The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Health Policy
BILL: SB 1572
INTRODUCER: Senator Baxley
SUBJECT: Dementia-related Staff Training
DATE: February 9, 2022
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Looke Brown HP Pre-meeting
2. AHS
3. AP
I. Summary:
SB 1572 creates the Alzheimer’s Disease and Dementia Training and Education Act. The bill
requires each covered provider (CP)
1
to:
Provide each of its employees
2
with basic written information about interacting with patients
who have Alzheimer’s disease or related dementia (ADRD) upon beginning employment and
with one hour of ADRD related training within 30 days of beginning employment.
3
Require each of its employees who are direct care workers
4
to complete two or three
additional hours of ADRD training, depending on the CP’s license type, within the first four
months after beginning employment.
If the CP advertises that it provides special care for persons with ADRD, require each of its
employees who are direct care workers to complete an additional four hours of training
within the first six months after beginning employment and four hours of continuing
education annually.
The bill specifies that all training offered must be developed or approved by the Department of
Elder Affairs (DOEA) or its designee and must be in a variety of formats. The DOEA must
provide the one hour training course at no cost to CPs and must make it available online.
Training taken by a health care practitioner that is required by his or her licensing board may
1
As defined in the bill a “covered provider” includes nursing homes, home health agencies, nurse registries, companion
homemaker services, assisted living facilities, adult family-care homes, and adult day care centers.
2
As defined in the bill a “employee” includes any staff member, contracted staff, or independent contractor hired or referred
by a covered provider who is required to undergo a level 2 background screening as required by s. 408.809(1)(e), F.S. The
term includes, but is not limited to, direct care workers; staff responsible for housekeeping, the front desk, and other
administrative functions; and companions or homemakers.
3
The employee is not required to take the one hour of training if he or she has already completed the one hour of training as
an employee of a different covered provider.
4
As defined in the bill a “direct care worker” is an individual who, as part of his or her employment duties, provides or has
access to provide direct contact assistance with personal care or activities of daily living to clients, patients, or residents of
any facility licensed under part II, part III, or part IV of chapter 400 or chapter 429.
REVISED: BILL: SB 1572 Page 2
offset the training required under the bill in certain circumstances. Additionally, ADRD training
taken by a direct care worker who is hired before July 1, 2022, may count toward the four hours
of training required to be taken by such workers.
The bill adds to the licensure statutes for nursing homes, home health agencies, nurse registries,
companion homemaker services, assisted living facilities, adult family-care homes, and adult day
care centers a requirement for each facility to meet the training requirements established by the
bill as a condition of licensure. Additionally, if the licensure statutes for any CP already includes
ADRD-specific training requirements, the bill removes those requirements in favor of the
requirements established by the bill.
The bill provides an effective date of July 1, 2022.
II. Present Situation:
Dementia and Alzheimer’s Disease
Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—and
behavioral abilities to such an extent that it interferes with a person’s daily life and activities.
These functions include memory, language skills, visual perception, problem solving, self-
management, and the ability to focus and pay attention. Some people with dementia cannot
control their emotions, and their personalities may change. Dementia ranges in severity from the
mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage,
when the person must depend completely on others for basic activities of living.
5
Alzheimer’s disease is the most common type of dementia. It is a progressive disease that begins
with mild memory loss and can lead to loss of the ability to carry on a conversation and respond
to one’s environment. Alzheimer’s disease affects parts of the brain that control thought,
memory, and language. It can seriously affect a person’s ability to carry out daily activities.
Although scientists are studying the disease, what causes Alzheimer’s disease is unknown.
6
There are an estimated 580,000 individuals living with Alzheimer’s disease in the state of
Florida.
7
By 2025, it is projected that 720,000 Floridians will have Alzheimer’s disease.
8
Most
individuals with Alzheimer’s can live in the community with support, often provided by spouses
or other family members. In the late stages of the disease, many patients require care 24 hours
per day and are often served in long-term care facilities.
5
National Institute on Aging, What is Dementia? Symptoms, Types, and Diagnosis, available at
https://www.nia.nih.gov/health/what-dementia-symptoms-types-and-diagnosis, (last visited on Jan. 28, 2022).
6
Centers for Disease Control and Prevention, Alzheimer’s Disease and Healthy Aging, available at
https://www.cdc.gov/aging/aginginfo/alzheimers.htm#AlzheimersDisease, (last visited Jan. 28, 2022).
