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DEPARTMENT OF HEALTH
NOTICE OF PROPOSED RULEMAKING
The Director of the Department of Health, pursuant to the authority set forth in section 302(14) of the District of Columbia Health Occupations Revision Act of 1985, effective March 15, 1986 (D.C. Law 6-99; D.C. Official Code § 3-1203.02(14)(2007 Repl.)), and Mayor’s Order 98-140, dated August 20, 1998, hereby gives notice of his intent to take final rulemaking action to adopt the following amendments to Title 17 (Business, Occupations, and Professions) of the District of Columbia Municipal Regulations in not less than thirty (30) days after the date of publication of this notice in the D.C. Register.
The purpose of these amendments is to establish certification and practice regulations for home health aides, a profession regulated pursuant to the Practice of Nursing Amendment Act of 2009, effective July 7, 2009 (D.C. Law 18-18; 56 DCR 3624).
Title 17, Business, Occupations, Professions, of the District of Columbia Municipal Regulations is amended by adding a new chapter 93 to read as follows:
CHAPTER 93 HOME HEALTH AIDES
9300 GENERAL PROVISIONS
9301 CERTIFICATION
9302 TERM OF CERTIFICATION
9303 CRIMINAL BACKGROUND CHECK
9304 CERTIFICATION REQUIREMENTS; APPLICATION FOR CERTIFICATION
9305 CERTIFICATION BY EXAMINATION
9306 CERTIFICATION BY ENDORSEMENT
9307 RENEWAL OF CERTIFICATION
9308 INACTIVE STATUS; REACTIVATION OF CERTIFICATION
9310 TEMPORARY CERTIFICATION FOR PURPOSES OF ENDorsement or Reinstatement
9311 WAIVER OF TRAINING REQUIREMENTS AND EXAMINATION FOR
PERSONS CURRENTLY FUNCTIONING AS HOME HEALTH AIDES
9312 PERFORMANCE REVIEWS; CONTINUING EDUCATION OR IN-SERVICE
9313 DELEGATION OF NURSING CARE TASKS TO HOME HEALTH AIDES
9314 RESERVED
9315 HOME HEALTH AIDE TASKS
9316 RESERVED
9317 DISCIPLINE
9318 RESERVED
9319 RESERVED
9320 STANDARDS FOR HOME HEALTH AIDE TRAINING PROGRAMS
9321 SUPERVISED PRACTICE OF HOME HEALTH AIDE TRAINEES
9322 RESERVED
9323 RESERVED
9324 HOME HEALTH AIDE PROGRAM APPROVAL PROCEDURES
9325 PERIODIC REVIEW OF APPROVED PROGRAMS
9326 RESERVED
9327 HOME HEALTH AIDE TRAINING PROGRAM CURRICULUM
9328 MINIMUM QUALIFICATIONS FOR HOME HEALTH AIDE TRAINEES
9329 RESERVED
9330 CLOSING OF EDUCATION AND TRAINING PROGRAMS
9331 RECORDS RETENTION
9332 RESOURCES, FACILITIES, AND SERVICES
9399 DEFINITIONS
9300 GENERAL PROVISIONS
9300.1 This chapter applies to applicants for, and holders of, certification to practice as a home health aide (HHA).
9300.2 Chapters 40 (Health Occupations: General Rules) and 41 (Health Occupations: Administrative Procedures) of this title shall supplement this chapter.
9301 CERTIFICATION
9301.1 No person shall practice as a home health aide in the District of Columbia without first being certified by the Board.
9302 TERM OF CERTIFICATION
9302.1 Subject to § 9301.2, certification issued pursuant to this chapter shall expire at 11:59 p.m. of October 30 of each odd-numbered year.
9302.2 The Director may modify the renewal system pursuant to § 4006.3 of chapter 40 of this title and may modify the date on which a certification expires.
9303 CRIMINAL BACKGROUND CHECK
9303.1 Persons applying for certification as home health aide (HHA) shall undergo a criminal background check (CBC) prior to issuance of the certification.
9303.2 After issuance of the initial certification, the applicant shall undergo additional background checks at periodic intervals as determined by the Department of Health.
9303.3 The applicant shall pay a fee for the CBC as established by the Department of Health.
9303.4 The Board shall review the results of a CBC of a person if, within the seven (7) years preceding the CBC, the person has been convicted in the District of Columbia, or in any state or territory of the United States where the person has worked or resided, of any of the following offenses or their equivalent in another state or territory:
(a) Murder, attempted murder, or manslaughter;
(b) Arson;
(c) Assault, battery, assault and battery, assault with a dangerous weapon, mayhem or threats to do bodily harm;
(d) Burglary;
(e) Robbery;
(f) Kidnapping;
(g) Theft, fraud, forgery, extortion, or blackmail;
(h) Illegal use or possession of a firearm;
(i) Rape, sexual assault, sexual battery, or sexual abuse;
(j) Child abuse or cruelty to children;
(k) Client abuse; or
(l) Unlawful distribution or possession with intent to distribute, a controlled substance.
