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 Fiscal Policy
BILL: CS/CS/SB 1182
INTRODUCER: Appropriations Committee on Health and Human Services; Children, Families, and
Elder Affairs Committee; and Senator Simon and others
SUBJECT: Education and Training for Alzheimer’s Disease and Related Forms of Dementia
DATE: April 19, 2023
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Delia Cox CF Fav/CS
2. Barr Money AHS Fav/CS
3. Delia Yeatman FP Pre-meeting
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/CS/SB 1182 creates s. 430.5025, F.S., to establish the Florida Alzheimer’s Disease and
Dementia Training Act. The bill establishes universal Alzheimer’s disease and related disorder
(ADRD) training requirements to be used by nursing homes, home health agencies, nurse
registries, companion or homemaker service providers, health care services pools, assisted living
facilities (ALF), adult family-care homes (AFCH), adult day care centers (ADCC), and ADCCs
that provide specialized Alzheimer’s services to replace each license type’s individual training
requirements on that topic.
The bill defines a number of terms, including “covered provider,” “department,” “employee,”
“personal care,” and “regular contact.”
The bill requires that all employees of covered providers receive basic written information about
interacting with persons who have ADRD upon beginning employment. Employees of covered
providers who provide personal care to or have regular contact with patients, participants, or
residents, must also complete one hour of dementia-related training within 30 days of his or her
initial employment.
The bill also requires that each employee of a home health agency, nurse registry, or companion
or homemaker service provider who provides personal care receive two hours of additional
training within the first seven months of employment. Each employee of a nursing home, ALF,
REVISED: BILL: CS/CS/SB 1182 Page 2
AFCH or ADCC who provides personal care must receive three hours of additional training
within the first seven months of employment. Employees of ALFs with a limited mental health
license are not required to complete this additional training.
Additionally, an employee of an ALF, AFCH, or ADCC that advertises and provides specialized
care for persons with Alzheimer’s disease must also receive the following additional training:
Three hours of additional training within the first three months of employment, rather than
the first seven months as with the non-specialize facilities;
Four hours of dementia-specific training within the first six months of employment; and
Four hours of continuing education each calendar year through:
o Contact hours;
o On-the-job training, limited to a certain amount of credit in each calendar year; or
o Electronic learning technology.
Employees of a health care services pool must complete the training that correlates with the
training required for the position and facility in which the employee will be working.
The bill directs the Department of Elder Affairs (DOEA) to provide the initial one hour of
dementia-related training in an online format at no cost. The training must contain information
on the following topics:
Understanding the basics about the most common forms of dementia;
How to identify the signs and symptoms of dementia; and
Skills for communicating and interacting with persons with ADRD.
The bill requires the DOEA to make a record of the completion of the one-hour training program
available to covered providers. The record must include the training, the name of the employee,
and the date of completion. The bill also requires covered providers to maintain a record of each
employee’s completion of the training and, upon request, provide the employee with a copy of
the completion record consistent with the employer’s written policies.
Employees hired, contracted, or referred to provide services before July 1, 2023, must complete
the training before July 1, 2026. However, proof of completion of equivalent training that has
been completed prior to July 1, 2023, may substitute for the training. Employees hired,
contracted, or referred to provide services on or after July 1, 2023, may satisfy training
requirements by completing current training curricula approved by the DOEA until the effective
date of the rules adopted by the DOEA under the bill.
The bill also requires the DOEA to offer education to the general public about ADRD. The
education must provide basic information about:
The most common forms of dementia;
How to identify the signs and symptoms of dementia;
Coping skills;
How to respond to changes;
Planning for the future; and
How to access additional resources about dementia.
BILL: CS/CS/SB 1182 Page 3
The bill may have a negative fiscal impact on private sector health care providers and an
insignificant negative fiscal impact on the Department of Elder Affairs. See Section V of this
analysis.
The bill takes effect on July 1, 2023.
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.
1
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.
2
There are an estimated 580,000 individuals living with Alzheimer’s disease in the state of
Florida.
3
By 2025, it is projected that 720,000 Floridians will have Alzheimer’s disease. More
than 6 million Americans are living with Alzheimer’s and the cost of caring for Alzheimer’s
disease and related disorders (ADRD) patients is estimated to total nearly $1 trillion by mid-
century.
4
1
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 March 11, 2023).
