabilities, personal care techniques, interpersonal communications skills, and patient rights. Infrequently employed substitute staff are not required to complete the 18 hours of initial training. Substitutes for direct service staff used on a regular basis with an on-call or other ongoing agreement must complete all training requirements.
After the first year of employment, all employees with direct care or program activity responsibilities, including the program administrator, must complete 3 hours of continuing education quarterly or 12 hours annually on pertinent topics.
- South Dakota. Ongoing training includes at least four in-service training sessions per year to enhance quality of care and job performance. At the time of employment and annually, each employee must receive training in needs of the participants in the center's target population; fire, safety, disaster, and emergency plans; choking prevention and intervention techniques; body mechanics, transfer techniques, and assistance with ADLs; basics of nutritional care, food safety, and safe feeding techniques; and CPR and first aid.
- South Carolina. Each facility must have and execute a written orientation program to familiarize each new staff member with the facility and its policies and procedures. The program must include, at a minimum, fire safety measures and infection control. In-service training programs must be planned and provided to ensure that all employees maintain their understanding of their duties and responsibilities.
- Texas. The facility must provide all staff with training in the fire, disaster, and evacuation procedures within 3 work days of employment and provide direct care staff a minimum of 18 hours of training during the first 3 months of employment.
- Utah. Staff must receive 8 hours of initial orientation training designed by the director to meet the needs of the program, plus 10 hours of work-related training annually. Directors must obtain 10 hours of related training annually.
- Virginia. Staff must have at least 24 hours of training no later than 3 weeks after starting. Staff who are primarily responsible for the direct care of participants must attend at least 8 contact hours of staff development activities annually. These staff development activities must be in addition to first aid, CPR, and orientation training.
- Washington. Provision must be made for orientation of new employees, contractors, and volunteers. All staff, contractors, and volunteers must receive, at a minimum, quarterly in-service training and staff development that meets their individual training needs to support program services. Staff, contractors, and volunteers must receive training about documentation, reporting requirements, and universal precautions.
As noted in Exhibit 3, many states have specific requirements for ADS providers who serve persons with dementia, most relating to staffing and training. Examples follow:
- Minnesota requires adult day care facilities that serve persons with dementia to ensure that the facility's direct care staff and their supervisors are trained in dementia care. Areas of required training include: (1) an explanation of Alzheimer's disease and other dementias, (2) assistance with ADLs, (3) problem solving with challenging behaviors, and (4) communication skills. The facility must provide to consumers in written or electronic form a description of the training program, the categories of employees trained, the frequency of training, and the basic topics covered.
- California requires that adult day health care centers that provide care for adults with dementia provide staff training regarding the use and operation of egress control devices (precluding the use of exits) utilized by the center, the protection of participants' personal rights, wandering behavior and acceptable methods of redirection, and emergency evacuation procedures for persons with dementia.
- Florida. Newly hired adult day care center personnel who have direct contact with participants with Alzheimer's disease or dementia-related disorders must complete initial training of at least 1 hour within the first 3 months after beginning employment. The training must include an overview of dementias and must provide instruction in basic skills for communicating with persons who have dementia.
- Iowa. All personnel employed by or contracting with a dementia-specific program must receive a minimum of 6 hours of dementia-specific education and training prior to or within 90 days of employment or the beginning date of the contract. The dementia-specific education or training must include, at a minimum, the following: (1) an explanation of Alzheimer's disease and related disorders; (2) the program's specialized dementia care philosophy and program; (3) skills for communicating with persons with dementia; (4) skills for communicating with family and friends of persons with dementia; (5) an explanation of family issues such as role reversal, grief and loss, guilt, relinquishing the caregiving role, and family dynamics; (6) the importance of planned and spontaneous activities; (7) skills in providing assistance with ADLs; (8) the importance of the care plan and social history information; (9) skills in working with challenging participants; (10) techniques for simplifying, cueing, and redirecting; and (11) staff support and stress reduction.