Iowa waives nursing aide training rules

The state of Iowa has agreed to temporarily waive training requirements for nurse aides who provide much of the practical care in nursing homes.

The waivers were issued by the director of the Iowa Department of Inspections and Appeals two weeks ago in response to a request from industry lobbyists. They will be in effect at least until the end of the state of emergency declared by the federal government due to the COVID-19 pandemic.

The waivers have the effect of extending some of the regulatory relief granted to nursing homes last year by Governor Kim Reynolds during the early stages of the pandemic. The regulatory relief comes at a time when the governor has refused to reinstate some of the mitigation efforts – like business and school closures, limits on public gatherings, restrictions on opening hours – intended for slow the spread of the virus.

“It’s so wrong in so many ways,” said John Hale, consultant and advocate for the Iowa seniors. He said some of the waived training standards are already “woefully outdated and woefully inadequate,” having been established over 30 years ago at a time when nursing home residents had less complex needs.

“At the start of the COVID crisis which unfolded horribly in nursing homes, it was popular for employers and elected officials to call these frontline workers ‘essential’,” Hale said. “Promises were made to honor them and their heroic efforts. This waiver of the rules in no way does that. On the contrary, it sends the message that it is business as usual in the industry, and that when the going goes, shortcuts will be taken and the essential workers and residents they care for will face the consequences. “

In approving the industry’s waiver request, Department of Inspections and Appeals Director Larry Johnson Jr. said that under the circumstances, forcing nursing homes to comply with existing regulations “would pose a problem. undue hardship on approved health establishments ”. Johnson also said approval of the waivers would still provide “substantially equal protection to public health, safety and welfare.”

DIA is the state agency that licenses, regulates, and oversees nursing homes in Iowa. The Johnson-approved waivers apply to regulations for direct caregivers in these homes:

Training course: The the requirement that a nurse’s aide who has not completed a 75-hour training program participate in a structured 20-hour on-the-job training program is waived, but only to the extent that the worker has completed at least 20 hours of the 75 hour-hour course.

Tests and exams: The requirement that a nurse’s aide who has received training outside of a state-approved program take an exam is waived. While an aide should always “demonstrate competence in the skills and techniques necessary to care for residents,” the rules do not specify how this competence would be demonstrated.

Medications : The requirement for a person certified as a medication aide by another state to pass a state-approved competency exam is waived as long as the person is “capable of demonstrating competence.”

Extension of proclamation

In March 2020, Reynolds issued the first of several disaster emergency proclamations, temporarily suspending various laws and regulations applicable to Iowa businesses after finding that complying with those regulations would hamper Iowa’s response to the COVID-19 pandemic.

At the same time, federal authorities have taken a similar direction, with the US Department of Health and Human Services suspending the ban on nursing homes from employing anyone for more than four months, unless the worker does meet certain training and certification requirements.

The governor’s regulatory relief for nursing homes was set to expire on Aug. 22, and the Iowa Healthcare Association, a lobbying organization that represents 360 healthcare facilities in the state, has estimated that it will not renew it. In an effort to effectively expand the proclamation’s provisions without the governor’s involvement, the association approached Johnson, the head of the state’s inspection agency, directly and requested regulatory waivers.

On August 16, Johnson agreed to the request. Three days later, the governor issued a proclamation extending the same set of waivers. They are expected to remain in place at least until the end of similar federal waivers, which is unlikely to happen until 2022.

Even before the pandemic, Iowa nursing homes struggled to attract workers, according to the association, and when COVID-19 hit, the workforce problem became a crisis of its own. whole. Since then, homes in Iowa have employed 2,100 “temporary nurse aides” to help meet the needs of residents. With the new exemptions now in place, households can continue to employ less trained helpers.

“The facilities have been operating with the use of temporary nurse aides for over 16 months since the onset of the public health emergency,” the president and CEO of the Iowa Heath Care Association told Johnson. , Brent Willett, asking for waivers. “Long-term care service and support providers have maintained the high quality of care provided in part through the ability of ANTs to continue to meet the needs of residents and the nursing supervision of temporary nurse aides. “

Hale said the state’s decision to waive enforcement of rules that are already inadequate to protect Iowa residents “scares the mind,” and asked what steps the state has taken to validate industry claims that resident care has improved in Iowa.

Training has long been a problem

While nursing aides provide much of the practical care in nursing homes, they are also among the least educated and lowest paid workers in health care. In nursing homes, the very skill and training of licensed professionals – registered nurses, licensed practical nurses, and administrative staff – is often the subject of state inspection reports.

Recently, DIA inspectors questioned the training of registered nurses, LPNs and others at the Altoona Nursing and Rehabilitation Center, where a woman died from an apparent heart attack.

State inspectors said a registered nurse at the home initiated chest compression and CPR, but with the resident still in bed rather than on a hard surface. After a few minutes, the nurse got tired and asked a nursing assistant who was in the room to take over. The IAA reportedly responded to the request by saying “she was tired, did not feel well and did not want to do CPR,” inspectors reported. The IAA also reportedly told a colleague that she was “too scared” to perform CPR.

A third worker – who later told inspectors that she had taken a high school CPR course five years before but had never done CPR and “had no idea what I was doing” – then attempted chest compression and CPR. A worker said she was last certified in CPR 13 years ago, and the registered nurse reportedly told inspectors she had no home training on what to do in a medical emergency, that she was not certified in CPR and that she did not know if the home had a defibrillator.

The home’s human resources manager, meanwhile, had hired at least four people without having completed the required criminal background check. She then told inspectors she was unaware that the governor’s proclamation suspending this requirement during the pandemic had expired.

This article first appeared in the Iowa Capital Dispatch.

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