2
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 March 11, 2023).
3
Alzheimer’s Association, Alzheimer’s Statistics Florida, available at https://www.alz.org/media/Documents/florida-
alzheimers-facts-figures-2022.pdf (last visited March 11, 2023).
4
Id. BILL: CS/CS/SB 1182 Page 4
Dementia and Alzheimer’s Disease Training
Overview of Current ADRD Training by Facility/Agency Type
Entity All Employees Employees with
Expected or
Required Direct
Contact
Employees
Providing
Direct Care
Health Care
Practitioner
Continuing
Education
Sufficient?
Training
Approved
By?
Additional
Reqs.
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
3 additional
hours of
training within
the first 9
months of
employment
Yes DOEA
Home Health
Agencies (HHA)
Not specified 2 hours of
training within
the first 9
months of
employment
Yes DOEA HHAs that
serve 90%
individuals
under age 21
are exempt.
Hospice
Providers
ADRD upon
beginning
employment
1 hour of
training within
the first 3
months of
employment
3 additional
hours of
training within
the first 9
months of
employment
Yes DOEA
Special Care
Assisted Living
Facilities
(ALF)
5
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. 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
3 additional
hours of
training within
the first 9
months of
employment
Yes DOEA
Specialized
Alzheimer’s
Services Adult
Day Care
Centers
Same as nursing
homes, home
health agencies,
and Hospice
4 hours of
training within
the first 3
months of
employment
4 additional
hours of
training within
the first 6
months of
employment
Yes DOEA
Adult Family-
Care Homes
None None None Not
Specified.
AHCA
Nurse
Registries/
Companion or
Homemaker
Services
None None None Not specified.
5
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: CS/CS/SB 1182 Page 5
Specific details for each facility/agency type are below:
Nursing Homes
A nursing home is a facility that provides 24-hour nursing care, personal care, or custodial care
to individuals who are ill or physically infirm.
6
Nursing homes are licensed and regulated by the
Agency for Health Care Administration (AHCA) under part II of ch. 400, F.S.
Section 400.1755, F.S., requires each nursing home to provide the following training:
Provide 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 problem 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 Department of Elder Affairs (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 also comply with other applicable continuing
education requirements.
Home Health Agencies
A home health agency provides one or more of the following home health services: nursing care;
therapy; home health aide services; dietetics and nutrition; or medical supplies.
7
Home health
agencies are licensed and regulated by the AHCA under part III of ch. 400, F.S.
Section 400.4785, F.S., requires a home health agency to provide the following staff training:
6
Section 400.021(7), F.S.
7
Section 400.462(12) and (14), F.S. BILL: CS/CS/SB 1182 Page 6
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 problem 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.
For a health care practitioner, as defined in s. 456.001, F.S.,
8
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
that states 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
An assisted living facility (ALF) is a residential establishment, or part of a residential
establishment, that provides housing, meals, and one or more personal services for a period
exceeding 24 hours to one or more adults who are not relatives of the owner or administrator.
9
ALFs are licensed and regulated by the AHCA under part I of ch. 429, F.S. An ALF that
advertises that it provides special care for individuals with ADRD is required to meet certain
staffing and ADRD training requirements that are not required of other ALFs.
10
8
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.
9
Section 429.02(5), F.S.
10
Sections 429.177 and 429.178(1), F.S. BILL: CS/CS/SB 1182 Page 7
All ALF employees are required to attend a preservice orientation provided by the facility prior
to interacting with residents. The preservice orientation must be at least two hours and must
cover certain topics, including resident’s rights and the services offered by the facility.
11
ADRD training is only required for employees of ALFs that provide special care for residents
with ADRD.
12
Further, s. 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
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 Family-Care Homes
An adult family-care home (AHCA) is a private home, under which a person who owns or rents
the home provides room, board, and personal care in a family-like living arrangement, on a 24-
hour basis, for no more than five disabled adults or frail elders who are not relatives of the
homeowner.
13
AFCHs are licensed and regulated by the AHCA under part II of ch. 429, F.S.
11
Section 429.52(1), F.S., and Rule 59A-36.011(2), F.A.C.