7
Alzheimer’s Association, Alzheimer’s Statistics Florida, available at https://www.alz.org/media/Documents/florida-
alzheimers-facts-figures-2018.pdf, (last visited Jan. 28, 2022).
8
Id. BILL: SB 1572 Page 3
Dementia and Alzheimer’s Disease Training
Providers not Currently Required to Provide Specific ADRD Training.
Nurse registries are prohibited from training a registered nurse, licensed practical nurse,
certified nursing assistant, companion or homemaker, or home health aide that it refers for
contract.
9
However, depending on his or her license type, an individual referred by the nurse
registry may have ADRD-specific training required by his or her practice act.
Companion and homemaker service providers are not required to train the companions or
homemakers they provide.
Adult family-care home providers are required to undergo 12 hours of training, some of which
must be related to identifying and meeting the special needs of disabled adults and frail elders.
However, these providers are not currently required to undergo training specific to ADRD.
10
Overview of ADRD Training Requirements by Facility Type
All Employees Employees with
Expected or
Required Direct
Contact
Employees
Providing Direct
Care
Health Care
Practitioner
Continuing
Education
Sufficient?
Training
Approved?
Exemptions
Nursing
Homes
Provided with
basic written
information about
interacting with
persons with
ADRD upon
beginning
employment.
1 hour of
training within
the first 3
months of
employment.
Additional 3
hours of training
within the first 9
months of
employment.
Yes By DOEA.
Home
Health
Agencies
Not specified. 2 hours of training
within the first 9
months of
employment.
Yes By DOEA. HHA’s that
serve 90%
individuals
under age 21
are exempt.
ALFs
11
Employees with
incidental contact
must be given
information within
3 months.
4 hours within 3
months of
employment
4 additional hours
within 9 months
of employment +
4 hours CE
annually
Not specified. By DOEA
Adult Day
Care
Centers
Same as nursing
homes, home
health agencies,
and Hospice.
1 hour of
training within
the first 3
months of
employment.
Additional 3
hours of training
within the first 9
months of
employment.
Yes By DOEA
9
Section 400.506(19), F.S.
10
See s. 429.75, F.S., and Fla. Admin. Code R. 59A-37.007 (2020).
11
Training is required if the ALF advertises that it provides special care for persons with Alzheimer’s disease or related
disorders. Section 429.178, F.S. BILL: SB 1572 Page 4
Details for each facility type are below:
Nursing Homes
Section 400.1755, F.S., requires each nursing home to provide the following training:
Provide each of its employees basic written information about interacting with persons with
ADRD upon beginning employment.
All employees who are expected to, or whose responsibilities require them to, have direct
contact with residents with ADRD must also have an initial training of at least one hour
completed in the first three months after beginning employment. This training must include,
but is not limited to, an overview of dementias and must provide basic skills in
communicating with persons with dementia.
An individual who provides direct care must complete the required initial training and an
additional three hours of training within nine months after beginning employment. This
training must include, but is not limited to, managing problematic behaviors, promoting the
resident’s independence in activities of daily living, and skills in working with families and
caregivers. Health care practitioners’ continuing education can be counted toward the
required training hours.
The DOEA or its designee must approve the initial and continuing training provided in the
facilities. The DOEA must approve training offered in a variety of formats, including, but not
limited to, Internet-based training, videos, teleconferencing, and classroom instruction. The
DOEA must keep a list of current providers who are approved to provide initial and
continuing training. The DOEA must adopt rules to establish standards for the trainers and
the training required in this section of statute.
Upon completing any training listed in the section, the employee or direct caregiver must be
issued a certificate that includes the name of the training provider, the topic covered, and the
date and signature of the training provider. The certificate is evidence of completion of
training in the identified topic, and the employee or direct caregiver is not required to repeat
training in that topic if the employee or direct caregiver changes employment to a different
facility or to an assisted living facility, home health agency, adult day care center, or adult
family-care home. The direct caregiver must comply with other applicable continuing
education requirements.
Home Health Agencies
Section 400.4785, F.S., requires a home health agency to provide the following staff training:
Upon beginning employment with the agency, each employee must receive basic written
information about interacting with participants who have ADRD.
Newly-hired home health agency personnel who will be providing direct care to patients
must complete two hours of training in ADRD within nine months after beginning
employment with the agency. This training must include, but is not limited to, an overview of
dementia, a demonstration of basic skills in communicating with persons who have dementia,
the management of problematic behaviors, information about promoting the client’s
independence in activities of daily living, and instruction in skills for working with families
and caregivers.
