411-049-0125 Caregiver Qualifications (1) LICENSEE AND ADMINISTRATOR QUALIFICATIONS. An AFH licensee or administrator must: (a) Live in the home that is to be licensed at least five 24-hour days per week and function as the primary caregiver as defined in OAR 411-049-0102 unless: (A) There is, or shall be upon licensure, an approved resident manager who lives in the home and works five days and nights per week as the primary caregiver; (B) There is, or shall be upon licensure, two approved primary caregivers who live in the home and work three and four days and nights per week respectively; or (C) The home is staffed 24-hours a day at least five days a week with a combination of approved shift caregivers. (See OAR 411-049-0125(6)). (b) Subsections (a)(A), through (a)(C) of this section are not intended to prohibit the occasional and temporary absence of the primary caregivers from the AFH. (c) Be at least 21 years of age. (d) Possess physical health, mental health, good judgment, and good personal character, including truthfulness, determined necessary by the Department to provide 24-hour care for adults who are older or adults with physical disabilities. An applicant and licensee must have a statement from a physician, nurse practitioner, or physician assistant indicating that the applicant or licensee is physically, cognitively, and emotionally capable of providing care to residents. An applicant or licensee with documented history or substantiated complaints of substance abuse or mental illness must provide evidence satisfactory to the Department of successful treatment, rehabilitation, or references regarding current condition. (e) Have an approved background check in accordance with OAR 411-049-0120 and maintain that approval as required. (f) Be proficient in the English language and demonstrate the ability to comprehend and communicate in English orally and in writing with the residents and the residents' family members or representatives, emergency personnel (e.g., emergency operator, law enforcement, paramedics, and fire fighters), licensed health care professionals, case managers, DHS and LLA staff, and others involved in the care of the residents. (g) Be able to respond appropriately to emergency situations at all times. (h) Have a clear understanding of their responsibilities, knowledge of the residents' care plans, and the ability to provide the care specified for each resident; and not be listed on either of the Exclusion Lists. (2) LICENSEE AND ADMINISTRATOR TRAINING REQUIREMENTS. For licensees designated as corporate entities, at least one administrator must meet the training requirements described in (2)(a) – (2)(g) of this rule in addition to obtaining a variance as outlined in OAR 411-049-0160(2)(c)(C). (a) Licensees and administrators must have the education, experience, and training to meet the requirements of the requested classification of the home. (See OAR 411-049-0125). (b) A potential applicant or applicant must complete the following training requirements prior to obtaining a license: (A) Attend a DHS-approved orientation program conducted by the LLA responsible for the licensing of the proposed AFH. (B) Attend the Department's Ensuring Quality Care Course and pass the examination to meet application requirements for licensure. (i) Applicants who fail the first examination may take the examination a second time; however, successful completion of the examination must take place within 90 calendar days of the end of the Department's Ensuring Quality Care Course. (ii) Potential applicants and applicants who fail a second examination must retake the Department's Ensuring Quality Care Course prior to repeating the examination. (C) Comply with the Department's current Ensuring Quality Care Course student policies. (D) Have and maintain current CPR and First Aid certification. (i) Accepted CPR and First Aid courses must be provided by or meet the standards of the American Heart Association or the American Red Cross. (ii) CPR or First Aid courses conducted online are only accepted by the Department when an in-person skills competency check is conducted by a qualified instructor meeting the standards of the American Heart Association, the American Red Cross. (c) All caregivers must complete dementia training approved by the Department before providing direct care as mandated by ORS 443.743. The training shall be based on current standards in dementia care, and shall include: (A) Education on the dementia disease process, including the progression of the disease, memory loss, and psychiatric and behavioral symptoms. (B) Techniques for understanding and managing behavioral symptoms, including, but not limited to reducing the use of psychotropic medications for nonstandard uses. (C) Strategies for addressing the social needs of persons with dementia and providing them with meaningful activities. (D) Specific aspects of dementia care and ensuring the safety of residents with dementia, including, but not limited to, how to: (i) Address pain. (ii) Provide food and fluids. (iii) Prevent wandering and elopement. (iv) Use a person-centered approach. (d) Licensees, administrators, resident managers, floating resident managers, or shift caregivers must complete the required dementia training as mandated by ORS 443.743. (e) Licensees, administrators, resident managers, floating resident managers, shift caregivers, and substitute caregivers must complete the Department-approved LGBTQIA2S+ training as mandated by ORS 441.111 to 441.122. The Department-approved training shall address the elements described in paragraph (11)(c) of this rule. The following dates apply to the initial LGBTQIA2S+ trainings: (A) Effective December 31, 2024, all staff must have completed the required training. All new staff, hired on or after January 1, 2025, must complete the required training prior to