HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/CS/HB 299 Education and Training for Alzheimer's Disease and Related Forms of
Dementia
SPONSOR(S): Health & Human Services Committee, Healthcare Regulation Subcommittee, Black and others
TIED BILLS: IDEN./SIM. BILLS:
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Healthcare Regulation Subcommittee 17 Y, 0 N, As CS Guzzo McElroy
2) Health & Human Services Committee 17 Y, 0 N, As CS Guzzo Calamas
SUMMARY ANALYSIS
Current laws require certain employees of nursing homes, home health agencies, assisted living facilities (ALFs), and
adult day care centers to complete training on Alzheimer’s disease or related disorders (ADRD). Employees of ALFs,
other than special care ALFs, nurse registries, homemaker and companion service providers, and adult family care homes
are not currently required to complete ADRD training.
The required training applies to employees whose duties require them to have direct contact with or provide direct care to
individuals with ADRD. No other employees are required to receive ADRD training other than receiving basic written
information, in most instances. The required number of hours of training and the timeframes in which the training must be
completed vary among the above provider types. This initial training must be completed within three months of beginning
employment.
The bill requires all employees of nursing homes, home health agencies, nurse registries, homemaker and companion
service providers, ALFs, adult family-care homes, and adult day care centers, to complete one hour of initial ADRD
training; not just those who have direct contact with individuals with ADRD. The bill requires the training to be completed
within 30 days of beginning employment, instead of within three months.
In addition to the initial training, current law requires employees of nursing homes, home health agencies, and adult day
care centers who provide direct care to individuals with ADRD to complete additional ADRD training within nine months of
beginning employment. Current law does not require additional training for such employees of ALFs, home health
agencies, nurse registries, homemaker and companion services providers, or adult family care homes. The bill fills in the
gaps of facility types not currently required to complete additional training in the first year of employment by requiring
employees of ALFs, nurse registries, homemaker and companion service providers, and adult family -care homes who
provide direct care to individuals with ADRD to complete the additional training.
Current law requires employees who provide direct care to individuals with ADRD in ALFs and adult day care centers that
provide special care for individuals with ADRD to complete four hours of continuing education annually. However, current
law does not require such employees of adult family-care homes to complete continuing education. The bill fills in another
gap to make training consistent among facility types by requiring employees of adult family -care homes to comply with the
same continuing education requirements as the other facility types that provide special care for individuals with ADRD –
four hours annually.
Current law does not require employees of health care services pools to complete any ADRD training. The bill requires
them to complete any training that is applicable to the type of facility they are working in.
The bill requires all individuals currently employed, contracted, or referred to provide services when the bill becomes
effective to complete the required training 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.
The bill has no fiscal impact on state or local government.
The bill provides an effective date of July 1, 2023.
This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives .
STORAGE NAME: h0299c.HHS
DATE: 4/11/2023
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Alzheimer’s Disease
Alzheimer’s disease is a form of dementia, a general term for memory loss. It is a progressive brain
disorder that damages and eventually destroys brain cells, leading to memory loss and changes in the
functions of the brain. Alzheimer’s disease accounts for 60 to 80 percent of dementia cases.
Alzheimer's disease is a progressive disease in which dementia symptoms worsen gradually over time.
In the early stages of Alzheimer’s disease, memory loss is mild; in late-stages, individuals lose the
ability to carry on a conversation and respond to their environment. Currently, the disease has no cure,
but treatment can temporarily slow the worsening of symptoms. 1
There are an estimated 6.2 million people in the United States with Alzheimer’s disease. 2 By 2050, the
number of people age 65 and older with Alzheimer’s disease in the U.S. is expected to double to a
projected 12.7 million people.3
Florida has an increasing number of individuals with Alzheimer’s disease. An estimated 580,000
Floridians have Alzheimer’s disease.4 The projected number of Floridians with Alzheimer’s disease is
estimated to increase by 24% to 720,000 individuals by 2025. 5
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.
Nursing homes are required to provide basic written information to new employees, upon beginning
employment, about interacting with individuals with ADRD. 7 If the employee’s duties require them to
have direct contact with residents with ADRD, they must complete one hour of initial training on ADRD
within three months of beginning employment.8 The initial training must address the following subject
areas:
Understanding ADRD;
Characteristics of ADRD; and
Communicating with residents who have ADRD. 9
1
Alzheimer’s Association, 2021 Alzheimer’s Disease Facts and Figures, available at https://www.alz.org/media/documents/alzheimers-
facts-and-figures.pdf (last accessed March 9, 2023).
2 Rajan KB, Weuve J, Barnes LL, McAninch EA, Wilson RS, Evans DA, Population Estimate of People with Clinical AD and Mild
Cognitive Impairment in the United States (2020-2060). Alzheimers Dement. 2021 Dec;17(12):1966-1975. doi: 10.1002/alz.12362.
Epub 2021 May 27. PMID: 34043283.
3 Id.
4 Florida Department of Elder Affairs, 2021 Alzheimer’s Disease Advisory Committee Annual Report, available at
https://elderaffairs.org/wp-content/uploads/ADAC-Report-2021_FINAL.pdf (last accessed March 9, 2023).
