S4500

An Act concerning Alzheimer’s disease and dementia care, amending various parts of statutory law, and supplementing Title 26 of the Revised Statutes.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. (New section) a. There is established a training requirement for the care of persons with Alzheimer’s disease and related disorders or other forms of dementia, to be overseen by the Commissioner of Health. Notwithstanding any law, rule, or regulation to the contrary, compliance with the training requirements of this section by direct care staff shall be a condition of State licensure for any program, facility, or residence licensed, administered, or operated by the Departments of Health, Human Services, Community Affairs, or Veterans’ Affairs.

Notwithstanding any law, rule, or regulation to the contrary, the training requirements of this section shall apply to all direct care staff, including any licensed health care professional, employed or contracted by or providing services to:

(1) an assisted living residence;

(2) a comprehensive personal care home;

(3) a non-residential assisted living program;

(4) a residential health care facility;

(5) a continuing care retirement community;

(6) a dementia care home;

(7) an adult family care facility;

(8) a long-term care facility; or

(9) an acute care facility, including a general hospital.

b. All direct care staff subject to subsection a. of this section shall demonstrate successful completion of a minimum number of hours of live training and instruction every two years as follows:

(1) four hours for any staff member who does not hold a State professional license, certificate, or permit;

(2) eight hours for any staff member who does hold a State professional license, certificate, or permit; and

(3) 12 hours for any staff member who has supervisory or managerial authority over other staff members.

Successful completion shall be demonstrated by correctly answering a minimum of five post-training examination questions in the area of dementia care.

c. The training required pursuant to this section shall consist of instruction in, at minimum, the following topics:

(1) The nature of dementia, including the cause, course and symptoms of the impairment, and the effects that brain changes have on the person’s moods, abilities, and functioning;

(2) The effects on the patient or client of staff verbal and nonverbal communication with the patient or client, and means of modifying these communications and approaches to facilitate effective interaction between patients, clients, and staff;

(3) The feeding and fluid intake problems associated with dementia and the specialized techniques for addressing those problems;

(4) The effect of the environment on patients or clients with dementia, the appropriate environmental stimuli to use with those patients or clients to reduce stress and maximize normal functioning, and how to incorporate strategies that preserve function and prevent excess disability;

(5) Possible causes of dementia-related symptomatic behavior changes, specifically focusing on understanding behavior as an attempt to communicate unmet needs, and how to address such unmet needs including an understanding of how pain impacts behavior;

(6) Ways to help the person with dementia continue meaningful involvement in his or her day, the importance of structure and routine, and the incorporation of the person’s life story and past interests, routines, tastes, values, and background; and

(7) The stress involved for the patient or client, family members, and staff in caring for a patient or client with dementia, techniques for coping with this stress, and ways to address the person with dementia’s core needs of having self−esteem boosted, being useful, giving and receiving love, and caring for self and others.

d. The Commissioner of Health, in consultation with the Alzheimer’s and Dementia Care Long-Term Advisory Commission, shall develop, administer, and ensure compliance with the training required pursuant to this section. The Commissioner shall, in accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), adopt rules and regulations as necessary to implement this section.

2. Section 21 of P.L.2015, c.125 (C.26:2H-152) is amended to read as follows:

21. The commissioner shall establish standards to ensure that each dementia care home is constructed and operated in such a manner as will protect the health, safety, and welfare of its residents and at the same time preserve and promote a homelike atmosphere appropriate to these facilities, including, but not limited to, standards to provide for the following:

a. Safety from fire;

b. Safety from structural, mechanical, plumbing, and electrical deficiencies;

c. Adequate light and ventilation;

d. Physical security;

e. Protection from harassment, fraud, and eviction without due cause;

f. Clean and reasonably comfortable surroundings;

g. Adequate personal and financial services rendered in the facility;

h. Disclosure of owner identification information;

i. Maintenance of orderly and sufficient financial and occupancy records;

j. Referral of residents, by the operator, to social service and health care providers for needed services;

k. Assurance that no constitutional, civil, or legal right will be denied solely by reason of residence in a dementia care home;

l. Reasonable access for employees of public and private agencies, and reasonable access for other citizens upon receiving the consent of the resident to be visited by them;

m. Opportunity for each resident to live with as much independence, autonomy, and interaction with the surrounding community as the resident is capable of doing; and

n. Assurance that the needs of residents of a dementia care home will be met, which shall include, at a minimum, the following:

(1) staffing levels, which shall ensure that the ratio of direct care staff to residents in the facility is equal to or higher than that which existed on the date of enactment of P.L.2015, c.125 (C.55:13B-5.1 et al.);

(2) staff qualifications and training in accordance with section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill);

(3) special dietary needs of residents;

(4) special supervision requirements relating to the individual needs of residents;

(5) building safety requirements appropriate to the needs of residents, including the requirement to maintain the operation 24 hours a day, seven days a week, of window, door, and any other locks or security system designed to prevent the elopement of a resident;

(6) special health monitoring of residents by qualified, licensed health care professionals, including a requirement that a medical assessment by a physician be performed on a resident with special needs as described in this subsection, as determined necessary by the commissioner, prior to admission and on a quarterly basis thereafter, to ensure that the facility is appropriate to the needs of the resident; and

(7) criteria for discharging residents which shall be set forth in the admission agreement, which shall be provided to the resident or

the resident’s representative prior to or upon admission. The commissioner may revoke the license of any provider who violates the criteria for discharging residents.

(cf: P.L.2015, c.125, s.21)

3. Section 1 of P.L.1987, c.440 (C.26:2M-7) is amended to read as follows:

a. The Commissioner of the Department of Health shall establish a training program for health care providers in licensed long-term health care facilities in the specialized care of patients with Alzheimer’s Disease. The training program shall include methods to deal with the specific problems encountered in the care of Alzheimer’s Disease patients, including communicating with patients and necessary safety measures.

b. The training program shall be made available, on a voluntary basis, to licensed long-term health care facilities which provide treatment and care to Alzheimer’s Disease patients. Upon request, the commissioner shall provide the training program at the long-term health care facility.

c. The training program shall include, at minimum, the training hours, proficiency examination, and all training topics set forth in subsections b. and c. of section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill). Successful completion of the training program established pursuant to this section shall be deemed to satisfy the requirements of section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill) for a two-year cycle.

(cf: P.L.1987, c.440, s.1)

4. Section 1 of P.L.2003, c.269 (C.26:2M-7.2) is amended to read as follows:

1. a. The Commissioner of Health shall establish a mandatory training program for long-term care facility staff, as described in subsection b. of this section, in the specialized care of patients who are diagnosed by a physician as having Alzheimer’s disease or a related disorder. The training program shall include the causes and progression of Alzheimer’s disease and related disorders and methods to deal with the specific problems encountered in the care of patients with Alzheimer’s disease and related disorders, including, but not limited to: communicating with patients with Alzheimer’s disease and related disorders; psychological, social and physical needs of patients with Alzheimer’s disease and related disorders; and safety measures which need to be taken for a patient with Alzheimer’s disease and related disorders.

b. A long-term care facility shall annually provide training, under the training program established pursuant to subsection a. of this section, to a certified nurse aide, licensed practical nurse, registered professional nurse, and other health care professionals, as appropriate, who provide direct care to a patient in the facility who is diagnosed as having Alzheimer’s disease or a related disorder.

(cf: P.L.2012, c.17, s.284)

5. Section 5 of P.L.1988, c.114 (C.26:2M-13) is amended to read as follows:

The department shall develop a training program which includes information on the symptoms and progress of the disease and appropriate techniques for dealing with the psychosocial, health and physical needs of the participants. The training program shall be developed and provided as on-going, on-site training for adult day care centers funded under this act and shall be available to other community based providers who serve this client population. The training program shall include, at minimum, the training hours, proficiency examination, and all training topics set forth in subsections b. and c. of section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill). Successful completion of the training program established pursuant to this section shall be deemed to satisfy the requirements of section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill) for a two-year cycle.

(cf: P.L.1988, c.114, s.5)

6. Section 2 of P.L.2023, c.41 (C.26:2M-21) is amended to read as follows:

2. a. The responsibilities of the Alzheimer’s and Dementia Care Long-Term Advisory Commission established pursuant to this act shall include, but not be limited to:

(1) studying the incidence, prevalence, and impact of Alzheimer’s disease and related disorders or other forms of dementia in the State and in each region of the State and make projections about the future Statewide and regional incidence, prevalence, and impact of these conditions;