9304 CERTIFICATION REQUIREMENTS; APPLICATION FOR CERTIFICATION
9304.1 Except as otherwise provided in this chapter, a person applying for certification as a home health aide shall:
(a) Be at least eighteen (18) years of age;
(b) Provide evidence of current Cardio-Pulmonary Resuscitation with Automated External Defibrillator (CPR/AED) certification; and
(c) Submit evidence of having successfully completed an approved home health aide program;
(d) Pass a Board of Nursing approved certification examination
(e) Complete a CBC; and
(f) Submit an application and application fee.
9304.2 A certified nursing assistant (CNA) applying for certification as a home health aide shall:
(a) Provide evidence of having successfully completed the training
requirements specific to the role of the home health aide as specified in
§ 9327;
(b) Complete a CBC; and
(c) Submit an application and application fee.
9305 CERTIFICATION BY EXAMINATION
9305.1 To qualify for certification by examination, an applicant for certification as a home health aide shall provide proof of one (1) of the following:
(a) Successful completion of a home health aide program approved by the Board or by a nursing board in the United States with standards determined by the Board to be substantially equivalent to the standards in the District within the past twenty-four (24) months;
(b) Completion of a practical nursing or registered nursing “Fundamentals of Nursing” course with a clinical component in the United States within the last thirty-six (36) months; or
(c) A Commission on Graduates of Foreign Nursing Schools certificate indicating education as a registered nurse (RN) or licensed practical nurse (LPN) outside the United States within the last thirty-six (36) months.
9305.2 The Board shall waive the training and certification examination requirements for an applicant for certification as a home health aide who can demonstrate, to the satisfaction of the Board, that he or she has been performing the tasks of a home health aide under the supervision of a licensed nurse or other licensed health professional if the applicant:
(a) Has completed a home health aide training program approved by the Education Licensure Commission and has worked one hundred (100) hours as a home health aide within a twenty-four (24) month period immediately preceding passage of the home health aide regulations; or
(b) Had practiced as an RN or LPN within the past five (5) years.
9305.3 An applicant for re-examination shall be required to retake his or her home health aide training if:
(a) He or she failed the certification examination three (3) times; or
(b) He or she cannot provide evidence that he or she has worked as a home health aide for one hundred (100) hours within the last twenty-four (24) months under the supervision of a licensed nurse or other health professional licensed in the District of Columbia.
9306 CERTIFICATION BY ENDORSEMENT
9306.1 An applicant for endorsement as a home health aide shall provide proof of the following:
(a) Current certification in another jurisdiction approved by the Board; and
(b) Current Cardio-Pulmonary Resuscitation (CPR) with Automated External Defibrillator (AED) certification
9307 RENEWAL OF CERTIFICATION
9307.1 An applicant for renewal shall have:
(a) Completed at least twenty-four (24) hours of continuing education or in-
service in the area of health or nursing needs of assigned client population during the certification period;
(b) Current CPR/AED certification;
(c) Practiced a minimum of one hundred (100) hours during the prior twenty-four (24) months as a home health aide under the supervision of a licensed nurse or other licensed health professional; and
(d) Completed CBC as required.
9308 INACTIVE STATUS; REACTIVATION OF CERTIFICATION
9309 REINSTATEMENT OF EXPIRED CERTIFICATION
(d) Provides evidence of having worked for a minimum of one hundred (100) hours within the last twenty-four (24) months as a home health aide under the supervision of a licensed nurse or other licensed health professional.
(a) Current certification in another jurisdiction approved by the Board;
(b) Current CPR/AED certification; and
(c) Having practiced for a minimum of one hundred (100) hours within the l ast twenty-four (24) months under the supervision of a licensed nurse or other licensed health professional.
9310 TEMPORARY CERTIFICATION FOR PURPOSES OF ENDorsement or Reinstatement
9310.1 An applicant for certification as a home health aide by endorsement or reinstatement may be issued a temporary certification if the applicant has an application pending for certification by endorsement or reinstatement of certification in the District of Columbia.
9310.2 An applicant who has been denied a certification, disciplined, or who has a criminal matter pending in the District of Columbia or another
jurisdiction shall not practice pursuant to this section unless first authorized by the Board.
9310.3 The Board may approve a temporary certification documenting that the applicant’s application is pending and that he or she is eligible to practice temporarily under the Act and this chapter. Temporary certification shall not be renewed and shall expire on the earlier of:
(a) Ninety (90) days after the date of issuance; or
(b) Receipt of written notice from the Board that the application for certification has been denied.
9310.4 Upon approval of the temporary certification, the applicant shall inform his or her employer of the date of expiration and shall immediately cease working as a home health aide in the District on that date or upon receipt of written notice from the Board that the application for certification has been denied.