5 Id.
6 S. 400.021(7), F.S.
7 S. 400.1755(1), F.S.
8 S. 400.1755(2), F.S.
9 Rule 58A-4.001(1)(a), F.A.C.
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Those employees who provide direct care to residents with ADRD must complete an additional three
hours of training within nine months of beginning employment. The additional training must address the
following subject areas:
Behavior management;
Assistance with activities of daily living;
Activities for residents;
Stress management for care givers;
Family issues;
Resident environment; and
Ethical issues.10
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.11 Home health
agencies are licensed and regulated by AHCA under part III of ch. 400, F.S.
Home health agencies are required to provide basic written information to new employees, upon
beginning employment, about interacting with individuals with ADRD.12 Those employees who provide
direct care to residents with ADRD must complete two hours of training on ADRD within nine months of
beginning employment.13 The training must include:
An overview of dementia;
A demonstration of basic skills in communicating with individuals with dementia;
Information on managing problem behaviors;
Information about promoting the client’s independence in activities of daily living; and
Skills for working with families and caregivers.14
Assisted Living Facilities (ALFs)
An 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.15 ALFs are licensed and regulated by 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. 16
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.17
ADRD training is only required for employees of ALFs that provide special care for residents with
ADRD.18 ALFs that provide special care for residents with ADRD are required to provide basic written
10 Rule 58A-4.001(1)(b), F.A.C.
11
S. 400.462(12) and (14), F.S.
12 S. 400.4785(1)(a), F.S.
13 S. 400.4785(1)(b), F.S.
14 Id.
15 S. 429.02(5), F.S.
16 S. 429.177, F.S., and s. 429.178(1), F.S.
17 S. 429.52(1), F.S., and rule 59A-36.011(2), F.S.
18 S. 429.178(1), F.S., requires an ALF that advertises that it provides special care for persons with ADRD to meet certain stan dards 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 1 7 residents,
the facility may have mechanisms in place to monitor residents instead of having an awake staff member on duty 24 hours a day; of fer
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.
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information to new employees about interacting with individuals with ADRD within 3 months of
beginning employment.19
An employee who has regular contact with residents who have ADRD but does not provide direct care
to such residents is required to complete four hours of initial ADRD training within three months of
beginning employment.20 The initial training must address the following subject areas:
Understanding ADRD;
Characteristics of ADRD;
Communicating with residents who have ADRD;
Family issues;
Resident environment; and
Ethical issues.21
A direct caregiver who is employed by an ALF that provides special care for residents with ADRD is
required to complete four hours of additional training within nine months of beginning employment. 22
The additional training must address the following subject areas:
Behavior management;
Assistance with activities of daily living;
Activities for residents;
Stress management for caregivers; and
Medical information.23
They are also required to complete four hours of continuing education on ADRD every year. 24
Adult Family-Care Homes
An adult family-care home 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.25 Adult family-
care homes are licensed and regulated by AHCA under part II of ch. 429, F.S.
An adult family-care home that claims to provide special care for individuals with ADRD is required to
disclose in its advertisements, or in a separate document, those services that distinguish the care as
being especially applicable to, or suitable for, such persons. 26
Employees of adult family-care homes are not currently required to complete any ADRD training.
Adult Day Care Centers
Adult day care centers provide therapeutic services and activities for adults in a non-institutional
setting.27 Participants may utilize a variety of services offered during any part of a day totaling less than
24-hours. Basic services provided by adult day care centers include leisure activities, self-care training,
nutritional services, and respite care.28
19 S. 429.178(2)(c), F.S.
20 S. 429.178(2)(a), F.S.
21 Rule 59A-36.011(10)(a), F.A.C.
22 S. 429.178(2)(b), F.S.
23 Rule 59A-36.011(10)(c), F.A.C.
24 S. 429.178(3), F.S.
25 S. 429.65(2), F.S.
26 S. 429.83, F.S.
27 S. 429.901(3), F.S.
28 Id.
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Adult day care centers are required to provide basic written information to new employees, upon
beginning employment, about interacting with individuals with ADRD.29 If the employee’s duties require
them to have direct contact with residents with ADRD, they must complete one hour of initial training on
ADRD within three months of beginning employment.30 The initial training must address the following
subject areas:
Understanding ADRD;
Characteristics of ADRD; and
Communicating with participants who have ADRD. 31
Those employees who provide direct care to residents with ADRD must also complete an additional
three hours of training on ADRD within nine months of beginning employment. 32 The additional training
must address the following subject areas:
Behavior management;
Assistance with activities of daily living to promote the participant’s independence;
Stress management for the caregiver;
Family issues;
Participant environment; and
Ethical issues.33
An adult day care center may hold a license designated by AHCA as a specialized Alzheimer’s services
adult day care center if it meets certain requirements.34 Employees of specialized Alzheimer’s services
adult day care centers, 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. 35
Employees of specialized Alzheimer’s services adult day care centers who provide direct care to
participants with ADRD are required to receive an additional four hours of training within six months of
beginning employment.36 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.
29 S. 429.917(1)(a), F.S.
30 S. 429.917(1)(b), F.S.
31 Rule 59A-16.110(1)(a), F.A.C.
32 S. 429.917(1)(c), F.S.
33 Rule 59A-16.110(1)(b), F.A.C.
34 S. 429.918(4), F.S.
35 Rule 59A-16.111(2), F.A.C.
36 Rule 59A-16.111(3), F.A.C.
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Employees of specialized Alzheimer’s services adult day care centers who provide direct care to
participants with ADRD are also required to receive 4-hours of continuing education annually in topics
related to ADRD.37
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
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