Current through all regulations passed and filed through September 16, 2024
(A) For the purposes of this rule:
(1) "Competency evaluation program" means a
program conducted by the director or the director's designee under division (C)
of section 3721.31 of the Revised Code and
rule 3701-18-22 of the Administrative
Code.
(2) "Licensed health
professional" means all of the following:
(a)
An occupational therapist or occupational therapy assistant licensed under
Chapter 4755. of the Revised Code;
(b) A physical therapist or physical therapy
assistant licensed under Chapter 4755. of the Revised Code;
(c) A physician as defined in section
4730.01 of the Revised
Code;
(d) A physician's assistant
for whom a physician holds a valid certificate of registration issued under
section 4730.04 of the Revised
Code;
(e) A registered nurse,
including those authorized to practice in an advance practice role, or a
licensed practical nurse licensed under Chapter 4723. of the Revised
Code;
(f) A social worker or
independent social worker licensed, or social work assistant certified under
Chapter 4757. of the Revised Code;
(g) A speech pathologist or audiologist
licensed under Chapter 4753. of the Revised Code;
(h) A dentist or a dental hygienist licensed
under Chapter 4715. of the Revised Code;
(i) An optometrist licensed under Chapter
4725. of the Revised Code;
(j) A
pharmacist licensed under Chapter 4729. of the Revised Code;
(k) A psychologist licensed under Chapter
4732. of the Revised Code;
(l) A
chiropractor licensed under Chapter 4734. of the Revised Code;
(m) A nursing home administrator licensed or
temporarily licensed under Chapter 4751. of the Revised Code;
(n) A dietitian licensed under Chapter 4759.
of the Revised Code;
(o) A
respiratory care professional licensed under Chapter 4761. of the Revised Code;
and
(p) A massage therapist
licensed under section
4731.17 of the Revised
Code.
(3) "Long-term
care facility" or "facility" means either of the following:
(a) A nursing home as defined in section
3721.01 of the Revised Code,
other than a nursing home or part of a nursing home certified as an
intermediate care facility for the mentally retarded under Title XIX of the
Social Security Act, 49 Stat. 620 (1935),
42 U.S.C.
301, as amended; or
(b) A facility or part of a facility that is
certified as a skilled nursing facility or a nursing facility under Title XVIII
or XIX of the Social Security Act.
(4) "Nurse aide" means an individual who
provides nursing and nursing-related services to residents in a long-term care
facility, other than a licensed health professional practicing within the scope
of his or her license or an individual who provides nursing or nursing-related
services as a volunteer without monetary compensation.
(5) "Nursing and nursing-related services"
when performed by a nurse aide in a long term care facility, means activities
including attending to the personal care needs of residents, and providing
personal care services and activities delegated by a nurse which may include
implementation of portions of the nursing regimen, as defined in section
4723.01 of the Revised Code, for
residents whose care does not require nursing assessment or the judgment of a
nurse during the performance of the delegated activity. Nursing and
nursing-related services does not include activities that are part of the
nursing regimen which require the specialized knowledge, judgment, and skill of
a registered nurse or the application of the basic knowledge and skill required
of a licensed practical nurse licensed under Chapter 4723. of the Revised Code
or any other activities that are required to be performed by a licensed nurse
under Chapter 4723. of the Revised Code. Nursing and nursing-related services"
does not include assisting residents with feeding when performed by a dining
assistant pursuant to rule
3701-17-07.2 of the
Administrative Code.
(6) To "use an
individual as a nurse aide" means to engage the individual to perform nursing
and nursing-related services in and on behalf of a long-term care
facility.
(7) "Training and
competency evaluation program" means a program of nurse aide training and
evaluation of competency to provide nursing and nursing-related services
approved by the director under division (A) of section
3721.31 of the Revised Code and
Chapter 3701-18 of the Administrative Code.
(B) No long-term care facility shall use an
individual as a nurse aide for more than four months unless the individual is
competent to provide the services he or she is to provide; the facility has
received from the nurse aide registry, established under section
3721.32 of the Revised Code, the
information concerning the individual provided through the registry; and one of
the following is the case:
(1) The individual
was used by a facility as a nurse aide on a full-time, temporary, per diem, or
other basis at any time during the period commencing July 1, 1989, and ending
January 1, 1990, and successfully completed, not later than October 1, 1990, a
competency evaluation program conducted under former rule 3701-18-07 of the
Administrative Code, in effect prior to October 1, 1990;
(2) The individual either has successfully
completed a training and competency evaluation program or has satisfied the
requirements of paragraphs (B)(2)(a) and (B)(2)(b) of this rule and, in either
case, also has completed successfully the competency evaluation program. An
individual shall be considered to have satisfied the requirement of having
successfully completed a training and competency evaluation program if the
individual meets both of the following:
(a)
The individual, as of July 1, 1989, completed at least sixty hours divided
between skills training and classroom instruction in the topic areas described
in divisions (B)(1) to (B)(8) of section
3721.30 of the Revised Code;
and
(b) The individual received, as
of that date, at least the difference between seventy-five hours and the number
of hours actually spent in training and competency evaluation in supervised
practical nurse aide training or regular in-service nurse aide education. For
an individual to satisfy the requirements of this paragraph, the combination of
skills training, classroom instruction, supervised practical nurse aide
training and in-service nurse aide education shall have addressed the topic
areas and subject matter components prescribed by former rule 3701-18-07 of the
Administrative Code and its appendix in effect at the time of the
determination.