12
Section 429.178(1), F.S., requires an ALF that advertises that it provides special care for persons with ADRD to meet certain standards
of operation that are not required of other ALFs. This is not a separate licensure category. The additional standards of operation include:
have an awake staff member on duty 24 hours a day, if the facility has 17 or more residents; if the facility has fewer than 17 residents, the
facility may have mechanisms in place to monitor residents instead of having an awake staff member on duty 24 hours a day; offer
activities specifically designed for persons who are cognitively impaired; have a physical environment that provides for the safety and
welfare of the residents; and employ staff who have completed the required training and continuing education.
13
Section 429.65(2), F.S. BILL: CS/CS/SB 1182 Page 8
AFCH 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, providers
are not currently required to undergo training specific to ADRD.
14
Adult Day Care Centers
Adult day care centers (ADCC) provide therapeutic services and activities for adults in a non-
institutional setting.
15
Participants may utilize a variety of services offered during any part of a
day totaling less than 24-hours. Basic services provided by ADCCs include leisure activities,
self-care training, nutritional services, and respite care.
16
Section 429.917, F.S., requires an ADCC 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
14
See s. 429.75, F.S., and Fla. Admin. Code R. 59A-37.007 (2020).
15
Section 429.901(3), F.S.
16
Id. BILL: CS/CS/SB 1182 Page 9
training in that topic if the employee or direct caregiver changes employment to a different
ADCC or to an ALF, nursing home, home health agency, or hospice. The direct caregiver
must comply with other applicable continuing education requirements.
Specialized Alzheimer’s Services Adult Day Care Centers
An ADCC may hold a license designated by the AHCA as a specialized Alzheimer’s services
adult day care center if it meets certain requirements.
17
Employees of specialized Alzheimer’s
services ADCCs, who have direct contact with, or provide direct care to, individuals with ADRD
are required to receive four hours of ADRD training within three months of beginning
employment.
18
Employees of specialized Alzheimer’s services ADCCs who provide direct care
to participants with ADRD are required to receive an additional four hours of training within six
months of beginning employment. The curriculum for the additional four hours of training must
address the following subject areas:
Understanding brain disease;
Normal brain functions and normal aging;
Understanding treatable and irreversible dementia;
Mental status tests;
Communication and the effects of damage to brain cells;
Influences on behavior and brain deterioration;
Interventions;
Physical causes and pain indications;
Common ADRD medications and side effects;
Malnutrition and dehydration;
Activities of daily living;
Validation therapy;
Safety; and
Caregiver stress management.
19
Employees of specialized Alzheimer’s services ADCCs who provide direct care to participants
with ADRD are also required to receive 4-hours of continuing education annually in topics
related to ADRD.
20
Nurse Registries and Companion and Homemaker Services
A nurse registry is an agency licensed to secure employment for registered nurses, licensed
practical nurses, certified nursing assistants, home health aides, companions, and homemakers,
who are compensated by fees as independent contractors to provide services in a patient’s home
or with health care facilities or other entities.
21
Nurse registries are governed by part II of chapter
408, F.S., and the nurse registry rules in ch. 59A-18, F.A.C. A nurse registry must be licensed by
17
Section 429.918(4), F.S.
18
Rule 59A-16.111(2), F.A.C.
19
Rule 59A-16.111(3), F.A.C.
20
Rule 59A-16.111(5), F.A.C.
21
Section 400.462(21), F.S. BILL: CS/CS/SB 1182 Page 10
the AHCA to offer contracts in Florida.
22
Current law does not require contracted personnel of
nurse registries to complete training on ADRD.
Companions spend time with and care for elderly, handicapped, or convalescent individuals,
prepare and serve meals to such individuals, and accompany such individuals on trips and
outings. Companions are prohibited from providing hands-on personal care to a client.
23
Homemakers perform household chores that include housekeeping, meal planning and
preparation, shopping assistance, and routine household activities for elderly, handicapped, or
convalescent individuals. Homemakers are prohibited from providing hands-on personal care to
a client.
24
Current law does not require companions or homemakers to complete training on
ADRD.
Health Care Services Pools
A health care services pool is a business that provides licensed, certified, or trained health care
personnel to work as temporary staff in health care facilities and residential facilities to support
or supplement the facilities’ work force as necessary to cover employee absences, temporary
skill shortages, seasonal workloads, and special assignments and projects.
25
Health care services
pools are governed by part II of chapter 408, F.S., and Rule 59A-27, F.A.C., and must be
licensed by the AHCA to offer services to Florida facilities.