For certified nursing assistants, the required two hours of training are part of the total hours
of training required annually. BILL: SB 1572 Page 5
For a health care practitioner, as defined in s. 456.001, F.S.,
12
continuing education hours
taken as required by that practitioner’s licensing board are counted toward the total of two
hours.
For an employee who is a licensed health care practitioner, training that is sanctioned by that
practitioner’s licensing board must be considered to be approved by the DOEA.
The DOEA, or its designee, must approve the required training. The DOEA must consider
for approval training offered in a variety of formats. The DOEA must keep a list of current
providers who are approved to provide the two-hour training. The DOEA must adopt rules to
establish standards for the employees who are subject to this training, for the trainers, and for
the training required in this section of statute.
Upon completing the training listed in the section, the employee must be issued a certificate
stating that the training mandated under the section has been received. The certificate must
be dated and signed by the training provider. The certificate is evidence of completion of this
training, and the employee is not required to repeat this training if the employee changes
employment to a different home health agency.
A licensed home health agency whose unduplicated census during the most recent calendar
year was composed of at least 90 percent of individuals aged 21 years or younger at the date
of admission, is exempt from the training requirements in this section of statute.
Assisted Living Facilities
Section 429.178, F.S., requires an ALF that advertises it provides special care for persons with
ADRD to provide the following training:
An employee who has regular contact with such residents must complete up to four hours of
initial dementia-specific training developed or approved by the DOEA. The training must be
completed within three months after beginning employment and satisfy the core training
requirements of s. 429.52(3)(g), F.S.
A direct caregiver who provides direct care to such residents must complete the required
initial training and four additional hours of training developed or approved by the DOEA.
The training must be completed within nine months after beginning employment and satisfy
the core training requirements of s. 429.52(3)(g), F.S.
An individual who is employed by a facility that provides special care for residents with
ADRD, but who only has incidental contact with such residents, must be given, at a
minimum, general information on interacting with individuals with ADRD, within three
months after beginning employment.
A direct caregiver must also participate in a minimum of four contact hours of continuing
education each calendar year. The continuing education must include one or more topics
included in the dementia-specific training, developed or approved by the DOEA, in which
the caregiver has not received previous training.
Upon completing any specified training, the employee or direct caregiver must be issued a
certificate that includes the name of the training provider, the topic covered, and the date and
signature of the training provider. The certificate is evidence of completion of training in the
12
Section 456.001(4), F.S., defines “health care practitioner” as any person licensed under ch. 457, F.S.; ch. 458, F.S.; ch.
459, F.S.; ch. 460, F.S.; ch. 461, F.S.; ch. 462, F.S.; ch. 463, F.S.; ch. 464, F.S.; ch. 465, F.S.; ch. 466, F.S.; ch. 467, F.S.; part
I, part II, part III, part V, part X, part XII, or part XIV of ch. 468, F.S.; ch. 478, F.S.; ch. 480, F.S.; part I or part II of ch. 483,
F.S.; ch. 484, F.S.; ch. 486, F.S.; ch. 490, F.S.; or ch. 491, F.S. BILL: SB 1572 Page 6
identified topic, and the employee or direct caregiver is not required to repeat training in that
topic if the employee or direct caregiver changes employment to a different facility. The
employee or direct caregiver must comply with other applicable continuing education
requirements.
The DOEA, or its designee, must approve the initial and continuing education courses and
providers.
The DOEA must keep a current list of providers who are approved to provide initial and
continuing education for staff of facilities that provide special care for persons with ADRD.
Adult Day Care Centers
Section 429.917, F.S., requires an adult day care center to provide the following staff training:
Upon beginning employment with the facility, each employee must receive basic written
information about interacting with participants who have ADRD.
In addition to the information provided, newly-hired adult day care center personnel who are
expected to, or whose responsibilities require them to, have direct contact with participants
who have ADRD must complete initial training of at least one hour within the first three
months after beginning employment. The training must include an overview of dementias
and must provide instruction in basic skills for communicating with persons who have
dementia.
In addition to the previous requirements, an employee who will be providing direct care to a
participant who has ADRD must complete an additional three hours of training within nine
months after beginning employment. This training must include, but is not limited to, the
management of problem behaviors, information about promoting the participant's
independence in activities of daily living, and instruction in skills for working with families
and caregivers.