(3) Prior
to July 1, 1989, if the long-term care facility is certified as a skilled
nursing facility or a nursing facility under Title XVIII or XIX of the Social
Security Act, 49 Stat. 620 (1935),
42 U.S.C.
301, as amended, or prior to January 1, 1990,
if the facility is not so certified, the individual completed a program that
the director determines included a competency evaluation component no less
stringent than the competency evaluation program conducted under former rule
3701-18-07 of the Administrative Code in effect at the time of the
determination and was otherwise comparable to approved training and competency
evaluation programs;
(4) The
individual is listed in a nurse aide registry maintained by another state and
that state certifies that its program for training and evaluation of competency
of nurse aides complies with Titles XVIII and XIX of the Social Security Act,
49 Stat. 620 (1935),
42 U.S.C.
301, as amended, and regulations adopted
thereunder;
(5) Prior to July 1,
1989, the individual was found competent to serve as a nurse aide after the
completion of a course of nurse aide training of at least one hundred hours'
duration. The determination of competency shall have been made by the director
or by an instructor of the course of nurse aide training;
(6) The individual is enrolled in a
prelicensure program of nursing education approved by the board of nursing or
by an agency of another state that regulates nursing education, has provided
the long-term care facility with a certificate from the program indicating that
the individual has successfully completed the courses that teach basic nursing
skills including infection control, safety and emergency procedures and
personal care, and has successfully completed the competency evaluation
program; or
(7) The individual has
the equivalent of twelve months or more of full-time employment in the
preceding five years as a hospital aide or orderly and has successfully
completed a competency evaluation program.
Before allowing an individual to serve as a nurse aide for more
than four months in accordance with this paragraph, a facility shall receive
registry verification that the individual has met the competency requirements
under this paragraph unless the individual can prove that he or she has
recently met the requirements and has not yet been listed on the registry. In
the event that an individual has not yet been listed on the registry,
facilities shall follow up by contacting the nurse aide registry to ensure that
such an individual actually becomes listed on the registry. Once the facility
receives written registry verification, it shall maintain such verification on
file.
(C) During
the four month period provided for in paragraph (B) of this rule, during which
a long-term care facility may, subject to paragraph (H) of this rule, use as a
nurse aide an individual who does not have the qualifications specified in
paragraphs (B)(1) to (B)(7) of this rule, a facility shall require the
individual to participate in one of the following:
(1) If the individual has successfully
completed a training and competency evaluation program, a competency evaluation
program conducted by the director;
(2) If the individual is enrolled in a
prelicensure program of nursing education described in paragraph (B)(6) of this
rule, and has completed or is working toward completion of the courses
described in that paragraph, or the individual has the experience described in
paragraph (B)(7) of this rule, a competency evaluation program; or
(3) A training and competency evaluation
program and the competency evaluation program.
(D) No long-term care facility shall continue
for longer than four months to use as a nurse aide an individual who previously
met the requirements of paragraph (B) of this rule but since most recently
doing so has not performed nursing and nursing-related services for monetary
compensation for twenty-four consecutive months, unless the individual
successfully completes additional training and competency evaluation by
complying with paragraphs (D)(1) and (D)(2) of this rule:
(1) Doing one of the following:
(a) Successfully completing a training and
competency evaluation program;
(b)
Successfully completing a training and competency evaluation program described
in paragraph (B)(4) of this rule; or
(c) Meeting the requirements specified in
paragraph (B)(6) or (B)(7) of this rule; and
(2) In the case of an individual who is
described in paragraph (D)(1)(a) or (D)(1)(c) of this rule, successfully
completing the competency evaluation program.
(E) During the four-month period provided for
in paragraph (D) of this rule during which a long-term care facility may,
subject to paragraph (H) of this rule, use as a nurse aide an individual who
does not have the qualifications specified in paragraphs (D)(1) and (D)(2) of
this rule, a facility shall require the individual to participate in one of the
following:
(1) If the individual has
successfully completed a training and competency evaluation program, a
competency evaluation program conducted by the director;
(2) If the individual is enrolled in a
prelicensure program of nursing education described in paragraph (B)(6) of this
rule and has completed or is working toward completion of the courses described
in that paragraph or the individual has the experience described in paragraph
(B)(7) of this rule, a competency evaluation program; or
(3) A training and competency evaluation
program and, in addition, a competency evaluation program.
(F) For the purposes of paragraphs (C) and
(E) of this rule, an individual shall be considered to be participating in a
training and competency evaluation program or a competency evaluation program,
as applicable, if, at minimum, the individual has a document signed by a
representative of the program attesting that the individual is scheduled to
attend the program.