9311 WAIVER OF TRAINING REQUIREMENTS AND EXAMINATION FOR
PERSONS CURRENTLY FUNCTIONING AS HOME HEALTH AIDES
9311.01 The Board of Nursing shall waive the training and examination requirements for
any person currently practicing as a home health aide provided that he or she meets the following:
(a) Demonstrate to the satisfaction of the Board that he or she has been performing the functions of a home health aide on a full-time or substantially full-time basis;
(b) Has completed a board approved home health aide training program;
(c) Provides a statement from supervising nurse or health care professional,
indicating the applicants continued competence to provide care;
(d) Has worked as a home health aide for a period of at least ninety (90) days
immediately preceding the date these regulations are published as final; and
(e) Submits an application no later than ninety (90) days after these regulations are published as final rulemaking.
9312 PERFORMANCE REVIEWS; CONTINUING EDUCATION OR IN-SERVICE
9312.1 The facility for which a home health aide works shall complete a performance review of every home health aide at least once every twelve (12) months.
9312.2 The facility for which a home health aide works shall provide regular in-service education or continuing education based on the outcome of the performance reviews. The training shall:
(a) Be sufficient to ensure the continuing competence of a home health aide, but not less than twelve (12) hours per year; and
(b) Address areas of weakness as determined in the home health aide’s performance review and may address the special needs of clients as determined by the facility staff.
9312.3 Continuing education or in-service programs provided for a home health aide shall be:
(a) Current in subject matter;
(b) Developed and taught by qualified individuals; and
(c) Relevant to the role of the home health aide.
9312.4 A minimum of two (2 ) hours of HIV/AIDS in-service or continuing education will be required for renewal of certification.
9313 DELEGATION OF NURSING CARE TASKS TO HOME HEALTH AIDES
9313.1 A licensed nurse or health care professional may delegate a task to home health aides if the task is appropriate to the level of knowledge and skill of the home health aide and is within the scope of authorized tasks of a home health aide.
9313.2 Home health aides shall not practice independently but shall work under the immediate supervision of a licensed nurse or other licensed health care professional if the supervisor determines that immediate supervision is necessary, or work under general supervision.
9313.3 Nursing care tasks that may be delegated shall be determined by:
(a) The knowledge and skills of the home health aide;
(b) Verification of the clinical competence of the home health aide by the employing agency;
(c) The stability of the client’s condition, including factors such as predictability, absence of risk of complication, and rate of change; and
(d) The variables in each health care setting which include, but are not limited to:
(1) The accessible resources and established policies, procedures, practices, and channels of communication that lend support to the type of nursing tasks being delegated to the home health aide;
(2) The complexity and frequency of care needed by a given
client population;
(3) The proximity of clients to staff;
(4) The number and qualifications of staff; and
(5) The accessibility of a licensed nurse or other licensed health professionals.
9313.4 Nursing tasks that inherently involve on-going assessment, interpretation, or decision making that cannot be logically separated from one or more procedures shall not be delegated to a home health aide.
9314 RESERVED
9315 HOME HEALTH AIDE TASKS
9315.1 Under the supervision of a licensed nurse or health professional a home health aide may complete the following tasks:
(a) Perform personal care including bathing, grooming, and assistance with toileting or bedpan use;
(b) Change urinary drainage bags;
(c) Assist the client with transfer, ambulation, and exercise as prescribed;
assist the client with self-administration of medication;
(d) Measure and record temperature, pulse, respiration and blood pressure;
(e) Measure and record height and weight;
(f) Observe, record, and report the client’s physical condition, behavior, or appearance;
(g) Prepare meals in accordance with dietary guidelines;
(h) Assist with eating;
(i) Implement universal precautions to assure infection control;
(j) Perform tasks related to keeping the client’s living area in a condition that promotes the client’s health and comfort;
(k) Change simple dressing that do not require the skills of a licensed nurse;
(l) Assist the client with activities that are directly supportive of skilled therapy services;
(m) Assist with routine care of prosthetic and orthotic devices; and
(n) Administer medications, provided that the home health aide has received
the medication administration training as required in the medication aide training program.
9316 RESERVED
9317 DISCIPLINE
9317.1 The Board of Nursing may revoke, suspend, or deny recertification of any home health aide who, after a hearing, is found to have been convicted of any of the crimes as listed in § 9303.4 or engaged in any of the following:
(a) Unsafe practice;
(b) Client abandonment;
(c) Client abuse;
(d) Fraud or deceit, which may include but is not limited to:
(1) Filing false credentials;
(2) Falsely representing facts on a certification application; or
(3) Giving or receiving assistance during the certification examination.
(e) Client neglect or abuse;
(f) Misappropriation of funds;
(g) Boundary violations;
(h) Unsafe client care;
(i) Performing acts beyond a home health aide’s authorized tasks or beyond those tasks delegated;
(j) Misappropriation or misuse of property;
(k) Failure to conform to acceptable standards of practice as a nursing assistant;
(l) Putting clients at risk of harm;
(m) Violating the privacy or failing to maintain the confidentiality of client information;
(n) The inability to function with reasonable skill and safety; or
(o) Any act specified in D.C. Official Code § 3-1205.14 (2007 Repl.; 2011 Supp.).