(2) gathering, analyzing, and disseminating to health care professionals, policymakers, and members of the public, as appropriate, data and information about: (a) the needs of persons with Alzheimer’s disease and related disorders or other forms of dementia, as well as the needs of their family members and caregivers; (b) the quality and consistency of care that is provided to persons with Alzheimer’s disease and related disorders or other forms of dementia in the State, including those members of the medically underserved community, the low income community, and the lesbian, gay, bisexual, transgender, questioning, queer, and intersex (LGBTQI) communities; (c) the affordability of care for Alzheimer’s disease and related disorders or other forms of dementia in the State and the actual and projected Statewide costs and individual costs associated with Alzheimer’s disease and related disorders or other forms of dementia in New Jersey, including, but not limited to, the costs of health care, mental health care, long-term care, and personal care, and ancillary or incidental costs such as those associated with the lost work productivity of, or the treatment of stress-related physical conditions or depression and other mental health conditions in, family caregivers; (d) the cost savings attained by the State through the provision of unpaid caregiving and personal care services by family caregivers; (e) the capacity of the State’s health care and long-term care facilities to house and provide specialized services to patients with Alzheimer’s disease and related disorders or other forms of dementia; (f) the status of Alzheimer’s disease and related disorders or other forms of dementia care in other states, as compared to New Jersey; and (g) with the approval of the Commissioner of the Department of Human Services and subject to the availability of funds as designated by the department, any other issue deemed by the commission to be relevant to effectuate the purposes of this act;

(3) assessing the availability and affordability of existing programs, services, facilities, and agencies in the State that are used to meet the needs of persons with Alzheimer’s disease and related disorders or other forms of dementia and the needs of their families and caregivers; evaluating the capacity of those existing policies, programs, services, facilities, and agencies to adapt to, and adequately address, the changing needs of dementia patients and their families and caregivers in the face of a continually increasing demand for services; and identifying and recommending improvements to existing policies, programs, services, facilities, or agencies or the institution of new policies, programs, services, facilities, or agencies to address unmet and expanding needs in this area;

(4) studying, and making recommendations to the Department of Human Services on, the appropriate roles of State government, local governments, and health care facilities and professionals in providing or ensuring the provision of appropriate services and other assistance to persons with Alzheimer’s disease and related disorders or other forms of dementia, including persons in the early stages of disease, and in providing or ensuring the provision of sufficient supportive and assistive services, including training and respite services, to unpaid family caregivers; and identifying ways in which State and local governments and health care systems could increase their awareness of, and improve their ability to more effectively address, issues affecting persons with Alzheimer’s disease and related disorders or other forms of dementia and their families;

(5) reviewing and analyzing the capacity of law enforcement officers and emergency medical responders in the State to compassionately and effectively interact with, diffuse conflicts involving, and provide emergency services to, persons with Alzheimer’s disease and related disorders or other forms of dementia;

(6) identifying and recommending best practices and training requirements for: (a) health care and mental health care professionals, particularly geriatric specialists and primary care practitioners, who are or will be practicing on the front lines of caring for patients with Alzheimer’s disease and related disorders or other forms of dementia, in order to ensure that such professionals are properly trained and are capable of accurately and timely diagnosing Alzheimer’s disease and related disorders or other forms of dementia, understanding the progression of the disease, and recognizing and responding to the evolving needs of patients; (b) personal care professionals who provide services to patients with Alzheimer’s disease and related disorders or other forms of dementia, in order to ensure that such professionals are capable of providing compassionate and high-quality personal care services and adapting to the evolving needs of their patients; and (c) law enforcement officers, emergency medical responders, and other public safety officers, in order to ensure that those officers understand the complexities of dealing with persons with Alzheimer’s disease and related disorders or other forms of dementia and are better prepared to compassionately diffuse or resolve conflicts and respond to emergencies involving such persons;

(7) evaluating the sufficiency of the State’s Alzheimer’s disease and related disorders or other forms of dementia care workforce, identifying current and future workforce needs, anticipating future workforce shortages, developing innovative strategies to encourage and increase the recruitment and retention of health care, mental health care, direct support, and personal care professionals who are trained to provide care for Alzheimer’s disease and related disorders or other forms of dementia, and taking any other action necessary to encourage and facilitate the development and maintenance of a robust and specialized professional Statewide workforce that is capable of delivering high-quality care for patients with Alzheimer’s disease and related disorders or other forms of dementia to a rapidly growing population in the State; and

(8) studying and making recommendations on any other issue related to Alzheimer’s disease and related disorders or other forms of dementia.

b. One year after the commission’s organizational meeting, annually thereafter for a period of no less than five years, and thereafter upon request of the Legislature or as determined by the commission, the commission shall prepare and submit a written report to the Governor and, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), to the Legislature. The written report shall contain, at a minimum:

(1) the commission’s annual findings on the issues described in subsection a. of this section;