26
A health care services pool must document that each temporary employee provided to a health
care facility has met the licensing, certification, training, or continuing education requirements
for the position in which her or she will be working.
27
ADRD Training Providers and Curricula
The DOEA or its designee is responsible for approving ADRD training providers and curricula
for employees of nursing homes, home health agencies, ALFs, and adult day care centers.
28
The
University of South Florida (USF) administers the program through a contract with DOEA.
29
To be approved as a training provider, an applicant must provide proof of certain educational and
experience requirements, including:
A Master’s degree from an accredited college in health care, human services, or gerontology;
or
A Bachelor’s degree from an accredited college, or licensure as a registered nurse; and
One year of experience as an educator of caregivers for individuals with ADRD; or
Completion of a specialized training program relating to ADRD and a minimum of two years
of practical experience in a program providing direct care to individuals with ADRD; or
22
Section 400.506(1), F.S.
23
Section 400.462(7), F.S.
24
Section 400.462(18), F.S.
25
Section 400.980(1), F.S.
26
Rule 58A-27.002, F.A.C.
27
Section 400.980(5), F.S.
28
Sections 400.1755(5), 400.4785(1)(f), 429.178(5), and 429.917(1)(g), F.S.
29
The University of South Florida, College of Behavioral & Community Sciences, USF’s Training Academy on Aging,
Alzheimer's Disease and Related Disorders
Frequently Asked Questions, available at http://www.trainingonaging.usf.edu/products/faq.cfm (last visited March 11, 2023). BILL: CS/CS/SB 1182 Page 11
Three years of practical experience in a program providing direct care to individuals with
ADRD.
30
Upon successful completion of training, the trainer is required to issue the trainee a certificate of
completion.
31
Training curricula is certified for a period of three years and must be resubmitted
for approval.
32
Approval of training curricula is based on how well it addresses the required
subject areas.
33
The table below depicts the number of approved trainers and training curricula by
facility/provider type.
34
Facility/Provider
Type
Approved
Training Providers
Approved
Training Curricula
Nursing Home 1,865 24
Assisted Living Facility 800 66
Home Health Agency 750 22
Adult Day Care Center 133 17
Total 3,548 129
Quality of Long-Term Care Facility Improvement Trust Fund
The Quality of Long-Term Care Facility Improvement Trust Fund (“Trust Fund”), created in
2001,
35
supports innovative ideas that directly impact quality of care or quality of life of nursing
home residents beyond minimum standards.
36
Section 400.0239, F.S., places the Trust Fund
within the AHCA.
37
Trust Fund expenditures can be made for:
Development and operation of a mentoring program for increasing the competence,
professionalism, and career preparation of long-term care facility direct care staff, including
nurses, nursing assistances, and social service and dietary personnel;
Development and implementation of specialized training programs for long-term care facility
personnel who provide direct care of residents:
o With ADRD;
o At risk of developing pressure sores; and
o With special nutrition and hydration needs.
Provision of economic and other incentives to enhance the stability and career development
of the nursing home direct care workforce, including paid sabbaticals for exemplary direct
30
Rule 58A-5.0194(1)(a), F.A.C.
31
Rule 58A-5.0194(3), F.A.C.
32
Rule 58A-5.0194(1)(b), F.A.C.
33
Id.
34
The University of South Florida’s Training Academy on Aging, Find Approved Applications, available at
https://usfweb.usf.edu/trainingonAging/default.aspx, (last visited March 11, 2023).
35
Ch. 2001-205, L.O.F.
36
The AHCA, Quality of Long-Term Care Facility Improvement Trust Fund, available at
https://ahca.myflorida.com/MCHQ/Health_Facility_Regulation/Long_Term_Care/Trust_Fund.shtml (last visited March 11,
2023).
37
Section 400.0239(1), F.S. BILL: CS/CS/SB 1182 Page 12
care career staff to visit facilities throughout the state to train and motivate younger workers
to commit to long-term care careers; and
Promotion and support for the formation and active involvement of resident and family
councils in the improvement of nursing home care.
38
The Trust Fund is funded through a combination of:
General Revenue;
The Civil Money Penalty Fund; and
Fifty percent of any punitive damages awarded in lawsuits against a nursing home or ALF.