(G) The four
month periods provided for in paragraphs (B) and (D) of this rule include any
time, on or after June 1, 1990, that an individual is used as a nurse aide on a
full time, temporary, per diem or other basis by the facility or any other
long-term care facility.
(H) A
long-term care facility shall not permit an individual used by the facility as
a nurse aide while participating in a training and competency evaluation
program to provide nursing and nursing-related services unless both of the
following are the case:
(1) The individual has
completed the number of hours of training that he or she must complete prior to
providing services to residents as prescribed by paragraph (A)(4) of rule
3701-18-05 of the Administrative
Code through the program in which the individual is enrolled; and
(2) The individual is under the personal
supervision of a registered or licensed practical nurse licensed under Chapter
4723. of the Revised Code.
An individual used by a long-term care facility as a nurse aide
while participating in a training and competency evaluation program shall wear
a name pin at all times that clearly indicates that the individual is a
trainee. As used in this paragraph, "personal supervision" means being present
physically on the floor where the individual is providing services, being
available at all times to respond to requests for assistance from the
individual, and being within a distance which allows the nurse periodically to
observe the individual providing services.
(I) No long-term care facility shall impose
on a nurse aide any charge for participation in any competency evaluation
program or training and competency evaluation program, including any charge for
textbooks, other required course materials or a competency
evaluation.
(J) No long-term care
facility shall require that an individual used by the facility as a nurse aide
or seeking employment as a nurse aide pay or repay, either before or while the
individual is employed by the facility or when the individual leaves the
facility's employ, any costs associated with the individual's participation in
a competency evaluation program or training and competency evaluation
program.
(K) In addition to
competency evaluation programs and training and competency evaluation programs
required by this rule, each long-term care facility shall provide all of the
following to each nurse aide it uses:
(1) An
orientation program that includes at least an explanation of the organizational
structure of the facility, its policies and procedures, its philosophy of care,
principles of person-centered care, a description
of its resident population, and an enumeration of its employee rules. The
orientation program shall be of sufficient duration to cover the topics
enumerated in this paragraph adequately in light of the size and nature of the
facility, its resident population, and the anticipated length of employment of
the nurse aide. The orientation program for nurse aides permanently employed by
the long-term care facility shall be at least three hundred and sixty minutes
in length to occur during the first forty hours worked, with one hundred and
eighty minutes occurring before the nurse aide has any resident
contact;
(2) Regular performance
review to assure that individuals working in the facility as nurse aides are
competent to perform the nursing and nursing-related services they perform.
Performance reviews shall be conducted at least ninety days after the nurse
aide completes successfully the competency evaluation program or commences work
in the facility and annually thereafter. The performance review shall
be conducted by the aide's immediate supervisor or a
nurse designated by the facility to conduct the performance evaluations
and consist, at minimum, of an evaluation of the nurse aide's working
knowledge, application of the principles of
person-centered care, and clinical performance . The facility shall maintain a written record of each
performance review; and
(3) Regular
in-service education, both in groups and, as necessary in specific situations,
on a one-to-one basis, based on the outcome of performance reviews required by
paragraph (K)(2)(a) of this rule. For the purposes of this provision,
"specialty unit" means a discrete part of the nursing home that houses
residents who have common specialized care needs, including, but not limited
to, dementia care, hospice care,
or mental health care units.
(a) Formal in-service education shall include
an instructional presentation and may include skills demonstration with return
demonstration and in-service training. In-service training may be provided on
the unit as long as it is directed toward skills improvement, is provided by
trained individuals and is documented.
(b) In-service education shall be sufficient
to ensure the continuing competence of nurse aides and address areas of
weakness as determined in nurse aides' performance reviews and shall address
the assessed needs of residents as determined by their care plan. It also shall
include, but is not limited to, training for nurse aides providing nursing and
nursing-related services to residents with cognitive impairment. The in-service
education for nurse aides working in specialty units shall address the assessed
needs of the residents in the unit.
(c) The facility shall assure that each nurse
aide receives at least twelve hours of formal in-service education each year
. In-service education may be obtained through web-based training
programs. For purposes of this paragraph, the year within which a nurse aide
must receive continuing education is calculated based on the commencement of
employment.
(d) The facility shall
maintain a written record of each formal in-service session which shall include
a description of the subject matter, the identity of the individual or
individuals providing the in-service education, a list of the nurse aides and
other individuals attending the session that is signed by each attendee and the
duration of the session.
(4)
In addition to
the requirements of this paragraph, a nursing home that holds itself out as
providing specialty care to residents shall ensure each nurse aide who provides
specialty care receives sufficient additional hours of training each year to
ensure competency and to meet the individual needs of the residents. For
purposes of this paragraph, a nursing home or part thereof is considered to
"hold itself out as providing specialty care" when it advertises the home
provides specialty care, represents to the department or the public that it
provides specialty care, or admits ten or more individuals with common
specialized care needs. "Specialty care" includes, but is not limited to,
dementia care, behavioral care, mental health care, or hospice
care.
