You asked for information on the state's regulation of home health aides, including past legislative proposals addressing their certification.

SUMMARY

The state does not require the licensure or certification of home health aides, but home health care agencies must be licensed by the Department of Public Health (DPH). Under state regulation, home health aides providing services on behalf of a home health agency must have successfully completed a DPH-approved training and competency program.

The General Assembly has considered, but not passed, numerous legislative proposals over the past few years addressing home health aides. Many of these called for background checks on aides. Bills in 2000 and 2001 would have established a DPH-administered certification program for home health aides. The 2000 bill passed the House but not the Senate while the 2001 legislation died in the Appropriations Committee.

TRAINING REQUIREMENTS FOR HOME HEALTH AIDES

State law does not require the certification or licensure of home health aides. But home health aides employed by home health agencies must receive minimum training, as prescribed by state regulations. This includes completion of a training program of at least 75 hours and a competency evaluation. The standard curriculum must include such areas as (1) communication skills; (2) observing, reporting, and documenting patient status and services and care provided; (3) reading and recording patient temperature, pulse, and respiration; (4) basic infection control; (5) appropriate and safe techniques in personal hygiene and grooming, including bathing, shampooing, skin care, toileting, and elimination; and (6) safe transfer techniques and ambulation. (see DPH Regs. , § 19-13-D69 (d)(2)).

The home health care agency regulations deem nurse's aides who have completed the requisite training and competency evaluation (see below) to have completed the home health aide training. These individuals must still complete a competency evaluation and must be provided with 10 hours of orientation by the agency employing them before they can provide services (DPH Regs. , § 19-13-D66, et. seq. ).

Nurse's aides working more than 120 days in a licensed nursing home must complete a 100-hour training and competency evaluation program. They must also be registered with DPH. A minimum of 75 of these hours must cover basic nursing skills, personal care skills, care of cognitively impaired residents, recognition of mental health and social service needs, basic restorative services, and residents' rights. An additional 25 hours must include specialized training in understanding and responding to physical, psychiatric, psychosocial, and cognitive disorders (DPH Regs. , § 19-13-D8t et seq. ).

PRIOR LEGISLATIVE PROPOSALS

Numerous legislative proposals requiring the certification of or background checks on home health care aides have been considered, but not passed, in recent legislative sessions. Generally these proposals failed because of cost issues for the responsible state agency, concerns about limiting individuals ability to work, and debate over who would be responsible for conducting and paying for background checks. Some of the proposals that received favorable committee action are highlighted below.

In the 2002 regular session, sSB 132 would have required nationwide criminal background checks on caregivers and administrators who seek and are offered work in a nursing home or home health care agency, including people hired through a temporary employment agency. Caregivers include people whose employment or contractual service with a care provider includes physical access to patients or access to patients' finances. The bill would have prohibited providers from hiring such employees without a background check starting October 1, 2002.

The bill established procedures for these background checks. It prescribed the duties of the Department of Public Safety (DPS), which would conduct the checks, and DPH, which would make the decision to disqualify people from such employment if they were unfit for it and had been convicted, incarcerated, or on probation in the past three years for any of a list of specified crimes. The bill gave a disqualified applicant an opportunity for a hearing and appeal. DPH had to keep the background check information confidential. This bill originated in the Aging Committee and was favorably reported by it and the Public Health Committee. The bill was later referred to the Judiciary Committee where it died.

A 2001 bill (sHB 6725) would have established a certification program for home health aides, administered by DPH. It set certification requirements and authorized DPH to take disciplinary action against aides for failing to conform to accepted professional standards. Under the bill, home health care agencies or homemaker-home health aide agencies could only employ certified aides or those seeking certification. The bill also required home health aides and caregivers employed by an agency other than as home health aides to submit to criminal history records checks. This bill was favorably reported by the Public Health Committee but died in the Appropriations Committee (A copy of this proposal is attached).

During the 2000 session, sHB 5788 was introduced and initially considered by the Public Health Committee. This bill would have established a certification program for home health aides administered by DPH. It also would have required home health aides (along with emergency medical technicians and "caregivers") to submit to criminal history records checks to work in the state. It would have prohibited a home health care agency from employing a person as a home health aide unless (1) he was certified and (2) the agency had obtained a state criminal history records check done within six months of the hiring date. This bill passed the House (with a number of amendments) on May 3, but died in the Senate.

A 1999 bill (HB 6727) would have required each individual applying to work as a caregiver in a nursing home, skilled nursing facility, rest home, home health agency, or adult day care center to undergo a criminal background check. The bill received a favorable report from the Aging Committee but the Public Health Committee took no action on the bill.

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