39
III. Effect of Proposed Changes:
Alzheimer’s Disease and Related Disorders (ADRD) Training Requirements
Section 1 creates s. 430.5025, F.S., which may be cited as the “Florida Alzheimer’s Disease and
Dementia Training Act”, to establish universal Alzheimer’s disease and related disorders
(ADRD) training requirements for nursing homes, home health agencies, nurse registries,
companion and homemaker service providers, health care services pools, assisted living facilities
(ALF), adult family-care homes (AFCH), and adult day care centers (ADCC) with limited
exception.
The bill defines the following terms:
“Covered provider” means a nursing home, a home health agency, a nurse registry, health
care services pool, a companion or homemaker service provider, an ALF, an AFCH, or an
ADCC licensed or registered under ch. 400, F.S., or ch. 429, F.S.
“Department” means the Department of Elderly Affairs.
40
“Employee” means a person, contracted staff, or independent contractor employed or
referred by a covered provider who is required to have a level 2 background screening as
required by s. 408.809, F.S., and ch. 435, F.S.
“Personal care” means providing, through in-person contact, assistance with activities of
daily living, assistance with self-administration of medication, homemaker or companion
services, nursing services, or other services that promote the physical, mental, and
psychosocial well-being of participants, patients, and residents of covered providers. The
term does not include duties involving administrative functions or maintaining the physical
environment of a licensed facility, including grounds maintenance, building maintenance,
housekeeping, laundry, or food preparation.
“Regular contact” means the performance of duties other than personal care which may
require employees to interact in person on a daily basis with participants, patients, or
residents.
The bill requires the Department of Elder Affairs (DOEA) to offer education about ADRD to the
general public. The education must provide basic information about:
The most common forms of dementia;
38
Section 400.0239(2), F.S.
39
Section 400.0238(4), F.S.
40
Also known as the Department of Elder Affairs (DOEA). BILL: CS/CS/SB 1182 Page 13
How to identify the signs and symptoms of dementia;
Coping skills;
How to respond to changes;
Planning for the future; and
How to access additional resources about dementia.
The bill also requires employees of covered providers who provide personal care to or have
regular contact with patients, participants, or residents, one hour of dementia-related training
within 30 days of his or her employment. All employees must also receive basic written
information about interacting with persons who have ADRD upon beginning employment.
The bill directs the DOEA to provide the initial one hour of dementia-related training. The
training must be provided in an online format at no cost and must contain information on the
following topics:
Understanding the basics about the most common forms of dementia;
How to identify the signs and symptoms of dementia; and
Skills for communicating and interacting with persons with ADRD.
The table below summarizes the changes (indicated by red font) to training requirements for all
employees of covered providers.
Initial Training for all “Employees”
Basic Written Info Hours
Current
Effect of
the Bill
Current
Effect of
the Bill
Nursing Homes
Basic written info upon
beginning employment
Basic written info upon
beginning employment
None.
1 hr w/in 1
st
30 days
Home Health
Agencies
Basic written info upon
beginning employment
Basic written info upon
beginning employment
None.
1 hr w/in 1
st
30 days
Nurse Registry
Companion or
Homemaker Service
None.
Basic written info upon
beginning employment
None.
1 hr w/in 1st
30 days
ALFs
Generally None.
Basic written info upon
beginning employment
None.
1 hr w/in 1
st
30 days
Special
Care
Basic written info
w/in 1
st
3 months
Basic written info upon
beginning employment
None.
1 hr w/in 1
st
30 days
Adult
Family-
Care
Home
Generally None.
Basic written info upon
beginning employment
None.
1 hr w/in 1
st
30 days
Special
Care
None.
Basic written info upon
beginning employment
None.
1 hr w/in 1
st
30 days
Adult
Day
Care
Centers
Generally
Basic written info upon
beginning employment
Basic written info upon
beginning employment
None.
1 hr w/in 1
st
30 days
Special
Care
Basic written info upon
beginning employment
Basic written info upon
beginning employment
None.
1 hr w/in 1
st
30 days BILL: CS/CS/SB 1182 Page 14
The bill also makes the following changes (indicated by red font) to the ADRD training
requirements for direct care workers employed by nursing homes, home health agencies, nurse
registries, ALFs, and ADCCs.
