NEW JERSEY REGISTER
VOLUME 33, NUMBER 13
MONDAY, JULY 2, 2001
RULE PROPOSAL
LAW AND PUBLIC SAFETY
DIVISION OF CONSUMER AFFAIRS
NEW JERSEY BOARD OF NURSING
HOMEMAKER-HOME HEALTH AIDE TRAINING PROGRAM;
HOME CARE AND HOSPICE CARE TRAINING PROGRAMS

Additions are indicated by <<+ Text +>>; deletions by <<- Text ->>.
Changes in tables are made but not highlighted.

Proposed Amendment: N.J.A.C. 13:37-14.4

Proposed New Rule: N.J.A.C. 13:37-14.5

Proposed Recodification with Amendments: N.J.A.C. 13:37-14.5 to 14.14 as 14.6 to 14.15

Authorized By: New Jersey Board of Nursing, Patricia Polansky, Executive Director.

Authority: N.J.S.A. 45:11-24.

Proposal Number: PRN 2001-262.

Submit written comments by August 1, 2001 to:

Patricia Polansky, Executive Director
New Jersey Board of Nursing
PO Box 45010
124 Halsey Street
Newark, NJ 07101
The agency proposal follows:

Summary

Pursuant to its rulemaking powers found in N.J.S.A. 45:11-24, the New Jersey Board of Nursing (the Board) proposes amendments to N.J.A.C. 13:37- 14.4 and new rule N.J.A.C. 13:37-14.5, concerning homemaker-home health aide training programs. The amendments to N.J.A.C. 13:37-14.4(d) require that the curriculum of a homemaker-home health aide course include instruction in the role of an unlicensed assistive person in a nursing care setting, foundations for working with people and foundations for a safeclient environment. Homemaker-home health aide training programs should also include information concerning the musculoskeletal system, the integumentary system, the upper gastrointestinal system, the lower gastrointestinal system, the urinary system, the cardiovascular and respiratory system, the neurological system, the endocrine system, the reproductive system and the immune system. Instruction should include an overview of the anatomy and physiology of each system, conditions and disorders common to each system, changes with regard to each system that the homemaker-home health aide should report to a nurse and client care related to each system. The amendment also requires that the training program include instruction in rest and sleep as well as instruction in death and dying.

New rule N.J.A.C. 13:37-14.5 requires additional courses for a homemaker- home health aide training program in home care and hospice care settings. A homemaker-home health aide training program must include instruction in the role of the homemaker-home health aide, foundations for a safe client environment, home care considerations, infant and child care, the responsibility of an agency to the homemaker-home health aide and foundations for working with the home care client, family, significant others and other home care team members. Existing N.J.A.C. 13:37-14.5 to 14.14 are recodified as new sections N.J.A.C. 13:37-14.6 to 14.15 in order to accommodate proposed new rule N.J.A.C. 13:37-14.5. Existing N.J.A.C. 13:37-14.6 and 14.8 are amended to correct cross-references, due to the recodification.

Social Impact

The Board believes that the proposed amendment to N.J.A.C. 13:37-14.1 and the new rule will benefit certified homemaker-home health aides and the consumers they serve. The amendment and new rule require that all homemaker- home health aides receive training in a variety of areas so that these aides are adequately prepared to provide care for their clients. Consumers are protected by the amendment and new rule because they will receive proper care from their aides.

Economic Impact

The Board does not believe that the proposed amendment to N.J.A.C. 13:37- 14.4 and the new rule will have an economic impact on applicants for certification as homemaker-home health aides because the training program for an applicant is provided free of charge by the agency for which the aide works. Agencies which provide training courses may incur costs because they will have to revise their curriculum to conform to the dictates of the proposed amendment to N.J.A.C. 13:37-14.4 and the new rule; however, the Board does not envision that this cost will be large, as the majority of training programs currently teach a curriculum that covers the information required by the amendment and rule.

Federal Standards Statement

No Federal standards or requirements are applicable to the proposed amendments and new rule.

Jobs Impact

The Board does not believe that the proposed amendments and new rule will have an impact on jobs in the State. A homemaker-home health aide is currently required to complete a training program and the amendment to N.J.A.C. 13:37- 14.4 and the new rule simply outline what the curriculum of that training program should include.

