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Attendant Education: Full-time facility
attendants must be at least 18 years old or a high-school
graduate.
(A) An attendant must be in the facility at all
times when residents are in the facility.
(B) Attendants are not precluded from performing other functions
as required by the assisted living facility.
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; in Type E
facilities, medications and recognizing, reporting, and
recording side effects;
(ii) resident's health conditions and how they may affect
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, or fall prevention, or 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 nursing 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.
*From: Texas Department of Aging and Disability
Services (DADS) Licensing Standards for Assisted Living Facilities
Subchapter A, §92.41
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