Oregon Health Authority
Public Health Division - Chapter 333
Division 536
IN-HOME CARE AGENCIES
333-536-0070
Caregiver Qualifications and Requirements
(1) The services and care provided by an agency shall be rendered by qualified and trained employees under the supervision of the administrator or administrator's designee.
(2) All caregivers must receive all training necessary to ensure the caregiver is able to competently provide the level of care they will be assigned to provide, which may include training to the level of classification type if the caregiver provides that level of care. The services shall be provided as requested by the client or client's representatives in accordance with these rules and the service plan.
(3) The agency owner or administrator shall ensure that the agency has qualified and trained employees sufficient in number to meet the needs of all clients receiving services.
(4) Caregivers must be at least 18 years of age and shall have sufficient communication and language skills to enable them to perform their duties and interact effectively with clients and other agency staff.
(5) Caregivers shall complete an agency-specific orientation, conducted by the agency administrator, administrator's designee, or administrator's delegate before independently providing services to clients. The orientation shall be a minimum of four hours, obtained online or in person, and include, but not be limited to, the following subject areas:
(a) Caregivers' job description and requirements;
(b) Clients' rights;
(c) Ethics, including confidentiality of client information;
(d) An overview of the agency's policies and procedures as specified in OAR 333-536-0051, with specific emphasis on the following:
(A) Requirements for traveling with a client, including reporting requirements if a client's condition changes while traveling outside geographic service area;
(B) Client care practices including personal care services provided;
(C) Client notification requirements;
(D) Infection control;
(E) Medical and non-medical emergency response; and
(F) Medication reminding, medication assistance and medication administration.
(e) A description of the services provided by the agency;
(f) Assignment and supervision of services;
(g) Documentation of clients' needs and services provided;
(h) The roles of, and coordination with, other community service providers;
(i) Information about what constitutes medication reminding and its specific limitations; and
(j) Other appropriate subject matter based on the needs of the special populations served by the agency.
(6) Caregivers shall complete appropriate caregiver training from a qualified individual, qualified entity, or qualified trainer and must have their competency evaluated and documented by the administrator or administrator's designee before independently providing services to clients. The competency evaluation shall include a combination of both direct observation and written or oral testing.
(7) A caregiver shall receive a minimum of eight hours of initial caregiver training:
(a) Two hours of initial caregiver training must be obtained before providing services;
(b) Six hours of initial caregiver training may be completed before providing services or after initiation of service through on-the-job training or other methodology within 120 days of hire;
(c) A maximum of one hour of competency evaluation may be used towards satisfying the minimum of eight hours of initial training;
(d) The initial caregiver training shall be based on the services provided by the agency, including, as applicable, but not limited to the following topics:
(A) Caregivers' duties and responsibilities;
(B) Recognizing and responding to medical emergencies;
(C) Dealing with adverse behaviors;
(D) Nutrition and hydration, including special diets and meal preparation and service;
(E) Appropriate and safe techniques in personal care tasks, including the tasks specified in OAR 333-536-0045;
(F) Methods and techniques to prevent skin breakdown, contractures, and falls;
(G) Hand washing and infection control;
(H) Body mechanics;
(I) Maintenance of a clean and safe environment;
(J) Fire safety and non-medical emergency procedures;
(K) Assisting clients with self-directed or client representative-directed non-injectable medication administration;
(L) Cultural competence. For purposes of the rule, cultural competence means an understanding of how institutions and individuals can respond respectfully and effectively to people from all cultures, economic statuses, language backgrounds, races, ethnic backgrounds, disabilities, spiritual beliefs, ages, tribal affiliations, national origins, genders, gender identifications, sexual orientations, gender expressions, marital statuses, immigration or refugee statuses, veteran statuses and other characteristics in a manner that recognizes, affirms and values the worth, and preserves the dignity, of individuals, families and communities. Cultural competence is an on-going process;
(M) Abdominal thrust and first aid. CPR is recommended but not required. For purposes of this rule, first aid means care or treatment given to an ill or injured person before regular medical aid can be obtained in an emergency; and
(N) Other appropriate subject matter based on the needs of the special populations served, such as taking vital signs and proper use and maintenance of medical devices used in the home, such as catheter care, Hoyer Lift, and oxygen use.