Direct Care Workers Providing Personal Care to Individuals with ADRD
41
Initial Training
42
Additional 1
st
Year Training Continuing
Current
Effect of
the Bill
Current
Effect of
the Bill
Current
Effect of
the Bill
Nursing Homes
1 hr.
w/in 1
st
3 months
1 hr
w/in 1st
30 days
3 hrs.
w/in 1
st
9 months
3 hrs.
w/in 1
st
7 months
None. No change.
Home Health Agencies None.
1 hr
w/in 1st
30 days
2 hrs.
w/in 1
st
9 months
2 hrs.
w/in 1
st
7 months
None. No change.
Nurse Registry
Companion or
Homemaker Service
None.
1 hr
w/in 1st
30 days
None.
2 hrs.
w/in 1
st
7 months
None. No change.
ALFs
Generally None.
1 hr
w/in 1st
30 days
None.
3 hrs.
w/in 1
st
7 months
43
None. No change.
Special
Care
4 hrs.
w/in 1
st
3 months
1 hr
w/in 1st
30 days
4 hrs.
w/in 1
st
9 months
3 hrs. w/in 1
st
3 months
plus
4 hrs. w/in 1
st
6 months
4 hrs.,
annually
No change.
Adult
Family-
Care
Home
Generally None.
1 hr
w/in 1st
30 days
None.
3 hrs. w/in 1
st
7 months
None. No change.
Special
Care
None.
1 hr
w/in 1st
30 days
None.
3 hrs. w/in 1
st
3 months
plus
4 hrs. w/in 1
st
6 months
None.
4 hrs.,
annually
Adult
Day
Care
Centers
Generally
1 hr.
w/in 1
st
3 months
1 hr
w/in 1st
30 days
3 hrs.
w/in 1
st
9
months
3 hrs.
w/in 1
st
7 months
None. No change.
Special
Care
4 hrs.
w/in 1
st
3 months
1 hr
w/in 1st
30 days
4 hrs.
w/in 1
st
6 months
3 hrs. w/in 1
st
3 months
plus
4 hrs. w/in 1
st
6 months
4 hrs.,
annually,
per rule
4 hrs.,
annually,
per statute
41
Note: New training requirements only apply to employees providing direct care to patients/residents with ADRD, as compared to training
requirements in current law which apply to employees providing direct care to any patient/resident.
42
Current law only provides an initial hour-based training requirement for the direct care workers of certain provider types. The proposed
initial hourly training requirement applicable to all “employees” is repeated here since all “direct care workers” will have to complete this
training. This initial training requirement is not in addition to the initial hour-based training that is currently applicable.
43
Note: Employees of an ALF licensed as a limited mental health facility will not be required to complete the additional three hours of
training within the first seven months of employment. BILL: CS/CS/SB 1182 Page 15
The bill requires each employee of a home health agency, nurse registry, or companion or
homemaker service provider who provides personal care to receive two hours of additional
training within the first seven months of employment. The additional training must include, but
is not limited to:
Behavior management;
Promoting the person’s independence in activities of daily living; and
Skills for working with families and caregivers.
Each employee of a nursing home, ALF, AFCH or ADCC who provides personal care must
receive three hours of additional training within the first seven months of employment. The
additional training must include the three above-mentioned topics and also include, but not be
limited to:
Group and individual activities;
Maintaining an appropriate environment; and
Ethical issues.
Each employee of an ALF, AFCH, or ADCC that advertises and provides specialized care for
persons with Alzheimer’s disease must also receive the following additional training if such
employee provides personal care, as defined in the bill:
Three hours of additional training within the first three months of employment, rather than
the first seven months;
Four hours of dementia-specific training within the first six months of employment; and
Four hours of continuing education each calendar year through:
o Contact hours;
o On-the-job training
44
which can account for no more than 2 hours of continuing
education credit each calendar year; or
o Electronic learning technology.
The bill requires the continuing education to cover at least one of the topics included in the
dementia-specific training in which the employee has not received previous training within the
last calendar year.
The bill allows ADRD training hours required under the bill to count toward the total hours of
training required for certified nursing assistants to maintain certification. The bill also allows
ADRD training hours to count toward the total hours of continuing education required for health
care practitioners, as defined in s. 456.001, F.S.
Employees of a health care services pool must complete the training that correlates with the
training required for the position and facility in which the employee will be working.
