ACT No. 571 NURSING FACILITY and ADULT RESIDENTIAL CARE FACILITY DEMENTIA TRAINING CURRICULUM APPROVAL APPLICATION PACKET

Similar documents
ACT NMMM ACT No. 571 NURSING FACILITY and ADULT RESIDENTIAL CARE FACILITY DEMENTIA TRAINING CURRICULUM APPROVAL APPLICATION PACKET

PROVIDER TYPE SPECIFIC PACKET/CHECKLIST. ENVIRONMENTAL ACCESSIBILITY ADAPTATIONS (EAA) (Environmental Modifications) ASSESSOR

Sponsor Continuing Education Instructions and Application

Registered Dietician (Individual)

Photo: YES or NO. Skills Performed Approved: YES or NO. Current Provider Certification. Affiliation Agreement. Candidate Application

PROVIDER TYPE SPECIFIC PACKET/CHECKLIST

First Aid/CPR Training Program Application Packet

APPLICATION INSTRUCTIONS FOR INITIAL LICENSURE BY EXAMINATION FOR REGISTERED NURSES GENERAL INFORMATION

South Carolina Department of Labor, Licensing and Regulation South Carolina Board of Long Term Health Care Administrators

NOTE: This document includes amendments, effective 3/20/15, to Regulations under COMAR 13A

NORTH CAROLINA MARRIAGE AND FAMILY THERAPY LICENSURE BOARD

STATE OF KANSAS OFFICE OF THE ATTORNEY GENERAL Through the KANSAS BUREAU OF INVESTIGATION INSTRUCTIONS

APPLICATION FOR WASHINGTON STATE CAREER AND TECHNICAL EDUCATION ENDORSEMENT (Specialty Area)

REQUEST FOR PROPOSALS FOR MENTAL HEALTH AWARENESS TRAININGS

NANT Contact Hour Application Instructions

LEM Basic APPLICATION BOOKLET

INSTRUCTIONS AND INFORMATION APPLICATION FOR INITIAL NURSE LICENSURE BY EXAMINATION

Clinical Fellowship or Doctoral Externship License Speech Language Pathologist (SLP)/Audiologist (Aud)

MEMORANDUM Department of Aging and Disability Services Regulatory Services Policy*Survey and Certification Clarification

Personal Care Attendant

NABET Accreditation Criteria for QMS Consultant Organizations (ISO 9001: 2008)

If applying for Testing Accommodations under the Americans with Disabilities Act (ADA):

Carefully read the following information, application instructions, and the NCLEX Candidate Bulletin prior to completing the enclosed application.

SIERRA-SACRAMENTO VALLEY EMS AGENCY PROGRAM POLICY REFERENCE NO. 1001

Single Program Application

Oklahoma Association of Health Care Providers Certified Medication Aide (CMA) Training Program 2018 General Information Qualifications for admission

Student Vice President Leadership Summit

RECERTIFICATION RENEWAL By 60 Points of Credit

ATTACHMENT B SAMPLE REQUEST FOR APPLICATION PROVIDERS OF SERVICES FOR CHILDREN AND FAMILIES UNDER THE EARLY INTERVENTION PROGRAM

Application. COMPANY INFORMATION (Web listing information will appear as provided in box below) APPLICATION TYPE: PAYMENT OPTIONS

A $ application fee in the form of a money order made payable to LSBN must accompany this form.

Independent Study Planning Documentation Form

Air Products PTEC Scholarship Application

REINSTATEMENT APPLICATION PACKET:

Professional Credential Services, Inc.

Prospective Conrad State 30 J-1 Visa Waiver Physician Employers/Sponsors. Director, Mississippi Office of Rural Health and Primary Care

Louisiana Press Association Foundation. Application. Please complete application and return to: 404 Europe St. Baton Rouge, LA 70802

NCCDP National Council of Certified Dementia Practitioners. Indiana Health Care Association

MEMO. DATE June Licensed Speech-Language Pathologist and Audiologist, Applicants for licenses and other interested persons

CUNA ELLy Awards 2018 cuna.org/ellys

REMINDER RFQ#: Administering Screens and Assessments: ASQ3 and ASQ-SE Training DEADLINE FOR SUBMISSION IS. July 24, PM

INSTRUCTIONS FOR LPC APPLICATION (Advancing from LAPC) Download this application to advance to LPC from LAPC.