9317.2 As used in § 9317.1(c), “client abuse” is defined as one (1) or more of the following:
(a) A physical injury caused by other than accidental means, or which appears to be at variance with the explanation given of the injury; or
(b) Neglect which leads to physical harm or significant mental injury through
withholding of services necessary to maintain health and well- being;
provided, a person who, in good faith, voluntarily undergoes treatment solely by spiritual means through prayer in accordance with the tenets and practices of a recognized church or religious denomination by a duly accredited practitioner of the denomination, shall, for this reason alone, not be considered subjected to abuse by reason of neglect as defined in these rules;
(c) Abandonment, or termination without adequate notice, of the professional relationship between a health care provider and a client at a time when the client is in need of emergency care;
(d) Willful infliction of physical pain or injury;
(e) Sexual contact or behavior, which includes, but is not limited to, sexual harassment, threats, and inappropriate or unwanted sexual comments; or
(f) Financial exploitation, which includes the illegal or improper use, by means including but not limited to deceit, coercion, fraud, or undue influence, of the resources (including medications) of a person, and subjecting a person to alarm by conveying a threat to wrongfully take or appropriate money or property, which would be expected to cause the person to believe the threat will be carried out.
9317.3 In addition to any other disciplinary action it may take, impose a civil penalty of not more than five thousand dollars ($5,000) per violation or
file a letter of concern if the Board believes there is insufficient evidence to support direct action against a home health aide.
9317.4 The Board shall maintain records of disciplinary actions and make available all public findings of abuse, neglect, or misappropriation of client property or other disciplinary findings and any statement disputing the finding by the home health aide listed on the registry.
9317.5 A home health aide who is unable to perform his or her duties due to drug or alcohol dependency or mental illness may use the services offered under the Nurse’s Rehabilitation Program pursuant to D.C. Official Code § 3-1251.01, et seq. (2007 Repl.; 2011 Supp.)
9317.6 The Board may refer for criminal prosecution any violation of the Act that it deems appropriate.
9318 RESERVED
9319 RESERVED
9320 STANDARDS FOR HOME HEALTH AIDE TRAINING PROGRAMS
9320.1 No institution shall provide home health aide training in the District of Columbia unless its training program has been approved by the Board.
9320.2 The following types of institutions may apply for approval to provide home health aide training:
(a) Private degree-granting educational institutions operating or incorporated in the District of Columbia that are licensed by the Education Licensure Commission pursuant to the Educational Institution Licensure Act of 1976; (D.C. Law 1-104; D.C. Official Code § 31-1601 et seq. (2009 Repl.));
(b) Private non-degree-granting post secondary schools operating in the District of Columbia which are licensed by the Education Licensure Commission;
(c) District public vocational or trade schools;
(d) District public universities or colleges; and
(e) Health care facilities licensed as training facilities by the Education Licensure Commission and operating in the District of Columbia that have received no adverse actions during the preceding two (2) years.
9320.3 The Board shall consider any one (1) of the following as an adverse action which would preclude a health care facility from providing home health aide training:
(a) A facility's participation in the Medicaid or Medicare program is terminated, restricted, or revoked;
(b) A facility, other than a new facility, has received a provisional or restricted license; or
(c) A facility given a provider agreement of less than one (1) year.
9320.4 All home health aide training programs shall have adequate faculty and clinical facilities to provide supervised clinical experience with early, realistic exposure to job requirements. The clinical experience shall include the full range of skills needed in the workplace.
9321 SUPERVISED PRACTICE OF HOME HEALTH AIDE TRAINEES
9321.1 A home health aide trainee may practice only in accordance with the Act and this chapter.
9321.2 A trainee who is fulfilling educational requirements under §§ 9312.1 and
9315.1 may engage in supervised practice without a District of Columbia
certification.
9321.3 All supervised practice of a trainee shall take place under the general or immediate supervision of a licensed nurse or other health professional
9321.4 A trainee shall identify himself or herself as a trainee before practicing.
9321.5 A trainee shall wear a picture identification badge with lettering clearly visible to the client bearing the name of the trainee and the position title.
9321.6 A trainee shall not receive compensation of any nature, directly or indirectly, from a client or client’s family member.
9321.7 The nurse supervising the trainee shall be responsible for all practice by a trainee during the period of supervision and may be subject to disciplinary action for violations of the Act or this chapter by the trainee.
9321.8 The Board may deny an application for certification by, or take other disciplinary action against, a trainee who is found to have violated the Act or this chapter. The Board may, in addition to any other disciplinary actions permitted by the Act, revoke, suspend, or restrict the privilege of the trainee.
