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 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Delia Cox CF Fav/CS
2. Barr Money AHS Fav/CS
3. Delia Yeatman FP Favorable
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,
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 Employees Health Care Training Additional
Expected or Providing Practitioner Approved Reqs.
Required Direct Direct Care Continuing By?
Contact Education
Sufficient?
Nursing Homes Provided with 1 hour of 3 additional Yes DOEA
basic written training within hours of
information about the first 3 training within
interacting with months of the first 9
persons with employment months of
ADRD upon employment
Home Health beginning Not specified 2 hours of Yes DOEA HHAs that
Agencies (HHA) employment training within serve 90%
the first 9 individuals
months of under age 21
employment are exempt.
Hospice ADRD upon 1 hour of 3 additional Yes DOEA
Providers beginning training within hours of
employment the first 3 training within
months of the first 9
employment months of
employment
Special Care Employees with 4 hours within 3 4 additional Not specified. DOEA
Assisted Living incidental contact months of hours within 9
Facilities must be given employment months of
(ALF)5 information employment +
within 3 months 4 hours CE
annually
Adult Day Care Same as nursing 1 hour of 3 additional Yes DOEA
Centers homes, home training within hours of
health agencies, the first 3 training within
and Hospice months of the first 9
employment months of
employment
Specialized Same as nursing 4 hours of 4 additional Yes DOEA
Alzheimer’s homes, home training within hours of
Services Adult health agencies, the first 3 training within
Day Care and Hospice months of the first 6
Centers employment months of
employment
Adult Family- None None None Not AHCA
Care Homes Specified.
Nurse None None None Not specified.
Registries/
Companion or
Homemaker
Services
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