beginning job responsibilities. (B) The Department-approved LGBTQIA2S+ trainings shall address the elements described in paragraph (11) of this rule. (f) HOME AND COMMUNITY-BASED SERVICES (HCBS) TRAINING. All caregivers, including licensees, administrators, resident managers, floating resident managers, shift caregivers or substitute caregivers are required to complete the Department-approved HCBS training, as provided below: (A) Effective March 31, 2024, all caregivers must have completed the required training. (B) All new caregivers, hired on or after April 1, 2024, must complete the required training prior to beginning job responsibilities. (g) CAREGIVER ORIENTATION. Prior to providing care to any resident, all caregivers must be oriented to the home and to the residents by the licensee or other qualified primary caregiver. Orientation must be clearly documented in the facility records. Orientation includes, but is not limited to: (A) Location of any fire extinguishers. (B) Demonstration of evacuation procedures. (C) Instruction of the emergency preparedness plan. (D) Location of resident records. (E) Location of telephone numbers for the residents' physicians, the licensee, and other emergency contacts. (F) Location of medications and the key for the medication cabinet. (G) Introduction to residents. (H) Instructions for caring for each resident. (I) How to administer medications properly. (J) How to document on the resident's medication administration record and other resident records. (K) Making arrangements with a registered nurse to delegate any nursing procedure that requires delegation prior to the caregiver performing that task. (L) Understanding the home's policies and procedures related to Advance Directives. (See OAR 411-050-0750). (3) FINANCIAL REQUIREMENTS. A licensee applicant and licensee must have the financial ability and maintain sufficient liquid resources to pay the operating costs of the AFH for at least two months without solely relying on potential resident income. (a) If an initial license applicant is unable to demonstrate the financial ability and resources required by this section, the Department may require the applicant to furnish a financial guarantee, such as a line of credit or guaranteed loan, to fulfill the requirements of this rule. (b) If at any time there is reason to believe an applicant or licensee may not have sufficient financial resources to operate the home in compliance with these rules, the LLA may request additional documentation, which may include verification of the applicant's or licensee's ability to readily access the requested funds. Circumstances that may prompt the request of additional financial information include, but are not limited to, reports of insufficient food, inadequate heat, or failure to pay employees, utilities, rent, or mortgage. Additional documentation of financial resources may include, but are not limited to: (A) The Department's Verification of Financial Resources form (APD 0448F) completed and stamped or notarized by the applicant's or licensee's financial institutions. (B) Documentation on letterhead of the applicant's or licensee's financial institutions that includes: (i) The last four digits of the applicant's or licensee's account number; (ii) The name of the account holder, and if the account is not in the applicant's or licensee's name, verification the applicant or licensee has access to the account's funds; (iii) The highest, lowest, and current balance for each of the most recent three full months; (iv) The line of credit balance available for each of the most recent three full months, if applicable; (v) The number of any non-sufficient fund (NSF) payments in each of the last three full months, if any; and (vi) The date and signature of the banking institution's representative completing the form. (C) Demonstration of cash on hand equal to a minimum of two months of operating expenses. (c) The LLA must request the least information necessary to verify compliance with this section. (4) RESIDENT MANAGER REQUIREMENTS. A resident manager must live in the home as specified in section (1)(a)(A) of this rule and function as the primary caregiver under the licensee or administrator’s supervision. A resident manager must meet and maintain the qualification and training requirements specified in sections (1)(c) through (2)(g) of this rule. The LLA shall verify all the requirements of these rules have been satisfied prior to approval of a resident manager. (5) FLOATING RESIDENT MANAGER REQUIREMENTS. (a) A floating resident manager must meet and maintain the qualification and training requirements specified in sections (1)(c) through (2)(g) of this rule, except as indicated in (5)(b) of this rule. (b) If the licensee has one or more homes within the jurisdiction of more than one LLA, a currently approved floating resident manager is not required to complete the Department-approved orientation in more than one licensing authority's jurisdiction. This exception does not prohibit the LLA within an exempt area from requiring the floating resident manager applicant to attend the LLA's orientation. (c) The floating resident manager must be oriented to each home prior to providing resident care in each home. (d) Facility records in each of the homes a floating resident manager is assigned to work must maintain proof the floating resident manager has a current and approved background check. (e) A floating resident manager may not be used in lieu of a shift caregiver, except on temporary basis, when the regular shift caregiver is unavailable due to circumstances, such as illness, vacation, or termination of employment. (6) SHIFT CAREGIVER REQUIREMENTS (a) Shift caregivers may be used in lieu of a resident manager. If shift caregivers are used, each shift caregiver must meet or exceed the experience and training