(8) Caregivers assigned to provide medication services must obtain a minimum of four hours of basic non-injectable medication training before providing the services.
(a) The medication training shall include at least the following areas:
(A) Medication abbreviations;
(B) Reading medication orders and directions;
(C) Reading medication labels and packages, including pill packs provided by a pharmacy;
(D) For agencies classified as intermediate or comprehensive, setting up medication labels and packages into secondary containers (medication set-up);
(E) Administering non-injectable medications:
(i) Pill forms, including identification of pills that cannot be crushed;
(ii) Non-injectable liquid forms, including those administered by syringe or dropper and eye and ear drops;
(iii) Suppository forms; and
(iv) Topical forms.
(F) Identifying and reporting adverse medication reactions, interactions, contraindications and side effects;
(G) Infection control related to medication administration; and
(H) Techniques and methods to ensure safe and accurate medication administration.
(b) Medication services training for caregivers employed by an agency classified as basic, intermediate or comprehensive shall be provided by a qualified individual or entity.
(c) Prior to providing medication services, caregivers shall demonstrate appropriate and safe techniques in the provision of medication tasks described in this rule and that must be evaluated by a qualified individual through a successful return demonstration.
(9) The training required in sections (5) through (8) of this rule shall be clearly documented and maintained in each caregiver's personnel record and shall include the following information, if applicable:
(a) Content of the training for each topic;
(b) The date(s), times(s) and training topics covered;
(c) The names (s) and signature(s) of the agency-specific orientation instructor, qualified individual(s), qualified entity, or qualified trainer conducting the training;
(d) For medication services:
(A) Evidence of successful return demonstrations; and
(B) A statement from the qualified individual that the caregiver has been evaluated to be competent to provide the medication services described in section (8) of this rule.
(10) An agency shall maintain sufficient information or documentation to demonstrate that the individual(s) or entity providing the training under this rule is a qualified individual, qualified entity or qualified trainer as those terms are defined under OAR 333-536-0005.
(11) Caregivers moving from one subunit to another in the same agency are not subject to additional training requirements, if previous training is current and documented.
(12) Caregivers who have completed training previously and are current with training requirements, and have documentation of that training, shall have their competency evaluated by the administrator, administrator's designee or administrator's delegate, and any potential training may be limited to areas requiring improvement after the evaluation.
(13) A caregiver with proof of a current Oregon health-care related license or certificate is exempt from in-home caregiver training.
(14) A caregiver shall receive a minimum of six hours of education from a qualified trainer, qualified individual or qualified entity related to caregiver duties annually. If a caregiver provides medication services to a client, one additional hour of education shall be required annually related to providing medication services.
(15) The skills of a caregiver must be matched with the care needs of a client. The administrator, administrator's designee, or administrator's delegate must assign caregivers to specific clients based on the care needs of the clients and the skills of the caregivers.
Statutory/Other Authority: ORS 443.340 & ORS 443.011
Statutes/Other Implemented: ORS 443.340 & ORS 443.011
History:
PH 50-2023, amend filed 10/23/2023, effective 10/23/2023
PH 26-2021, amend filed 06/29/2021, effective 07/01/2021
PH 10-2012, f. 6-26-12, cert. ef. 7-1-12
PH 14-2007, f. 12-19-07, cert. ef. 1-1-08
PH 22-2004, f. & cert. ef. 6-25-04
PH 3-2004(Temp), f. & cert. ef. 2-6-04 thru 7-30-04
OHD 19-2002, f. 12-4-02, cert. ef. 2-1-03