One of the most important elements of running a successful Assisted Living Facility is hiring, training, and retaining the right people to care for your residents. The Texas HHSC has issued specific guidelines for what these employees must be given training on in order to provide care for residents. HHSC also provides facilities with standards for the appropriate number of staff needed in a community. Take a look below:
RULE 553.41 Standards for Type A and Type B Assisted Living Facilities
(A) A facility must develop and implement staffing policies, which require staffing ratios based upon the needs of the residents, as identified in their service plans.
(B) Prior to admission, a facility must disclose, to prospective residents and their families, the facility’s normal 24-hour staffing pattern and post it monthly in accordance with §92.127 of this title (relating to Required Postings).
(C) A facility must have sufficient staff to:
(i) maintain order, safety, and cleanliness;
(ii) assist with medication regimens;
(iii) prepare and serve meals that meet the daily nutritional and special dietary needs of each resident, in accordance with each resident’s service plan;
(iv) assist with laundry;
(v) assure that each resident receives the kind and amount of supervision and care required to meet his basic needs; and
(vi) ensure the safe evacuation of the facility in the event of an emergency.
(D) A facility must meet the staffing requirements described in this subparagraph.
(i) Type-A facility: Night shift staff in a small facility must be immediately available. In a large facility, the staff must be immediately available and awake.
(ii) Type B facility: Night shift staff must be immediately available and awake, regardless of the number of licensed beds.
(4) Staff training. The facility must document that staff members are competent to provide personal care before assuming responsibilities and have received the following training.
(A) All staff members must complete four hours of orientation before assuming any job responsibilities. Training must cover, at a minimum, the following topics:
(i) reporting of abuse and neglect;
(ii) confidentiality of resident information;
(iii) universal precautions;
(iv) conditions about which they should notify the facility manager;
(v) residents’ rights; and
(vi) emergency and evacuation procedures.
(B) Attendants must complete 16 hours of on-the-job supervision and training within the first 16 hours of employment following orientation. Training must include:
(i) in Type A and B facilities, providing assistance with the activities of daily living;
(ii) resident’s health conditions and how they may affect the provision of tasks;
(iii) safety measures to prevent accidents and injuries;
(iv) emergency first aid procedures, such as the Heimlich maneuver and actions to take when a resident falls, suffers a laceration, or experiences a sudden change in physical and/or mental status;
(v) managing disruptive behavior;
(vi) behavior management, for example, prevention of aggressive behavior and de-escalation techniques, practices to decrease the frequency of the use of restraint, and alternatives to restraints; and
(vii) fall prevention.
(C) Direct care staff must complete six documented hours of education annually, based on each employee’s hire date. Staff must complete one hour of annual training in fall prevention and one hour of training in behavior management, for example, prevention of aggressive behavior and de-escalation techniques, practices to decrease the frequency of the use of restraint, and alternatives to restraints. Training for these subjects must be competency-based. Subject matter must address the unique needs of the facility. Suggested topics include:
(i) promoting resident dignity, independence, individuality, privacy, and choice;
(ii) resident rights and principles of self-determination;
(iii) communication techniques for working with residents with hearing, visual, or cognitive impairment;
(iv) communicating with families and other persons interested in the resident;
(v) common physical, psychological, social, and emotional conditions and how these conditions affect residents’ care;
(vi) essential facts about common physical and mental disorders, for example, arthritis, cancer, dementia, depression, heart and lung diseases, sensory problems, or stroke;
(vii) cardiopulmonary resuscitation;
(viii) common medications and side effects, including psychotropic medications, when appropriate;
(ix) understanding mental illness;
(x) conflict resolution and de-escalation techniques; and
(xi) information regarding community resources.
(D) Facilities that employ licensed nurses, certified nurse aides, or certified medication aides must provide annual in-service training, appropriate to their job responsibilities, from one or more of the following areas:
(i) communication techniques and skills useful when providing geriatric care (skills for communicating with the hearing impaired, visually impaired, and cognitively impaired; therapeutic touch; recognizing communication that indicates psychological abuse);
(ii) assessment and interventions related to the common physical and psychological changes of aging for each body system;
(iii) geriatric pharmacology, including treatment for pain management, food, and drug interactions, and sleep disorders;
(iv) common emergencies of geriatric residents and how to prevent them, for example, falls, choking on food or medicines, injuries from restraint use; recognizing sudden changes in physical condition, such as stroke, heart attack, acute abdomen, acute glaucoma; and obtaining emergency treatment;
(v) common mental disorders with related nursing implications; and
(vi) ethical and legal issues regarding advance directives, abuse and neglect, guardianship, and confidentiality.
(b) Social services. The facility must provide an activity and/or social program at least weekly for the residents.
- While there is no magic number for minimum staff to residents ratio, you should use the resident’s service plans and the overall needs of your community to determine how many staff should be on shift in order to handle all of the many required tasks for care.
- (C) Direct care staff must complete six documented hours of education annually, based on each employee’s hire date. Staff must complete one hour of annual training in fall prevention and one hour of training in behavior management, for example, prevention of aggressive behavior and de-escalation techniques, practices to decrease the frequency of the use of restraint, and alternatives to restraints. Training for these subjects must be competency-based. Subject matter must address the unique needs of the facility. Suggested topics include: i-xi
It is suggested for you to provide this training upon the date of orientation. Make sure you have a system as to who is training in these areas and how the training will be tracked.