qualifications for the license classification requested. (b) Shift caregivers must meet and maintain the qualification and training requirements specified in sections (1)(c) through (2)(g) of this rule. The LLA shall verify all the requirements of these rules have been satisfied prior to approval of a shift caregiver. (7) SUBSTITUTE CAREGIVER REQUIREMENTS. A substitute caregiver left in charge of the residents for any period of time, may not be a resident, and must at a minimum, meet all the following qualifications prior to working alone in the home. (a) Be at least 18 years of age. (b) Have an approved background check in accordance with OAR 411-049-0120 and maintain that approval as required. (c) Be proficient in the English language and demonstrate the ability to comprehend and communicate in English orally and in writing with the residents and the residents' family members and representatives, emergency personnel (e.g., emergency operator, law enforcement, paramedics, and fire fighters), licensed health care professionals, case managers, Department and LLA staff, and others involved in the care of the residents. (d) Be able to respond appropriately to emergency situations at all times. (e) Have a clear understanding of their responsibilities, have knowledge of the residents' care plans, and be able to provide the care specified for each resident, including appropriate delegation or consultation by a registered nurse. (f) Possess physical health, mental health, good judgment, and good personal character, including truthfulness, determined necessary by the Department to provide care for adults who are older or adults with physical disabilities, as determined by reference checks and other sources of information. (g) Substitute caregivers must complete CPR and First Aid training and certification within 30 calendar days of the start of employment. Certification must be maintained according to the standards established in (2)(b)(D) of this rule. (h) Not be listed on either of the Exclusion Lists. (A) The licensee or administrator must verify the substitute caregiver is not listed on either of these Exclusion Lists; and (B) Clearly document that verification in the facility's records. (i) All substitute caregivers must complete dementia training as stated in (2)(c). (j) All substitute caregivers must complete LGBTQIA2S+ training as outlined by OAR 411-049-0125(2)(e). (k) All substitute caregivers must complete HCBS training as outlined in OAR 411-049-0125(2)(f). (l) A substitute caregiver must be oriented to the home, as stated in (2)(g) of this rule, by the licensee or administrator at the home, before providing direct care to any residents. (m) A substitute caregiver must complete the Department's Caregiver Preparatory Training Study Guide (DHS 9030) and Workbook (DHS 9030-W) and receive instruction in specific care responsibilities from the licensee or administrator prior to working or training in the home. The Workbook must be completed by the substitute caregiver without the help of any others. The Workbook is considered part of the required orientation to the home and residents. (A) The LLA may grant a variance to the Caregiver Preparatory Training Study Guide and Workbook requirement for a substitute caregiver who: (i) Holds a current Oregon license as a health care professional, such as a physician, nurse practitioner, physician assistant, registered nurse, or licensed practical nurse; and (ii) Demonstrates the ability to provide adequate care to residents based on similar training or at least one year of experience providing direct care to adults who are older or adults with physical disabilities. (B) A certified nursing assistant (CNA) or certified medical assistant (CMA) must complete the Caregiver Preparatory Training Study Guide and Workbook and have a certificate of completion signed by the licensee or administrator. (8) Contractors who provide services or supports directly to residents must complete the LGBTQIA2S+ trainings outlined in paragraph (11)(c) of this rule. (a) Contractors who must be trained include, but are not limited to, RN consultants and administrative consultants, housekeeping services, dietary services, beauticians, barbers, or other contractors who provide services or supports directly to residents. (b) Exempt from this training requirement are contractors who contract directly with the resident or the resident’s representative, and contractors who do not generally provide services or supports directly to residents, including but not limited to, contractors for landscaping, pest control, deliveries and building repairs. (c) By December 31, 2024, licensees or administrators shall ensure that all contracts entered into with entities described in paragraph (a) of this section shall include language requiring contractors provide Department-approved LGBTQIA2S+ training to their employees within 12 months of entering into the contract with the licensee or administrator and every two years thereafter. (d) For existing contracts in effect January 1, 2025, licensees or administrators shall require the contractor provide Department-approved LGBTQIA2S+ training to employees by December 31, 2025, and every two years thereafter. (e) For new contracts created after January 1, 2025, licensees or administrators shall require contractors provide the Department-approved LGBTQIA2S+ training to employees within 12 months of entering into the contract with the facility, and every two years thereafter. (f) Licensees or administrators must inform contractors that the cost of all LGBTQIA2S+ trainings for contracted employees shall be paid by the contractor. (9) TRAINING WITHIN FIRST YEAR OF INITIAL LICENSURE OR APPROVAL. Within the first year of obtaining an initial license or approval, the licensee, administrator, resident manager, floating resident manager, and shift caregivers