44
The bill defines “on-the-job training” to mean a form of direct coaching in which a facility administrator or his or her
designee instructs an employee who provides personal care with guidance, support, or hands-on experience to help develop
and refine the employee’s skills for caring for a person with ADRD. BILL: CS/CS/SB 1182 Page 16
ADRD Training Providers and Curricula
Current law authorizes DOEA or its designee to approve the initial 1-hour training curricula, the
additional training (post-initial training) curricula, and the continuing education curricula for
nursing homes, ALFs, adult family-care homes, home health agencies, and adult day care
centers. The bill adds the authority for DOEA to approve such training curricula for nurse
registries and homemaker and companion services.
The bill provides that any ADRD training and curriculum that has been approved before July 1,
2023 remains in effect until the curriculum’s expiration date. The bill authorizes the DOEA to
create training curricula guidelines and adopt rules to establish requirements for the approval of
other qualified training providers, and to conduct samplings of training curricula as necessary to
monitor for compliance with curriculum guidelines. The bill also permits the DOEA to develop
or provide continuing education training or curricula as an option for covered providers and
employees.
For the post-initial training and continuing education, the bill allows training providers who meet
certain qualifications to offer training without prior approval, including:
A person approved by the DOEA or its designee before July 1, 2023.
An individual who is approved by an applicable board or the Department of Health (DOH) to
provide training, is registered with the DOH electronic continuing education tracking system,
and meets one of the following experience requirements:
o At least one year of teaching experience as an educator for caregivers of persons with
ADRD;
o At least one year of practical experience in a program providing care to persons with
ADRD; or
o Completion of a specialized ADRD training program from an accredited health care,
human services, or gerontology education provider.
Training Records
Under the bill, employees are not required to repeat any of the training requirements in the bill
upon a change of employment to a different covered provider. To facilitate this, the bill
addresses employee access to their own training records.
For the initial training, the bill requires trainers to provide a record of an employee’s completion
of training to the covered provider. The bill requires the covered provider to maintain a record of
the employee’s completion of the training, and upon written request by the employee, provide a
copy of the record of completion to the employee.
For post-initial training and continuing education, the bill requires trainers to provide a record of
an employee’s completion of training and continuing education, but it does not specify to whom
the record must be provided (covered provider or employee). Further, the bill does not require a
covered provider to maintain the record of completion or provide a copy of the record of
completion as it does for records of completion of initial training.
BILL: CS/CS/SB 1182 Page 17
Health care services pools will be required to verify and maintain documentation that each
employee or independent contractor has met the ADRD training requirements of the position in
which he or she will be working prior to assigning or referring the employee. The health care
services pool must provide supporting documentation to the covered provider upon request.
Implementation
The bill requires all employees hired before July 1, 2023, to complete the training requirements
of the bill by July 1, 2026. Individuals newly employed, contracted, or referred to provide
services on or after the effective date of the bill may complete training using any existing
training curriculum approved by DOEA. The bill provides a grandfather clause for an employee
who shows proof of completion of training that is equivalent to the training requirements of the
bill.
Section 2 amends s. 400.0239, F.S., to allow funds from the Quality of Long-Term Care Facility
Improvement Trust Fund to be allocated for direct support of the development and
implementation of specialized training programs for long-term care facility personnel who
provide direct care for residents with ADRD as provided under the bill.
Section 3 amends s. 400.1755, F.S., to repeal the individual ADRD training requirements in the
licensure statutes for nursing homes and related facilities in favor of the uniform training
requirements established by the bill.
Section 4 amends s. 400.4785, F.S., to repeal the specific ADRD training requirements for home
health agencies in favor of the uniform training requirements established by the bill.
Section 5 creates s. 400.51, F.S., implementing the training requirements established by the bill
for persons employed, contracted, or referred by a nurse registry or a person registered with an
agency to provide companion or homemaker services.
Section 6 amends s. 400.980, F.S., to require a health care services pool to verify and maintain
documentation that each employee or independent contractor provided, assigned, or referred to a
health care facility has met all training and certification requirements for the position in which he
or she will be working. The bill specifically prohibits a health care services pool from delegating
this responsibility to another provider.
Section 7 amends s. 429.178, F.S., to repeal the specific ADRD training requirements for ALFs
in favor of the uniform training requirements established by the bill.