Licensed Nursing Assistant Renewal/Reinstatement Application

NASW-Idaho Chapter. Application Date: Date of Event: Applying Agency: Name of Event:

DEPARTMENT OF HUMAN SERVICES AGING AND PEOPLE WITH DISABILITIES DIVISION OREGON ADMINISTRATIVE RULES CHAPTER 411 DIVISION 58

INSTRUCTIONS AND INFORMATION FOR APPLICATION FOR INITIAL NURSE LICENSURE BY EXAMINATION

Post-Completion Optional Practical Training (OPT)

RULES OF DEPARTMENT OF COMMERCE AND INSURANCE DIVISION OF REGULATORY BOARDS CHAPTER PRIVATE PROTECTIVE SERVICES TABLE OF CONTENTS

East Baton Rouge Parish Junior Deputy

*NOTICE * THIS APPLICATION WAS REVISED IN JULY 2016 PLEASE READ CAREFULLY -

Portfolio Review Process to obtain Northern Lights Career Development Center Level I Certificate

Please Note: Please send all documentation related to the credentialing portion of this documentation to:

SECURITY GUARD. LICENSE First Time Licensees or New Qualifier

MARIJUANA BUSINESS NEW LICENSE APPLICATION

Individual Training Accounts & Eligible Training Provider Policy

Enhances and validates your nursing specialty knowledge and competence. Recognizes you as a resource and leader to your colleagues in your specialty.

Application for Admission

NAMI Illinois 2010 Annual Conference

Personal Emergency Response System

Carefully read the following information and instructions prior to completing the enclosed forms.

NATIONAL ACADEMY of CERTIFIED CARE MANAGERS

Maryland Commercial Air Ambulance Services

SB 420 Medical Marijuana Identification Card MMIC Program

Advanced Practice. RECERTIFICATION RENEWAL By 80 Points of Credit

Travis County Commissioners Court APPLICATION PACKET. For

KEY PERSONNEL REGISTRATION (Application forms are a part of this bulletin)

Empower. Excel. Succeed. Don t Delay, Become a CEAL. Now! Certified Executive for Assisted Living

ANCC Accreditation Self-Study Criteria for Approved Providers

EMPLOYERS TRAINING RESOURCE TH STREET BAKERSFIELD, CA POLICY BULLETIN: #ETR 21-05

FIREARMS TRAINING COURSE REQUIREMENTS TO OBTAIN A FIREARMS QUALIFICATION CARD

City of Hudson Department of Fire 520 Warren Street Hudson, New York 12534

NABET Criteria for Food Hygiene (GMP/GHP) Awareness Training Course

Sidewalk Café Permit GUIDELINES & CHECKLIST

Transportation Safety Center Licensing Section UNM Continuing Education MSC University of New Mexico Albuquerque, NM

EPSDT Health Services

Maryland Workers Compensation Rehabilitation Service Practitioner Application Instructions

Dental Hygienists Caring for the Community

2015 DISTRICT STUDENT TRUSTEE. Election Packet. Compiled and distributed by the Student Trustee Advisory Council

2017 CAL COAST CARES FOUNDATION SCHOLARSHIP PROGRAM

Tulane University APPLICATION FOR ADMISSION Public Health In Cuba May 27 June 7, 2013

[ ] DEFINITIONS.

NURSING HOME ADMINISTRATOR REQUIREMENTS AND INSTRUCTIONS

2017 Partnership Opportunities

2018 State Combined Charitable Campaign - Charity Application

Developmental Disabilities Nurses Association

July 1, June 30, 2019

Professional Credential Services, Inc.