For certified nursing assistants, the required four hours of training is part of the total hours of
training required annually.
For a health care practitioner as defined in s. 456.001, F.S., continuing education hours taken
as required by that practitioner’s licensing board are counted toward the total of four hours.
For an employee who is a licensed health care practitioner as defined in s. 456.001, F.S.,
training that is sanctioned by that practitioner’s licensing board is considered to be approved
by the DOEA.
The DOEA or its designee must approve the one-hour and three-hour training provided to
employees and direct caregivers under this section of statute. The DOEA must consider for
approval training offered in a variety of formats. The DOEA must keep a list of current
providers who are approved to provide the one-hour and three-hour training. The DOEA
must adopt rules to establish standards for the employees who are subject to this training, for
the trainers, and for the training required in this section of statute.
Upon completing any training described in the section, the employee or direct caregiver must
be issued a certificate that includes the name of the training provider, the topic covered, and
the date and signature of the training provider. The certificate is evidence of completion of
training in the identified topic, and the employee or direct caregiver is not required to repeat
training in that topic if the employee or direct caregiver changes employment to a different
adult day care center or to an assisted living facility, nursing home, home health agency, or
hospice. The direct caregiver must comply with other applicable continuing education
requirements. BILL: SB 1572 Page 7
Current Administration of ADRD Training
The DOEA has authority for administering the existing ADRD training
13
and currently does so
through a contract with the University of South Florida (USF).
14
USF, through its Training
Academy on Aging, reviews and approves ADRD Training Providers and Training Curriculum
Programs for the DOEA. The mission of the ADRD training program is to improve the care of
individuals with ADRDs who receive services from nursing homes, assisted living facilities,
home health agencies, adult day care centers, and hospice care facilities. The ADRD training
program is designed to ensure that agency and facility staff members who have regular contact
with or provide direct care to, persons with ADRD receive the relevant ADRD training.
15
III. Effect of Proposed Changes:
SB 1572 creates s. 430.5025, F.S., entitled the Florida Alzheimer’s Disease and Dementia
Training and Education Act. The bill defines the following terms:
“Covered provider” means a nursing home facility, home health agency, nurse registry, or
companion or homemaker service provider licensed or registered under ch. 400, F.S., or an
ALF, adult family-care home, or adult day care center licensed under ch. 429, F.S.
“Department” means the Department of Elder Affairs.
“Direct care worker” means an individual who, as part of his or her employment duties,
provides or has access to provide direct contact assistance with personal care or activities of
daily living to clients, patients, or residents of any facility licensed under part II, part III, or
part IV of ch. 400 or ch. 429, F.S.
“Employee” means any staff member, contracted staff, or independent contractor hired or
referred by a CP who is required to undergo a level 2 background screening as required by
s. 408.809(1)(e), F.S. The term includes, but is not limited to, direct care workers; staff
responsible for housekeeping, the front desk, and other administrative functions; and
companions or homemakers.
The bill requires the DOEA or its designee to develop or approve the education and training
required by the bill and specifies that the training must be in a variety of formats, including, but
not limited to, internet-based training, videos, teleconferencing, and classroom instruction.
Additionally, the bill requires the DOEA or its designee to offer training to the general public
which includes basic information about the most common forms of dementia, how to identify the
signs and symptoms of dementia, skills for coping with and responding to changes as a result of
the onset of dementia symptoms, planning for the future, and how to access additional resources
about dementia.
13
Fla. Admin. Code R. 58A-5.0194 (2020).
14
Contract XQ092.A3, effective July 1, 2021.
15
Department of Elder Affairs, DOEA Bill Analysis of SB 1572 (Jan. 13, 2022) (on file with the Senate Committee on Health
Policy). BILL: SB 1572 Page 8
Required Training and Information
Basic Information
The bill requires CPs to provide each employee, upon beginning employment, with basic written
information about interacting with patients who have Alzheimer’s disease or related dementia.
Training for All Employees
The bill requires each CP to provide each employee with one hour of dementia-related training.
The CP must require the employee to complete the training within 30 days after employment
begins and must maintain in its records a copy of the employee’s certificate of completion. The
bill specifies that an employee who completes the training is not required to retake the training
when switching employment. The bill specifies that the DOEA or its designee must develop or
approve the one hour ADRD training which must include basic information about the most
common forms of dementia and instruction on methods for identifying warning signs and
symptoms of dementia and skills for communicating and interacting with individuals who have
Alzheimer’s disease or related dementia.