9322 RESERVED
9323 RESERVED
9324 HOME HEALTH AIDE PROGRAM APPROVAL PROCEDURES
9324.1 Each institution applying for approval to provide home health aide training shall do the following:
(a) Submit to the Board a statement of intent to establish a home health
aide training program; and
(b) Submit to the Board a proposal to establish a home health aide training program which shall contain the following information:
(1) A statement of purpose;
(2) A statement of need for the training program in the District of Columbia;
(3) A description of the proposed program’s potential effect on existing home health aide training programs in the area;
(4) The organizational structure of the institution showing the relationship of the proposed training program within the organization;
(5) Evidence of adequate financial resources for planning, implementation, and continuation of the program;
(6) Evidence of current licensure by the Education Licensure Commission or other board approved credentialing or accreditation
organization;
(7) The background and qualifications of the proposed instructors;
(8) The number of budgeted instructor positions;
(9) Evidence of the availability of adequate clinical facilities;
(10) The anticipated trainee population and tentative time schedule for planning and initiating the program;
(11) Fee schedules; and
(c) Submit the application fee.
9324.2 Within thirty (30) days after receiving the application, the application shall be reviewed for completeness. If the application is complete, the application shall be reviewed for compliance with §§ 9327 and 9332.
9324.3 After reviewing the application, based on the applicant’s compliance with §§ 9327 and 9332, a decision will be made to:
(a) Approve the program on a provisional basis;(b) Defer provisional approval if additional information is needed; or
(c) Deny approval of the program.
9324.4 The determination described in § 9324.3 shall be made within one hundred eighty (180) days after determining that the application is complete.
9324.5 If provisional approval has been granted, a site visit shall be scheduled todetermine the program’s compliance with § 9327 and the program’s ability to meet criteria set forth in §§ 9331 and 9332. Following the site visit the following recommendations may be made to the Board:
(a) Defer approval if it is determined that the program does not meet all criteria set forth in §§ 9327 and 9332, but the deficiencies in the program may be corrected in a short period of time; or
(b) Deny approval if it is determined that the program fails to meet the
criteria set forth in §§ 9327 and 9332 and the deficiencies in the program are unlikely to be corrected in a short period of time.
9324.6 After receiving the approval recommendations, the Board shall vote to approve, deny, or defer approval of the application.
9324.7 The Board shall make the determination described in § 9324.6 within sixty (60) days after receiving the approval recommendation.
9324.8 A training program shall not admit trainees to the program before the program has been approved to operate a home health aide training program by the Board.
9324.9 Approval shall remain in effect for a period not to exceed two (2) years.9325 PERIODIC REVIEWS OF APPROVED PROGRAMS
9325.1 Programs approved by the Board to train home health aides shall submit to the Board an annual report in accordance with procedures set out by the Board.
9325.2 The Board shall re-evaluate home health aide training programs at least every two (2) years.
9325.3 The Board may make unannounced visits to review and assess each home health aide training program to ensure that the program is in compliance with §§ 9327, 9331, and 9332.
9325.4 The Board shall assess each training program on the basis of visits to the facility, the progress of the training program, and any other information deemed appropriate by the Board.9325.5 The Board shall withdraw approval of a training program if:
(a) It determines that the program is not in compliance with standards set forth in §§ 9327, 9331, and 9332;
(b) The program does not permit an unannounced site visit;
(c) The institution loses its license from the Education Licensure Commission; or
(d) The training program has not graduated a home health aide class in a year or more.
9325.6 If the training program does not meet the requirements for continued approval, the Board may grant conditional approval pending correction of the deficiencies for the following reasons:
(a) The program has not met or maintained the board’s regulatory requirements;
(b) The program fails to correct the deficiencies identified by the Board within the allotted time period;
(c) The program fails to hire a nurse administrator who meets the board’s qualifications;
(d) The program fails to hire faculty who meet the board’s qualification;
(e) The program is noncompliant with the program’s stated philosophy, program design, objectives or outcomes, or policies;
(f) The program fails to implement the District-approved curriculum;
(g) The program fails to meet the seventy-five percent (75%) passing rate on the District’s competency evaluation for a period of one (1) year or more;
(h) The program fails to submit records and reports to the Board in a timely manner; or
(i) The program is noncompliant with any of the regulations in this chapter, and other activities or situations, as determined by the Board to indicate the program is not meeting the legal requirements and nursing education standards.
9325.7 Programs placed in conditional approval status may be required to comply with any of the following conditions:
(a) Prohibit a program from admitting new students;
(c) Require the program to limit student admissions;
(d) Reduce the frequency that classes are offered; or
(e) Any other conditions deemed necessary by the Board to assure that the program meets the regulatory requirements of this chapter.
9325.8 Training program deficiencies sufficient to warrant withdrawal of approval shall include, but are not limited to:
(a) Failure to fully implement the District-approved curriculum for the training program;
(b) Failure to maintain an adequate number of instructors with required qualifications;
(c) Failure to meet the seventy-five percent (75%) passing rate on the District’s competency evaluation for a period of two (2) years or more;
(d) Failure of trainees to demonstrate adequate competencies upon employment;
(e) Failure to adhere to the training program’s stated philosophy, objectives, and policies; or
(f) Failure to maintain adequate resources, facilities, and services required to meet training objectives.