Registered Nurse Renewal Application

KIDMED SCREENING CLINIC

All Members of Florida Land Title Association, Inc. AND Florida Title Professionals

Registered Nurse Renewal/Reinstatement Application

CDDO HANDBOOK MISSION STATEMENT

Wisconsin Builders Foundation Scholarship Fund Application

Workshop Proposal Form

Kansas City Associated Equipment Distributors Scholarship Application 2017

Louisiana State Board of Nursing Perkins Road, Baton Rouge, LA Main Telephone: (225)

2018 Community Tennis Grant

Professional Credential Services, Inc.

Nlifll~lI~wil(iMI~I~llllllllli

Agency-based Provider vs. Independent Provider

Transcription:

ACT No. 571 NURSING FACILITY and ADULT RESIDENTIAL CARE FACILITY DEMENTIA TRAINING CURRICULUM APPROVAL APPLICATION PACKET GENERAL INFORMATION Acts 2008, No. 571 was enacted in the Regular Session of the Louisiana Legislature in 2008. The legislation is to define requirements for initial dementia training in Adult Residential Care and Nursing Facilities. The legislation requires that all employees in these facilities be trained according to the provisions of Acts 2008, No. 571 (R.S. 40:2200.1-.5). The Louisiana Department of Health (LDH), Office of Aging and Adult Services (OAAS) designated Pennington Biomedical Research Center (PBRC) as the Oversight Organization for the review and approval of dementia training curricula used in long-term care settings for new employees. Any provider, organization, entity or individual may submit a curriculum for approval. The information and instructions that follow will assist you in completing your applications for curriculum approval. Please note that if your facility is using a dementia training curriculum from another entity that already has an active approval from the State of Louisiana, you do not have to apply for approval again. Refer to that entity to verify that the curricula being used are approved, and/or see the Approved Curricula List located on PBRC s website. Current approval codes for all curricula must be kept on file as evidence of compliance with Act 571. Should you have any questions concerning the application and/or the approval process, please send an email to dementiatraining@pbrc.edu or call (225)763-2990. 1

CURRICULUM APPROVAL APPLICATION PROCESS Within 10 working days of receiving an application, PBRC will notify applicants as to whether their application is administratively complete and ready for technical review or whether additional information or materials need to be submitted in order for the curriculum to be reviewed. Once receipt of a complete application has been confirmed, PRCC has 30 calendar days to complete the technical review of the curriculum. PBRC will notify applicants in writing of: approval status expiration date of curriculum approval/renewal approval/renewal numbers for all curricula. Status assigned will be approved, approved with comments and recommendations, or denied with comments. Approved curricula and contact information for the provider will be posted on PBRC s web site. PBRC will provide a link to the LDH site where requirements for compliance with Acts 2008, No. 571 can be found. CURRICULUM TYPES AND COMPONENTS There are two types of Dementia Training curricula that are subject to review and approval/renewal: 1. Curricula intended for use with Nursing Facility staff (Nursing Facility Curricula), or 2. Curricula intended for use with Adult Residential Care staff (ARC Curricula). Within these two types, there are different training requirements depending on the type of new employee (please see the list of employee categories on the website). Curricula may target all employees, including those that work on a dementia special care unit and those that do not, or it may target sub-categories of employees (for instance, just direct care staff who work on a dementia special care unit in an ARC). The fees for an initial curriculum review depends on the scope of the submitted curriculum (i.e., numbers of hours) and the category/type of employee to be trained using the curriculum. The fees for a renewal also depend on the above as well as whether or not a significant change has been made to a previously approved curriculum. Please see the fee schedule at the end of this application. CURRICULUM Documentation of curriculum must include the following: 1) objectives clearly stated in measurable terms for each of the curriculum requirements for each specific employee category 2) topics to be included and outline of information to be presented on each topic 3) topics must include those required by Acts 2008, No. 571: (1) an overview of Alzheimer s disease and related dementias; (2) communicating with persons with dementia; (3) behavior management for person with dementia; (4) promoting independence in activities of daily living for persons with dementia; and (5) understanding and dealing with family issues for persons with dementia; 4) amount of time dedicated to each topic covered 5) teaching methods to be used 6) references on which the curriculum is based. It is your responsibility to ensure that no copyright laws have been violated if material from another source is used as part of your curriculum. 2