The DOEA is required to provide the training to CPs at no cost and make it available online.
Additionally, the DOEA must provide certificates of completion for each employee who
completes the course which includes the name of the training and training provider, the name of
the employee, and the date of completion.
Training for Direct Care Workers
In addition to the one hour of training, the bill requires CPs to require all employees who are
direct care workers to receive additional training if they are required to have direct contact with
clients, patients, or residents with Alzheimer’s disease or related dementia, as follows:
Two hours of additional training if the CP is a home health agency, nurse registry, or a
companion or homemaker service provider;
Three hours of additional training if the CP is a nursing home, ALF, adult-family care home,
or adult day care center.
The training must be completed within the first four months after employment begins and must
include, but is not limited to, information related to management of problematic behaviors,
promotion of independence in activities of daily living, and instruction on skills for working with
family members and caregivers of patients. The bill specifies that a direct care worker who is
hired before July 1, 2022, and who has completed ADRD training may count the completed
hours toward these training requirements or must complete the required training by July 1, 2023.
If the direct care worker works for a CP that advertises special care for individuals with ADRD,
the direct care worker must complete a minimum of four contact hours of continuing education
annually. The continuing education must cover at least one of the topics included in the
dementia-related training developed or approved by the DOEA in which the direct care worker
has not received previous training.
The bill specifies that both the one hour of training for all employees and the additional two or
three hours of training for direct care workers may count toward a certified nursing assistant’s BILL: SB 1572 Page 9
annual training requirements. Additionally, the bill specifies that a health care practitioner’s
16
continuing education hours required by that practitioner’s licensing board may count toward the
practitioner’s one required hour and his or her two or three additional required hours if the if the
course curriculum of the continuing education covers the same topics as the training developed
or approved by the DOEA or its designee if the DOEA approves such continuing education
hours.
The bill grants the DOEA rulemaking authority to implement these provisions.
Additionally, the bill amends and creates ss. 400.511, 400.1755, 400.4785, 429.178, 429.52,
429.75, 429.83, 429.917, and 429.918, F.S., to eliminate existing ADRD training requirements
from the licensure statutes for all CPs and to add a requirement that each license type meet the
training requirements established by the bill.
The bill provides and effective date of July 1, 2022.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
None.
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
16
As defined in s. 456.001, F.S. BILL: SB 1572 Page 10
B. Private Sector Impact:
SB 1572 may have an indeterminate fiscal impact on license types that must require
employees to receive ADRD training under the bill if those license types are not currently
required to provide such training or if the training required by the bill is greater than the
training currently required.
C. Government Sector Impact:
None.
VI. Technical Deficiencies:
None.
VII. Related Issues:
Subsection (8) of SB 1572 refers to “four hours of training required under subsections (5) and
(6).” However, it is possible that the amount of training required to be completed under
subsections (5) and (6) combined equals only three hours of training. The bill should be clarified
to refer to three or four hours of training required under the specified subsections if the intent is
to include certified nursing assistants who work for CPs licensed under Part III of ch. 400, F.S.
SB 1572 includes nurse registries under the definition of CP and creates s. 400.511 to require
that each individual employed, contracted, or referred by a nurse registry must complete the
training established in the bill. The bill requires CPs to “provide” one hour of training to all
employees (as defined) and to “require all employees who are direct care workers to receive”
additional training as specified in the bill. However, s. 400.506(19), F.S., states that a nurse
registry may not “monitor, supervise, manage, or train a registered nurse, licensed practical
nurse, certified nursing assistant, companion or homemaker, or home health aide referred for
contract under this chapter.” Section 400.511, F.S., as created by the bill, does not provide an
exemption from this prohibition, and it is unclear whether the training required by the bill would
violate this provision. The bill should be amended to provide an exemption from s. 400.506(19),
F.S., for the training required related to nurse registries under the bill.
VIII. Statutes Affected:
This bill substantially amends the following sections of the Florida Statutes: 400.1755, 400.4785,
429.178, 429.52, 429.75, 429.83, 429.917, and 429.918.
This bill creates the following sections of the Florida Statutes: 430.5025 and 400.511.
IX. Additional Information:
A. Committee Substitute – Statement of Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
None. BILL: SB 1572 Page 11
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.