9325.9 The Board may consider reinstatement or approval of a training program upon submission of satisfactory evidence that the program meets the standards set forth in this chapter.
9325.10 The Board may investigate complaints made against a program and may conduct hearings in connection with such complaints.
9325.11 Any Board action for suspension or withdrawal of a training program’s approval shall take place only upon notice to the program and the opportunity for a hearing in accordance with D.C. Official Code § 3-1205.14 (2007 Repl.; 2011 Supp.).
9326 RESERVED
9327 HOME HEALTH AIDE TRAINING PROGRAM CURRICULUM
9327.1 Core training requirements include:
(a) The role of nursing assistive personnel;
(b) Client rights;
(c) Legal and ethical duties, including recognition, prevention, and reporting of abuse or neglect;
(d) Care sensitive to culture, religion, national origin, gender identity and sexual orientation;
(e) Interpersonal communication;
(f) Receiving delegation and working as a member of the health care team;
(g) Basic safety skills;
(h) Infection prevention, including standard precautions;
(i) Delegated nursing skills including:
(1) Taking and documenting vital signs, intake and output, and other routine observations;
(2) Measuring and documenting the client’s height and weight; and
(3) Recognizing, reporting, and documenting abnormal changes in behavior or body functions;
(j) Basic restorative skills, including safe transfer, ambulation, maintaining
range of motion, and positioning;
(k) Personal care skills, including but not limited to bathing, feeding, hydration, skin care, dressing, grooming, and toileting;
(l) Caring for the client’s environment;
(m) Promoting the client’s independence;
(n) Characteristics that may put the client at risk which include but are not
limited to:
(1) Cognitive impairment;
(2) Sensory deficits or impairments;
(3) Communication limitations;
(4) Altered level of consciousness; and
(5) Agitation or combativeness;
(o) Working with agitated or combative clients, including techniques useful in the prevention of abuse;
(p) Limitations on use of restraints;
(q) End of life care;
(r) Supporting individuals with cognitive impairments;
(s) Supporting individuals with developmental disabilities;
(t) Supporting individuals with behavioral problems;
(u) Basic emergency procedures;
(v) Preventing fatigue and burn-out;
(w) Parameters of abusive behavior; and
(x) Requirements of reporting incidents;
9327.2 Training requirements specific to the role of the home health aide shall include:
(a) Tasks and responsibilities of a home health aide;
(b) Implementation of a plan of care;
(c) Legal and ethical considerations for a home health aide;
(d) Respect for client property;
(e) Personal and community safety for a home health aide;
(f) Delegated nursing skills, including:
(1) Basic restorative skills, including transfers, ambulation, range of motion, and positioning, that are appropriate for the home setting;
(2) Assisting with self-administration of medication; and
(3) Medication administration following medication aide certification;
(g) The foundations for working with the home care client, the family and
significant others of the client and home care team members, including:
(1) Family dynamics;
(2) Communication with the client, the client’s family, and significant others in the home setting;
(3) Dealing with barriers to communication in the home;
(4) Communication with the home care team;
(5) Maintaining relationships with the client, the client’s family, and significant others;
(6) Understanding basic human needs; and
(7) Individual, family, and cultural differences;
(h) Foundations for a safe client environment, including:
(1) General home safety;
(2) Infection prevention in the home;
(3) Fire safety in the home setting;
(4) Emergencies in the home setting;
(5) Home care considerations, including:
(A) Food and nutrition, meal planning, and meal preparation;
(B) Housekeeping, laundering, and food shopping;
(C) Maintenance of a clean, safe, and healthy environment; and
(D) Use and care of medical equipment in the home;
(6) Simple procedures such as non-sterile dressings; and
(i) Understanding and working with various client populations in home care settings including:
(1) Introduction to infant and child care;(2) Mental and physical disabilities;
(3) Chronic illness and disease conditions;
(4) Caring for the terminal client in the home;
(5) The elderly client; and
(6) Proper use of assistive devices, for example, use of prosthetic and orthotic devices.
9327.3 The training program for a home health aide using Board approved model curriculum shall provide a minimum of:
(1) One hundred twenty-five (125) hoursof didactic and clinical training; or
(2) Thirty-two (32) hoursof didactic and clinical training in a certified nursing assistant (CNA) bridge course
9327.4 Each training program’s curriculum shall prepare trainees to practice as required
in § 9327 prior to any direct contact with a client.
9327.5 Each training program shall report to the Board for approval of any proposed change in its curriculum prior to the implementation of the change.
9327.6 Each training program shall have a sufficient number of qualified instructors to meet the purposes and objectives of the program.
9327.7 The training program shall be coordinated by a registered nurse with:
(a) A current, unencumbered license issued by the District of Columbia;
(b) At least two (2) years of experience as a registered nurse; and(c) Clinical experience in the practice setting that he or she is coordinating.