Documents required for review and approval must also include the following: One (1) copy of each curriculum (handouts, power point slides, instructor notes, etc.) identified by employee category for training Name of training coordinator and his/her qualifications Current resume of coordinator Method of instruction (classroom, web-based, or brochure, etc.) Method of evaluation of instruction (see below) RENEWALS Please note that for renewals, any significant change to a previously-approved curriculum must be indicated. A significant change is defined as any change of 50% or more to the training content; a change to the content regarding three or more required topics; or a change in the delivery method of the training (e.g., from classroom-based to web-based). PROGRAM EVALUATION Curriculum providers must include some methods of evaluation to determine the effectiveness of the Dementia Training curriculum. Evaluations should be done at the conclusion of each curricula training session. The purpose of such evaluation is to ensure that learning needs of employees have been fulfilled and to assist in planning better programs in the future. Evaluation of the curricula training session must include: achievement of objectives evaluation of satisfaction with the presenter's content evaluation of the facilities and arrangements for the training session DETERMINATION OF CREDIT HOURS The number of training hours (60 minutes equals one contact hour) will be reviewed based on the employee category requirements as specified in Acts 2008, No. 571. Curricula must be approved by PBRC prior to Dementia Training for credit to be awarded to individual employees. Approved contact hour credit will apply only to designated instruction time with the presenter and discussions led by the presenter or staff. It shall not include informal discussions over lunch or other non-instructional activities outside designated instruction time. DOCUMENTATION OF ATTENDANCE Each Nursing Facility and Adult Residential Care Facility must monitor participant attendance at Dementia Training through the use of sign-in records. Electronic records can be used for computer based instruction. ISSUANCE OF CERTIFICATES Certificates must be issued to all participants who have successfully completed the program. The certificate must include the employee name and job title, curriculum title, date and location (city) of the program and signature of the trainer. The certificate must include the following statement: This Dementia Training Curriculum has been approved for (number) Dementia Training contact hours by Pennington Biomedical Research Center as authorized by the State of Louisiana Department of Health. Certificates for partial attendance may not be issued. 3

PERMANENT RECORDS As part of the permanent record of each approved curricula, and in order to document compliance with Acts 2008, No. 571, Nursing Facility and Adult Residential Care providers should keep the following information: Up-to-date curriculum approval/renewal numbers Intended audience Course learning objectives Program content Program length Teaching methodology/format Curricula developer and presenter qualifications Evaluation of presenter Sign-sheets Handouts provided to participants Copy of approved curriculum and references 4

Acts 2008, No. 571 NURSING FACILITY and ADULT RESIDENTIAL CARE FACILITY DEMENTIA TRAINING REQUIREMENTS CURRICULA APPROVAL APPLICATION FORM SPECIAL INSTRUCTIONS: Please carefully read this application and fill in all of the blanks. Send the completed application and all training curricula materials to: By Email: (preferred method) dementiatraining@pbrc.edu By Regular or Express Mail: Pennington Biomedical Research Center Institute for Dementia Research & Prevention ATTN: Dementia Training Approval 6400 Perkins Road Baton Rouge, LA 70808 *If you would like the materials returned, please include a postage-paid label For Agency Use Only: Type Initial Renewal Received Acknowledged Need More Information Approved Fees received Approval Codes. APPLICANT CONTACT INFORMATION: Name: Credentials: Organization: Mailing Address: (Street or P.O. Box) (City) (State) (Zip code) Telephone: ( ) Fax: ( ) Email: Check the proper code for each curriculum for which you are seeking approval/renewal: 5