Agriculture Industry Impact

The Board does not believe that the proposed amendments and new rule will have any impact on the agriculture industry of this State.

Regulatory Flexibility Analysis

If, for the purposes of the Regulatory Flexibility Act, N.J.S.A. 52:14B-16 et seq., the approximately 165 training programs that instruct student homemaker-home health aides are considered "small businesses," then the following analysis applies.

The Act requires the Board to set forth the reporting, recordkeeping and other compliance requirements of the proposed amendments and new rule including the kinds of professional services likely to be needed to comply. The Act further requires the Board to estimate the initial and annual compliance costs of the proposal with an indication of the varying impact on small businesses of differing types and sizes and to outline the manner in which it has designed the rules to minimize any adverse economic impact upon small businesses.

The proposed amendments and new rule do not impose reporting or recordkeeping requirements. They do impose compliance requirements in that a homemaker-home health aide training program must provide training in the areas required by the proposed amendment to N.J.A.C. 13:37-14.4 and new rule. The Board believes that because the proposed amendments and new rule further the welfare and safety of the public in its dealings with homemaker-home health aides, by ensuring that these aides have proper instruction, the proposed amendments and new rule must be applied uniformly to all training programs regardless of their size.

The costs imposed on small businesses by the proposed amendments and new rule are the same costs that are imposed on all businesses as outlined in the Economic Impact above.

The Board does not believe that licensees will need to employ any professional services to comply with the requirements of the proposed amendments and new rule.

Full text of the proposal follows:

<< NJ ADC 13:37-14.4 >>

13:37-14.4 Homemaker-home health aide training program

(a) (No change.)

(b) A homemaker-home health aide training program shall consist of at least 76 hours, to include 60 hours of classroom instruction and 16 hours of clinical instruction in a skills laboratory or patient care setting<<+, covering topics outlined in (d) below and N.J.A.C. 13:37-14.5+>>. The student-to- instructor ratio for classroom instruction shall not exceed 30 students to one classroom instructor.

(c) (No change.)

(d) The curriculum for a homemaker-home health aide training program shall include <<-the activities described in N.J.A.C. 13:37-14.3 and shall be consistent with the laws governing the practice of nursing and the delegation of selected tasks by the registered professional nurse.->> <<+instruction in:+>>

<<+1. The role of unlicensed assistive personnel in nursing care settings, including:+>>

<<+i. Long term care, acute care, subacute, outpatient services, rehabilitation centers, home care agencies, assisted living and hospice;+>>

<<+ii. The role, responsibilities and scope of practice of the registered nurse;+>>

<<+iii. The role, responsibilities and scope of practice of the licensed practical nurse;+>>

<<+iv. The role and responsibilities of the unlicensed assistive personnel; and+>>

<<+v. Legal and ethical considerations for the unlicensed assistive personnel, such as client rights, confidentiality, accountability, legal documentation, eligibility, reporting physical, mental, verbal, emotional and financial abuse, and maintenance of certification including necessity for unlicensed assistive personnel to complete a course, competency testing and criminal background checks;+>>

<<+2. Foundations for working with people, including:+>>

<<+i. Components of communication;+>>

<<+ii. Factors that affect communication;+>>

<<+iii. Barriers to communication;+>>

<<+iv. Enhancing communication;+>>

<<+v. Skills for basic communication;+>>

<<+vi. Communicating with staff members;+>>

<<+vii. Guidelines for communicating with individuals who are visually impaired, hearing impaired, speech impaired, cognitively impaired, experiencing stress or who have transcultural considerations; and+>>

<<+viii. An introduction to human behavior including instruction on understanding basic human needs, understanding mental health, emotional growth and needs throughout a person's lifetime, behavior as a response to stress or unmet needs, responses to changes in health, spiritual needs and reactions to loss, grief and dying;+>>

<<+3. Foundations for a safe client environment, including:+>>

<<+i. Environmental conditions;+>>

<<+ii. Physical conditions including potential hazards and safety measures;+>>

<<+iii. Emotional conditions including potential hazards and protective measures;+>>

<<+iv. Prevention of, and response to, fire and disaster emergencies;+>>

<<+v. Infection control, including the chain of infection, standard precautions, hazardous waste and special concerns regarding tuberculosis (TB), Human Immunodeficiency Virus (HIV) and Hepatitis B;+>>