9327.8 The program coordinator’s responsibilities shall include, but not be limited to:
(a) Ensuring that the curriculum is coordinated and implemented in accordance with this chapter;
(b) Establishing job descriptions stating the responsibilities of the instructors;
(c) Ensuring that each instructor meets the qualifications specified in this chapter;
(d) Ensuring that each student is properly supervised during the student’s clinical experience; and
(e) Ensuring that each clinical preceptor evaluates the student’s performance and provides the evaluation results to the clinical instructor.
9327.9 The training for home health aides shall be performed by a licensed nurse who is:
(a) Licensed as a registered nurse in the District of Columbia and has a minimum of two (2) years of current clinical experience in the clinical practice setting in which he or she teaches; or
(b) Licensed as a practical nurse in the District of Columbia and has a minimum of three (3) years of current clinical experience in the clinical practice setting in which he or she teaches.
9327.10 A licensed, qualified health professional as listed in D.C. Official Code § 3-1201.02 (2007 Repl.; 2011 Supp.) who has a minimum of two (2) years of experience may offer training to home health aides in non-nurse related content.
9327.11 When clinical preceptors are used, the criteria for selecting a clinical preceptor shall be in writing and shall include the following:
(a) The method of selecting clinical preceptors;
(b) The plans for orientation of clinical preceptors;
(c) The clinical objectives or outcomes of the preceptorship; and
(d) A system for monitoring and evaluating the preceptor’s learning experiences.
9327.12 There shall be a written agreement between the preceptor and the training program specifying the following:
(a) The clinical objectives or outcomes; and
(b) The system used for monitoring and evaluating the trainee’s learning experiences.
9327.13 The clinical instructor shall:
(a) Retain responsibility for the trainee’s learning experiences and meet periodically with the clinical preceptor and the trainee to monitor and evaluate the trainee’s learning experiences; and
(b) Be readily available, either directly or by a communication device, when preceptors are in the clinical area.
9327.14 The clinical preceptor shall have:
(a) A minimum of two (2) years of experience as a licensed nurse or home health aide;
(b) Experience providing direct client care, during the five (5) years immediately preceding the date of the written agreement between the preceptor and the training program;
(c) A philosophy of health care congruent with that of the home health aide program; and
(d) Current knowledge of practice at the home health aide level.
9327.15 Each clinical instructor and preceptor shall be licensed or registered in the District of Columbia.
9327.16 Clinical instruction shall be offered in the setting in which the home health aide shall work.
9327.17 The ratio of clinical instructors-to-trainees in clinical areas involving direct care of clients shall:(a) Be based upon client acuity level, skill level of the trainee, and the clinical setting; and
(b) Not exceed one (1) instructor or preceptor to two (2) home health aides.
9327.18 Each clinical instructor and preceptor’s qualifications shall be documented in the official records of the program and available for review by the Board.
9327.19 Each clinical instructor shall be responsible for:
(a) Assisting in the development, implementation, and evaluation of the purpose, philosophy, and objective of the training program;
(b) Helping to implement and evaluate the curriculum;
(c) Facilitating preceptor participation in the program and evaluating the progress and retention of preceptors in the program;
(d) Giving guidance to preceptors;
(e) Evaluating preceptor achievement in the program;
(f) Providing for preceptor and peer evaluation of his or her teaching effectiveness; and
(g) Participating in continuing nursing education programs to improve his or her competence in areas of responsibilities.9328 MINIMUM QUALIFICATIONS FOR HOME HEALTH AIDE TRAINEES
9328.1 Each trainee shall be required to take a pre-admission examination to assess reading, writing, and math skills prior to enrollment in a training program to ensure that the trainee is able to understand, speak, read, and write the English language at a minimum of the fifth (5th) grade level.
9328.2 Each trainee shall be provided information in writing on the policies governing admission, retention, dismissal, and the course requirements of the training program.
9328.3 Each trainee shall be admitted on individual merit without discrimination by reason of:(a) Race;
(b) Color;
(c) Religion;
(d) National origin;
(e) Sex, including but not limited to:
(1) Pregnancy;
(2) Childbirth; or
(3) Related medical conditions.
(f) Age;
(g) Marital status;
(h) Personal appearance;
(i) Sexual orientation;
(j) Family responsibility;
(k) Matriculation;
(l) Political affiliation;
(m) Physical handicap;
(n) Source of income;
(o) Place of residence;
(p) Business; or
(q) Place of employment.
9328.4 Each trainee shall be free of communicable disease as verified in writing by a nurse practitioner or physician.
9329 RESERVED
9330 CLOSING OF EDUCATION AND TRAINING PROGRAMS
9330.1 Each home health aide program that voluntarily closes shall:
(a) As early as reasonably possible, notify the Board, in writing, of the intended closing, stating the reason(s) and planned date of the intended closing;
(b) Continue the training program until the committed class scheduled for currently enrolled trainees is completed;
(c) Notify the Board of the final closing date at least thirty (30) days before the final closing; and
(d) Submit records to the Educational Licensure Commission (ELC) for custody and retention, pursuant to the regulations of the ELC.