NF/SCU-8 NF-4A ARC/SCU-8 ARC-2 NF/SCU-4 NF-4B ARC/SCU-4 ARC-W NF/SCU-W NF-W ARC/SCU-W Is this application for a renewal of previously approved curricula? YES NO If renewing, has there been a significant change to the curriculum (as defined on page 3)? Yes (please detail changes on a separate page) No APPLICATION AFFIDAVIT I HERBY AFFIRM THAT ALL INFORMATION INCLUDED IN THIS APPLICATION PACKET IS TRUE AND CORRECT. Print or Type Name of Applicant Signature of Applicant Date 6

APPLICATION FEES: The fee for the curriculum review depends on the scope of the submitted curriculum (i.e., the number of hours) and the category and type of employees to be trained using the curriculum. Renewal fees also depend on the category and type of employees being trained and whether or not a significant change in content has been made to a previously approved curriculum. Significant change is defined as any change of 50% or more to the training content; a change to the content regarding three or more required topics; or a change in the delivery method of the training (e.g., from classroom-based to web-based). INITIAL APPLICATION: Facility Type (A) Employee provides direct care (B) Employee provides regular communication, NO direct care Employee has incidental contact with residents Nursing Facility with Special Care Unit 8 hours $200 4 hours $100 Written $35 Nursing Facility with NO Special Care Unit 4 hours $100 4 hours $100 Written $35 Adult Residential Care with Special Care Unit 8 hours $200 4 hours $100 Written $35 Adult Residential Care with NO Special Care Unit 2 hours $75 Written $35 Written $35 Facility Type SIMPLE RENEWAL (NO Significant Change): (A) Employee provides direct care (B) Employee provides regular communication, NO direct care Employee has incidental contact with residents Nursing Facility with Special Care Unit 8 hours $100 4 hours $50 Written $20 Nursing Facility with NO Special Care Unit 4 hours $50 4 hours $50 Written $20 Adult Residential Care with Special Care Unit 8 hours $100 4 hours $50 Written $20 Adult Residential Care with NO Special Care Unit 2 hours $35 Written $20 Written $20 RENEWAL/REVISION WITH SIGNIFICANT CHANGE TO PREVIOUSLY APPROVED CURRICULUM Facility Type (A) Employee Employee has incidental provides direct care contact with residents (B) Employee provides regular communication, NO direct care Nursing Facility with Special Care Unit 8 hours $150 4 hours $75 Written $25 Nursing Facility with NO Special Care Unit 4 hours $75 4 hours $75 Written $25 Adult Residential Care with Special Care Unit 8 hours $150 4 hours $75 Written $25 Adult Residential Care with NO Special Care Unit 2 hours $50 Written $25 Written $25 An approved training curriculum remains effective seven (7) years from the date approval is obtained from the Oversight Organization. Please make checks payable to: Pennington Biomedical Research Center. All fees are non-refundable. Send payment to: Pennington Biomedical Research Center Institute for Dementia Research & Prevention Attn: Dementia Training Approval 6400 Perkins Road Baton Rouge, LA 70808 7

APPLICANT CHECKLIST Application Contact Information Form Curriculum Category for Approval or Renewal indicated Indication That a Significant Change Has/Has Not Been Made (if renewing) Name of Curriculum Coordinator Qualifications Current Resume Curriculum Title Page(s) for Each Employee Category Objectives Content Topics Detailed Content Outline Time Frame for Each Topic Teaching Methods (ie, face-to-face, online, etc.) Curriculum Evaluation Form Sign-in Sheet Sample Certificate One (1) copy of each curriculum for each employee category (please include postage-paid label if you would like your training materials returned) Please make checks payable to: Pennington Biomedical Research Center. All fees are non-refundable. Send payment to: Pennington Biomedical Research Center Institute for Dementia Research & Prevention Attn: Dementia Training Approval 6400 Perkins Road Baton Rouge, LA 70808 If you have any questions regarding this application, please email dementiatraining@pbrc.edu or call 225-763-2990. 8