<<+vi. Body mechanics; and+>>

<<+vii. Medical emergencies, emergency preparedness and guidelines for handling medical emergencies;+>>

<<+4. The musculoskeletal system, including:+>>

<<+i. Overview of anatomy and physiology;+>>

<<+ii. Common conditions and disorders of the musculoskeletal system;+>>

<<+iii. Examples of changes in the musculoskeletal system to report to a nurse; and+>>

<<+iv. Client care procedures related to the musculoskeletal system including exercise, activity and positioning, range of motion, transferring, ambulation, and assistive devices;+>>

<<+5. The integumentary system, including:+>>

<<+i. Overview of anatomy and physiology;+>>

<<+ii. Common conditions and disorders of the integumentary system;+>>

<<+iii. General skin care;+>>

<<+iv. Examples of changes in the integumentary system to report to a nurse; and+>>

<<+v. Client care procedures related to the integumentary system including personal hygiene and positioning;+>>

<<+6. The upper gastrointestinal system, including:+>>

<<+i. Overview of anatomy and physiology;+>>

<<+ii. Common conditions and disorders of the upper gastrointestinal system;+>>

<<+iii. General care including nutrition across the lifespan, factors affecting nutrition, therapeutic diets and alternative nutrition souces;+>>

<<+iv. Examples of gastrointestinal changes to report to a nurse; and+>>

<<+v. Client care procedures related to upper gastrointestinal system;+>>

<<+7. The lower gastrointestinal system:+>>

<<+i. Overview of anatomy and physiology;+>>

<<+ii. Common conditions and disorders of the lower gastrointestinal system;+>>

<<+iii. General care including factors affecting bowel elimination;+>>

<<+iv. Examples of gastrointestinal changes to report to a nurse; and+>>

<<+v. Client care procedures related to lower gastrointestinal system;+>>

<<+8. The urinary system, including:+>>

<<+i. Overview of anatomy and physiology;+>>

<<+ii. Common conditions and disorders of the urinary system, specifically incontinence;+>>

<<+iii. Examples of urinary changes to report to a nurse; and+>>

<<+iv. Client care procedures related to the urinary system;+>>

<<+9. The cardiovascular and respiratory systems, including:+>>

<<+i. Overview of anatomy and physiology;+>>

<<+ii. Common conditions and disorders of the cardiovascular and respiratory systems;+>>

<<+iii. Examples of cardiovascular or respiratory changes to report to a nurse; and+>>

<<+iv. Client care procedures related to cardiovascular and respiratory systems specifically, vital signs, applying antiembolism stockings, assisting the client to use oxygen and positioning the client for circulatory and respiratory comfort;+>>

<<+10. Neurological system, including:+>>

<<+i. Overview of anatomy and physiology;+>>

<<+ii. Common conditions and disorders of the neurological system;+>>

<<+iii. Examples of neurological changes to report to a nurse; and+>>

<<+iv. Client care procedures related to the neurological system, specifically, care needs of a client with cognitive impairment, care of a client with a seizure disorder, care of a client following a stroke and rehabilitation or restorative care;+>>

<<+11. The endocrine system, including:+>>

<<+i. Overview of anatomy and physiology;+>>

<<+ii. Common conditions and disorders of the endocrine system;+>>

<<+iii. Changes to report to a nurse, including hyperglycemia and hypoglycemia and their causes, symptoms and emergency response; and+>>

<<+iv. Client care related to the endocrine system, specifically foot care, skin care and nutrition for a client with diabetes;+>>

<<+12. The reproductive system, including:+>>

<<+i. Overview of anatomy and physiology;+>>

<<+ii. The structure of, function of and age related changes to reproductive organs;+>>

<<+iii. Common conditions and disorders of the reproductive system, specifically sexually transmitted diseases such as gonorrhea, syphilis, herpes and Acquired Immunodeficiency Syndrome (AIDS); and+>>

<<+iv. Examples of changes in the reproductive system to report to a nurse;+>>

<<+13. The immune system, including:+>>

<<+i. Overview of anatomy and physiology; and+>>

<<+ii. Common conditions and disorders of the immune system, such as AIDS, HIV and cancer;+>>