must complete the "DHS Six Rights of Safe Medication Administration" and a Fire and Life Safety training as available. The Department or LLA and the Office of the State Fire Marshal or the local fire prevention authority may coordinate the Fire and Life Safety training program. (10) ANNUAL TRAINING REQUIREMENTS. (a) Each year after initial licensure, the licensee, administrator, resident manager, floating resident manager, and shift caregivers must complete at least 12 hours of Department-approved training related to the care of adults who are older or adults with physical disabilities in an AFH setting. Up to: (A) Four hours of the required annual training may be related to the business operation of the AFH. (B) Two hours of CPR training and two hours of First Aid training may count as part of the required annual training. (b) A licensee, administrator, resident manager, floating resident manager, and shift caregivers, as applicable, must maintain approved CPR and First Aid certification. (c) HOME AND COMMUNITY-BASED SERVICES (HCBS) TRAINING. (A) All caregivers, including licensees, administrators, resident managers, floating resident managers, shift caregivers or substitute caregivers are required to complete the Department-approved annual HCBS training. (B) These annual training requirements will be required as of April 1, 2025. (d) Registered nurse delegation or consultation, and the Ensuring Quality Care Course (not including approved EQC refresher courses), AFH orientation, Ventilator Assisted Care Course and skills competency checks, or consultation with an accountant do not count toward the required 12 hours of annual training. (11) BIENNIAL TRAINING REQUIREMENTS. Licensees, administrators, resident managers, floating resident managers, shift-caregivers, substitute caregivers, and contracted staff, shall be required to complete biennial training addressing LGBTQIA2S+ protections, as described in this section. Licensees or administrators are responsible for the cost of providing this training to all staff. (a) Each AFH shall designate two employees, as reasonable, one to represent management and one to represent direct care staff by July 1, 2024. The individual designated to represent management shall serve as a point of contact for the AFH regarding compliance with preservice training and biennial training. This person shall develop a general training plan for the AFH. For licensees and administrators that are also the primary caregiver, only one staff person will be required to be designated. (b) The licensee or administrator must select the LGBTQIA2S+ training to be used by the AFH by either: (A) Choosing to use the standard Department-approved biennial LGBTQIA2S+ training; or (B) Applying to the Department to request approval of a biennial LGBTQIA2S+ training to be developed and provided by the licensee or administrator. (c) ORS 441.116 requires all LGBTQIA2S+ trainings address: (A) Caring for LGBTQIA2S+ residents and residents living with human immunodeficiency virus; and (B) Preventing discrimination based on a resident’s sexual orientation, gender identity, gender expression or human immunodeficiency virus status. (C) The defined terms commonly associated with LGBTQIA2S+ individuals and human immunodeficiency virus status. (D) Best practices for communicating with or about LGBTQIA2S+ residents and residents living with human immunodeficiency virus, including the use of an individual’s chosen name and pronouns. (E) A description of the health and social challenges historically experienced by LGBTQIA2S+ residents and residents living with human immunodeficiency virus, including discrimination when seeking or receiving care at care facilities and the demonstrated physical and mental health effects within the LGBTQIA2S+ community associated with such discrimination. (F) Strategies to create a safe and affirming environment for LGBTQIA2S+ residents and residents living with human immunodeficiency virus, including suggested changes to care facility policies and procedures, forms, signage, communication between residents and their families, activities, in-house services and staff training. (G) The individual or entity providing the training must demonstrate a commitment to advancing quality care for LGBTQIA2S+ residents and residents living with human immunodeficiency virus in this state. (d) The proposal for training submitted by a licensee, administrator, entity, or individual shall include: (A) The regulatory criteria described in paragraph (c) of this section as part of the proposal. (B) The following elements must be included in the proposal: (i) A statement of the qualifications and training experience of the individual or entity providing the training. (ii) The proposed methodology for providing the training either online or in person. (iii) An outline of the training. (iv) Copies of the materials to be used in the training. (C) The Department will review the materials and determine whether to approve or deny the training. No later than 90 days after the request is received, the Department will inform the licensee or administrator in writing of the Department’s decision. Statutory/Other Authority: ORS 409.050, 410.070, 413.085, 441.122, 443.001, 443.004, 443.725, 443.730, 443.735, 443.738, 443.742, 443.767, 443.775 & 443.790 Statutes/Other Implemented: ORS 409.050, 410.070, 413.085, 441.116, 441.118, 443.001 - 443.004, 443.705 - 443.825, 443.875 & 443.991 History: APD 31-2024, amend filed 06/21/2024, effective 07/01/2024 APD 10-2024, temporary amend filed 03/27/2024, effective 04/01/2024 through 07/06/2024 APD 1-2024, temporary amend filed 01/08/2024, effective 01/09/2024 through 07/06/2024 APD 45-2022, minor correction filed 09/26/2022, effective 09/26/2022 APD 61-2021, amend filed 12/23/2021, effective 01/01/2022 APD 19-2019, adopt filed 06/20/2019, effective 07/01/2019