(2) a description as to whether, how, and why the commission’s findings have changed over time, including an indication as to the implementation status of the commission’s prior recommendations, a description of actions that have been undertaken by any person or public or private entity in the State over the prior reporting period to implement those prior recommendations, and a description of the perceived or documented effects resulting from implementation of those prior recommendations;

(3) a copy of, or reference to, the statistical, demographic, testimonial, or other data or information that was used by the commission to: (a) support its current findings under paragraph (1) of this subsection; or (b) inform its analysis of the impact of the commission’s prior recommendations under paragraph (2) of this subsection. The data provided pursuant to this paragraph shall be presented in aggregate form and shall not contain the personal identifying information of any patient, caregiver, or other person; and

(4) the commission’s recommendations for actions that can be undertaken, or strategies that can be implemented, to: (a) improve the quality, consistency, or affordability of care for Alzheimer’s disease and related disorders or other forms of dementia in the State and ensure the accessibility of care to all who need it; (b) reduce, eliminate, or mitigate the societal and individual impact of, and the Statewide, local, and individual costs or financial burdens associated with, Alzheimer’s disease and related disorders or other forms of dementia; (c) ensure that the State’s professional workforce is adequately trained, is capable of providing affordable, high-quality care for patients with Alzheimer’s disease and related disorders or other forms of dementia throughout the State, and is sufficient in numbers and flexible enough to adapt to a rapidly increasing demand for services in the State; (d) ensure that unpaid caregivers in the State are recognized for their dedicated service and significant contributions to society and are provided with sufficient supportive and respite services, as well as financial assistance where possible and appropriate, as may be necessary for them to capably perform their caregiving tasks while avoiding unnecessary physical, mental, or financial strain; or (e) otherwise address the issues or mitigate the problems identified by the commission in its annual findings.

c. In addition to the annual reports prepared pursuant to subsection b. of this section, one year after the effective date of P.L. , c. (C. ) (pending before the Legislature as this bill), and annually thereafter, the commission shall prepare and submit a written report to the Governor and, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), to the Legislature, concerning the implementation and effectiveness of the direct care staff training requirements pursuant to section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill). The written report shall contain, at minimum:

(1) an assessment of the quality and availability of training providers and training opportunities Statewide;

(2) an assessment of the contents of the mandatory curriculum, the minimum hour requirements, and the methods of instruction;

(3) an assessment of the effectiveness of the training requirements as applied to the actual care of persons with Alzheimer’s disease and related disorders or other forms of dementia; and

(4) recommendations concerning changes or updates, as necessary, to the training requirements.

(cf: P.L.2023, c.41, s.2)

7. This act shall take effect on the first day of the third month next following enactment, except that the Commissioner of Health may take such anticipatory action as may be necessary for the timely implementation of this act.

STATEMENT

This bill establishes a uniform training requirement for direct service health care staff who deal with or are likely to come into contact with persons with dementia, which will be developed and administered by the Commissioner of Health in consultation with the Alzheimer’s and Dementia Care Long-Term Advisory Commission.

The training requirement will apply as a condition of State licensure for any program, facility, or residence licensed, administered, or operated by the Departments of Health, Human Services, Community Affairs, or Veterans’ Affairs. As such, the training requirement will apply to all direct care staff, including any licensed health care professional, employed or contracted by or providing services to:

(1) an assisted living residence;

(2) a comprehensive personal care home;

(3) a non-residential assisted living program;

(4) a residential health care facility;

(5) a continuing care retirement community;

(6) a dementia care home;

(7) an adult family care facility;

(8) a long-term care facility; or

(9) an acute care facility, including a general hospital.

The bill provides that all direct care staff subject to the training requirement must demonstrate successful completion of a minimum number of hours of live training and instruction every two years as follows: four hours for any staff who do not hold a State professional license, certificate, or permit; eight hours for any staff who do hold a State professional license, certificate, or permit; and 12 hours for any staff who hold supervisory or managerial authority. Successful completion will be demonstrated by correctly answering a minimum of five post-training examination questions in the area of dementia care.

The training required under the bill will consist of instruction in, at minimum, the following topics:

(1) The nature of dementia, including the cause, course and symptoms of the impairment, and the effects that brain changes have on the person’s moods, abilities and functioning;

(3) The feeding and fluid intake problems associated with dementia and the specialized techniques for addressing those problems;

Finally, the bill requires the Alzheimer’s and Dementia Care Long-Term Advisory Commission to report annually to the Governor and the Legislature concerning the implementation of the training requirement, with recommendations for improvement or updates to the curriculum.