HB-4789, As Passed House, October 19, 2005

 

 

 

 

 

 

 

 

 

 

 

 

 

SUBSTITUTE FOR

 

HOUSE BILL NO. 4789

 

 

 

 

 

 

 

 

 

 

 

 

     A bill to amend 1978 PA 368, entitled

 

"Public health code,"

 

(MCL 333.1101 to 333.25211) by adding section 21794.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     Sec. 21794. (1) Except as otherwise provided under subsection

 

(7), with the consent of the resident or the resident's designated

 

representative a nursing home may use a dining assistant to feed

 

residents who, based on the charge nurse's assessment of the

 

resident and the resident's most recent plan of care, need

 

assistance or encouragement with eating and drinking, but do not

 

have complicated feeding problems, including, but not limited to,

 

difficulty swallowing, recurrent lung aspirations, tube or

 

parenteral feedings, or behavioral issues that may compromise


 

nutritional intake. The charge nurse's assessment and plan of care

 

shall be documented in the resident's medical record. For those

 

residents who are assigned a dining assistant and are not on a

 

quarterly resident plan of care, the charge nurse shall perform a

 

special quarterly assessment to monitor the appropriateness of

 

utilizing the dining assistant.

 

     (2) A nursing home that chooses to utilize dining assistants

 

shall provide dining assistants with training through their own

 

dining assistant training program that has been approved by the

 

department or by arranging for another approved dining assistant

 

training program to provide the training. In order to be approved

 

by the department, the dining assistant training program shall

 

include, at a minimum, a 1-hour practicum of direct resident

 

contact, a written examination, and courses on each of the

 

following totaling not less than 15.5 hours:

 

     (a) Dining assistants program overview.

 

     (b) Resident rights.

 

     (c) Communication and interpersonal skills.

 

     (d) Appropriate responses to resident behavior.

 

     (e) Recognizing changes in residents.

 

     (f) Infection control.

 

     (g) Assistance with feeding and hydration.

 

     (h) Feeding techniques.

 

     (i) Safety and emergency procedures.

 

     (j) End of life.

 

     (3) An individual shall not be paid by the nursing home as a

 

dining assistant unless that individual has successfully completed


 

a dining assistant training program described under subsection (2). 

 

A nursing home shall not employ or allow an individual who is less

 

than 17 years of age to work as a dining assistant.

 

     (4) A dining assistant shall work under the supervision of a

 

registered professional nurse or a licensed practical nurse. A

 

dining assistant's sole purpose is to provide feeding assistance to

 

residents, and he or she shall not perform any other nursing or

 

nursing-related tasks, such as toileting or transporting residents.

 

Except as otherwise provided under subsection (5), a dining

 

assistant shall only provide feeding assistance under the direction

 

of a registered professional nurse, licensed practical nurse, or

 

certified nurse aid. A dining assistant is not nursing personnel

 

and shall not be included in computing the ratio of patients to

 

nursing care personnel or used to supplement or replace nursing

 

personnel. Except as otherwise provided under subsection (5),

 

dining assistants shall only provide feeding assistance in

 

designated dining areas and shall not feed residents in their

 

rooms. A dining assistant shall not be assigned more than 3

 

residents at 1 time. Because providing feeding assistance to

 

residents is providing direct services to residents, dining

 

assistants are subject to the criminal background checks under

 

section 20173.

 

     (5) If approved by the charge nurse and subject to subsection

 

(1), a dining assistant may feed a resident who is unable to make

 

it into a designated dining area in his or her room. A registered

 

professional nurse or a licensed practical nurse is not required to

 

be physically present within the resident's room during the


 

feeding, but a registered professional nurse or licensed practical

 

nurse shall be immediately available to provide help if needed. A

 

dining assistant who is feeding a resident in his or her room as

 

provided under this subsection shall not be assigned to assist

 

another resident at the same time.

 

     (6) A nursing home that utilizes dining assistants shall

 

maintain a written record of each individual used as a dining

 

assistant. The written record shall include, at a minimum, the

 

complete name and address of the individual and the date the

 

individual successfully completed the dining assistant training

 

program along with a copy of the written record of the satisfactory

 

completion of the training program.

 

     (7) A nursing home that meets any of the following shall not

 

utilize dining assistants without obtaining written approval from

 

the department that includes a monitoring plan to ensure the

 

health, safety, and welfare of the residents within that facility:

 

     (a) Has received an actual harm dietary related citation

 

within the immediately preceding year.

 

     (b) Has received a staffing level citation within the

 

immediately preceding 2 years.

 

     (c) Has had a ban on admissions imposed within the immediately

 

preceding 2 years.

 

     (d) Has received an immediate jeopardy citation for nursing

 

related issues within the immediately preceding 2 years.  

 

     (e) Has received more than 2 times the statewide average

 

number of citations on the 2 most recent surveys.

 

     (f) Did not complete, or provided inaccurate, eating,


 

hydration, and weight status information in residents' charts for

 

the most recent survey.

 

     (8) Nothing in this section prohibits a family member or

 

friend from providing feeding assistance to a resident within the

 

nursing home or requires a friend or family member to complete the

 

training program prescribed under subsection (2). However, a

 

nursing home may offer to provide the dining assistant training

 

program to family members and friends.

 

     (9) If the final report on the merits of the Michigan dining

 

assistant pilot project conducted by the department of community

 

health and Michigan state university is not completed by May 1,

 

2006, the department shall issue an interim report on the

 

utilization of dining assistants within a nursing home by June 1,

 

2006 and by July 1, 2006 present that interim report to the house

 

of representatives and senate standing committees that reported

 

House Bill No. 4789 of the 93rd Legislature.

 

     (10) As used in this section:

 

     (a) "Certified nurse aid" means a nurse's aid or nurse

 

assistant trained as required under 42 USC 1395i-3 and 42 USC

 

1396r.

 

     (b) "Dining assistant" means an individual who meets the

 

requirements of this section and who is only paid to feed nursing

 

home residents by the nursing home or who is used under an

 

arrangement with another agency or organization.

 

     (c) "Direction" means being within the field of vision of

 

where the feeding assistance is being provided and immediately

 

available to provide help in the event of an emergency.


 

     (d) "Immediately available" means being capable of responding

 

to provide help if needed to a dining assistant at any time either

 

in person or by voice or call light system, radio, telephone,

 

pager, or other method of communication during a feeding.

 

     (e) "Registered professional nurse" or "licensed practical

 

nurse" means an individual licensed under article 15 to engage in

 

the practice of nursing.

 

     (f) "Supervision" means a registered professional nurse or

 

licensed practical nurse who oversees the work of a dining

 

assistant and complies with each of the following:

 

     (i) Designates a resident to whom feeding assistance is to be

 

provided.

 

     (ii) Is physically present in the nursing home and immediately

 

available to provide help in the event of an emergency.

 

     Enacting section 1. It is the intent of this legislature that

 

this amendatory act take effect September 30, 2006 unless the

 

legislature concludes, after consulting with the department of

 

community health, reviewing the interim report or final report, if

 

completed, of the dining assistant pilot project conducted by the

 

department of community health and Michigan state university, and

 

holding at least 1 meeting open to the public for discussion of

 

that report, that the use of dining assistants within a nursing

 

home has a detrimental impact on patient care and well-being and

 

repeals section 21794 of the public health code, 1978 PA 368, MCL

 

333.21794.