Section 8 amends s. 429.52, F.S., to require all ALF employees to complete the training
requirements established by the bill. An exception is created for an employee of an ALF licensed
as a limited mental health facility who is not required to complete the additional three hours of
training within seven months after beginning employment that is required under the newly
created s. 430.5025(4)(d), F.S.
The bill also allows the 1-hour training requirement for ALF employees to count toward an
existing mandatory 2-hour preservice orientation, if completed before interacting with residents. BILL: CS/CS/SB 1182 Page 18
Section 9 amends s. 429.83, F.S., to require all adult family-care homes to provide ADRD staff
training pursuant to the requirements established in the bill.
Section 10 amends s. 429.917, F.S., to repeal the specific ADRD training requirements for
AFCHs in favor of the uniform training requirements established by the bill.
Section 11 amends s. 429.918, F.S., to repeal the specific ADRD training requirements for
ADCCs and specialized Alzheimer’s services ADCCs in favor of the uniform training
requirements established by the bill.
Section 12 provides an effective date of July 1, 2023.
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 identified.
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
The bill is likely to have a negative fiscal impact on health care facilities and providers as
a result of the increased training requirements of the bill. The level of fiscal impact is
indeterminate. BILL: CS/CS/SB 1182 Page 19
C. Government Sector Impact:
The Department of Elder Affairs (DOEA) states that there are potential expenditures to
develop and distribute informational materials beyond what is currently provided,
potential expenditures for developed training curricula, approval and monitoring beyond
what is currently provided, and potential expenditures to develop a database to store
training participant information.
45
The DOEA anticipates that any expenditures generated
by the bill can be absorbed by existing resources.
46
VI. Technical Deficiencies:
None.
VII. Related Issues:
None.
VIII. Statutes Affected:
This bill substantially amends the following sections of the Florida Statutes: 400.0239, 400.1755,
400.4785, 400.980, 429.178, 429.52, 429.83, 429.917, and 429.918.
This bill creates the following sections of the Florida Statutes: 430.5025 and 400.510.
IX. Additional Information:
A. Committee Substitute – Statement of Substantial Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
CS/CS by Appropriations Committee on Health and Human Services on April 12,
2023:
The committee substitute:
Requires employees who are provided, assigned, or referred by a health care services
pool to complete the Alzheimer’s training and continuing education contemplated by
the bill as applicable to the covered provider and position in which the employee will
be working;
Requires a health care services pool to verify and maintain proper documentation
before providing, assigning, or referring an employee to a covered provider;
Requires a health care services pool to provide documentation verifying the
completed training and continuing education of the employee to the covered provider
upon request;
Prohibits health care service pools from delegating documentation and verification of
the training requirements to other employers; and
45
E-mail from Tyler Jefferson, Legislative Affairs Director, the DOEA, RE: SB 1182 - Education and Training for
Alzheimer's Disease and Related Forms of Dementia, March 11, 2023 (on file with the Senate Committee on Children,
Families, and Elder Affairs).
46
Id. BILL: CS/CS/SB 1182 Page 20
Clarifies that employees of assisted living facilities licensed as limited mental health
facilities are exempt from a portion of the training requirements of the bill.
CS by Children, Families, and Elder Affairs on March 14, 2023:
Removes authority for the Department of Elder Affaires (DOEA) to delegate the
administration of any of the bill provisions;
Makes employees responsible for compliance with the training requirements instead
of employers;
Requires the DOEA to provide a record of the completion of the 1-hour training
program to the covered provider, rather than a record of the training program;
Makes the training requirements apply to employees who provide personal care to
any resident of a facility, instead of only to residents with Alzheimer’s disease.
Authorizes the DOEA to develop or provide continuing education training or
curricula;
Removes authority for a person with a master’s or doctoral degree in health care,
social services, or gerontology to act as a training provider;
Authorizes the DOEA to adopt rules to create training curriculum guidelines;
Retains current law relating to training requirements on Alzheimer’s disease for
hospice employees;
Clarifies that all assisted living facility (ALF) employees must complete Alzheimer’s
disease and related disorder training under the bill, rather than adding training as a
topic on the core competency test for ALF administrators; and
Allows the 1-hour training requirement for ALF employees to count toward the 2-
hour preservice orientation, if completed before interacting with residents.
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.