9330.2 If the Board denies or withdraws approval of a training program, the institution shall:
(a) Close the program after the transfer or graduation of all trainees currently enrolled;
(b) Submit to the Board a list of trainees transferred to approved programs and dates of transfer;
(c) Consider the date on which the last trainee was transferred as the closing date of the program;
(d) Comply with the requirements of all applicable rules and notify the Board that the requirements have been fulfilled and give the date of final closing; and
(e) Submit records to the ELC for custody and retention.
9331 RECORDS RETENTION
9331.1 Each HHA training program shall maintain an accurate and appropriate system of record keeping.
9331.2 Each training program shall ensure that administrative and personnel records are protected against loss, destruction, and unauthorized review.
9331.3 A record for each trainee shall be maintained by the facility and shall include the trainee’s evaluation and health information.
9331.4 Each instructor’s personnel records shall be maintained by the facility and shall include application data, qualifications, and position description.
9331.5 All records shall be maintained by the training program for a minimum of five (5) years.
9332 RESOURCES, FACILITIES, AND SERVICES
9332.1 Each HHA training program shall maintain resources, facilities, and services which are adequate to accommodate the training program. The resources, facilities, and services shall include, but are not limited to:
(a) Adequate temperature controls in each training facility;
(b) Clean and safe conditions of the facility’s premises;
(c) Adequate space to accommodate faculty;
(d) Adequate lighting in each facility; and
(e) Sufficient and adequate equipment for the program’s needs, including audio-visual equipment and equipment needed for simulating client care.
9332.2 Each classroom, conference room, laboratory, and office shall be adequate to meet the needs of the training program.
9332.3 Each cooperative agreement between a training program and an agency, shall be in writing. The training program shall maintain a copy of the agreement in its records.
9399 DEFINITIONS
9399.1 As used in this chapter, the following terms shall have the meanings ascribed:
Applicant - a person applying for a certification to practice as an HHA.Board - the Board of Nursing, established by § 204 of the Act, D.C. Official Code § 3-1202.04 (2007 Repl.; 2011 Supp.).
Clinical activities - faculty-planned and guided learning activities designed to assist preceptors in meeting course objectives and to apply nursing knowledge and skills in the direct care of clients, including clinical conferences, planned learning activities in acute care facilities, and other community resources. Clinical activities shall not include skills lab activities.
Clinical preceptor - an individual meeting the requirements of this chapter who is an employee of a clinical agency and works with a trainee in a clinical setting to facilitate student learning in a manner specified in a signed written agreement between the agency and the educational institution.
Clinical preceptorship - an organized system of clinical experiences which allows a home health aide trainee to be paired with a clinical preceptor for the purpose of attaining specific learning objectives.
Continuing education - systematic learning experiences designed to augment the knowledge, skills, and attitudes of the HHA. Content of continuing education reflects current and emerging concepts, principles, practices, theories, and/or nursing related research, information beyond that which is taught in the training program. Continuing education is not: basic skill training, competency training, local policy administrative procedures training, or update briefings.
Conditional approval - the approval status that is granted for a time period, specified by the Board, to a home health aide training program to correct deficiencies when the training program has failed to meet or maintain the requirements and standards of this chapter.
Direct supervision - supervision in which the supervisor is physically present and accessible in the immediate client area and is available to intervene if necessary.
Endorsement - the process of issuing a certification to an HHA applicant who is registered by a state board and recognized by the Board as a qualified professional according to standards that were the substantial equivalent at the time of the certification to the standards for that profession set forth in this chapter and who has continually remained in good standing with the Board from the date of certification until the date of certification in the District.
General supervision - supervision in which the supervisor is available for consultation either in person or by a communication device, but need not be physically present on the premises.
Home health aide (HHA) - an individual, including a personal care aide (PCA), who as a result of training and demonstrated competencies, works under the supervision of a nurse or other health professional licensed in the District of Columbia and provides nursing or nursing related services to clients in a home setting or in assistive living facilities.
Immediate supervision – supervision in which the supervisor is physically with the supervisee and is either discussing or observing the supervisee’s practice.
In-service –learning experiences provided in the work setting for the purpose of assisting staff members in performing their assigned functions in that particular agency or institution; and consists of activities intended to assist the home health aide to acquire, maintain, or increase competence in fulfilling the assigned responsibilities specific to the expectations of the employer.
9399.2 The definitions in § 4099 of chapter 40 of this title are incorporated by reference and are applicable to this chapter.
All persons desiring to comment on the subject matter of this proposed rulemaking should file comments in writing not later than thirty days after the date of publication of this notice in the D.C. Register. Comments should be sent to the Department of Health, Office of the General Counsel, 899 North Capitol Street, N.E., 4th Floor, Washington, D.C. 20002. Copies of the proposed rule may be obtained from the Department at the same address during the hours of 9:00 a.m. and 5:00 p.m., Monday through Friday, excluding holidays.