<<+14. Rest and sleep, including:+>>

<<+i. Functions of rest and sleep;+>>

<<+ii. Factors affecting and/or causing sleep disturbances; and+>>

<<+iii. Promoting sleep; and+>>

<<+15. Death and dying, including:+>>

<<+i. Responding to the physical and emotional needs of a client with a terminal illness;+>>

<<+ii. Legal and quality of life issues including the New Jersey Advance Directives for Health Care Act (N.J.S.A. 26:2H-53 et seq.), living wills and "do not resuscitate" orders;+>>

<<+iii. Signs of impending death; and+>>

<<+iv. Post-mortem care of the patient.+>>

(e)-(g) (No change.)

<< NJ ADC 13:37-14.5 >>

<<+13:37-14.5 Home care and hospice care training programs+>>

<<+(a) In addition to the curriculum training requirements of N.J.A.C. 13:37-14.4(d), the training program for a homemaker-home health aide in home care or hospice care shall include instruction in:+>>

<<+1. The role of the homemaker-home health aide, including:+>>

<<+i. Settings utilizing homemaker-home health aides;+>>

<<+ii. Role of the homemaker-home health aide; and+>>

<<+iii. Legal and ethical considerations for the homemaker-home health aide;+>>

<<+2. The foundations for working with the home care client, the family and significant others of the home care client and home care team members, including:+>>

<<+i. Communication with the client and the client's family and significant others;+>>

<<+ii. Barriers to communication;+>>

<<+iii. Communication with the home care team; and+>>

<<+iv. Maintaining relationships with the client and the client's family and significant others;+>>

<<+3. Foundations for a safe client environment, including:+>>

<<+i. General home safety;+>>

<<+ii. Fire safety;+>>

<<+iii. Personal safety and body mechanics;+>>

<<+iv. Infection control;+>>

<<+v. Emergencies; and+>>

<<+vi. Assistance with medications;+>>

<<+4. Home care considerations, including:+>>

<<+i. Food;+>>

<<+ii. Housekeeping;+>>

<<+iii. Use and care of medical equipment in the home;+>>

<<+iv. Cultural diversity; and+>>

<<+v. Death and dying;+>>

<<+5. Infant and child care, including:+>>

<<+i. Introduction to infant and child care; and+>>

<<+ii. Family dynamics; and+>>

<<+6. The responsibility of an agency to the homemaker-home health aide, including:+>>

<<+i. The supervision to be provided by a registered professional nurse;+>>

<<+ii. The agency's responsibility to comply with Federal and State employment laws;+>>

<<+iii. Mandatory taxes to be withheld by the agency;+>>

<<+iv. In-services provided to the homemaker-home health aide;+>>

<<+v. Job descriptions provided by the agency;+>>

<<+vi. Personnel policies of the agency;+>>

<<+vii. Service policies and procedures of the agency; and+>>

<<+viii. Agency policies on patient and family confidentiality.+>>

<< NJ ADC 13:37-14.6 >>

13:37-<<-14.5->><<+14.6+>> (No change in text.)

<< NJ ADC 13:37-14.7 >>

13:37-<<-14.6->><<+14.7+>> Program coordinator; responsibilities

(a) (No change.)

(b) The program coordinator's responsibilities shall include, but not be limited to, the following:

1.-2. (No change.)

3. Ensuring that each instructor meets the qualifications specified in N.J.A.C. 13:37-<<-14.7->><<+14.8+>>;

4.-7. (No change.)

(c) (No change.)

<< NJ ADC 13:37-14.8 >>

13:37-<<-14.7->><<+14.8+>> (No change in text.)

<< NJ ADC 13:37-14.9 >>

13:37-<<-14.8->><<+14.9+>> Homemaker-home health aides; training program requirement

Every applicant for certification as a homemaker-home health aide in this State shall be required to complete a training program approved by the Board of Nursing, except as provided in N.J.A.C. 13:37-<<-14.11 and 14.13->><<+ 14.12 and 14.14+>>. The applicant shall have completed the training program no later than four months after commencing the program.

Recodify existing N.J.A.C. 13:37-14.9 through 14.14 as <<+14.10 through 14.15+>> (No change in text.)

33 N.J.R. 2241(a)


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Posted July 2, 2001