The following employees shall receive a minimum of 8 hours of training on cognitive impairment and mental illness within the first 90 days of employment: Any employee who is licensed, certified, or registered under the Health Occupations Article, Annotated Code of Maryland; and Any employee whose job duties include assisting residents with activities of daily living. The training on cognitive impairment and mental illness shall be designed to meet the specific needs of the nursing home’s population as determined by the staff trainer, including the following as appropriate: An overview of the following: A description of normal aging and conditions causing cognitive impairment; A description of normal aging and conditions causing mental illness; Risk factors for cognitive impairment; Risk factors for mental illness; Health conditions that affect cognitive impairment; Health conditions that affect mental illness; Early identification and intervention for cognitive impairment; Early identification and intervention for mental illness; and Procedures for reporting cognitive, behavioral, and mood changes; Effective communication including: The effect of cognitive impairment on expressive and receptive communication; The effect of mental illness on expressive and receptive communication; Effective verbal, non-verbal, tone and volume of voice, and word choice techniques; and Environmental stimuli and influences on communication; Behavioral interventions including: Identifying and interpreting behavioral symptoms; Problem solving for appropriate intervention; Risk factors and safety precautions to protect the individual and other residents; and De-escalation techniques; Making activities meaningful including: Understanding the therapeutic role of activities; Creating opportunities for productive, leisure, and self-care activities; and Structuring the day; Staff and family interaction including: Building a partnership for goal-directed care; Understanding families' needs; and Effective communication between family and staff; End-of-life care including: Pain management; Providing comfort and dignity; and Supporting the family; and Managing staff stress including: Understanding the impact of stress on job performance, staff relations, and overall facility environment; Identification of stress triggers; Self-care skills; De-escalation techniques; and Devising support systems and action plans. Employees who are not licensed, certified, or registered or who do not assist residents with activities of daily living shall receive a minimum of 2 hours of training on cognitive impairment and mental illness within the first 90 days of employment. The training shall include: An overview of the following: A description of normal aging and conditions causing cognitive impairment; A description of normal aging and conditions causing mental illness; Risk factors for cognitive impairment; Risk factors for mental illness; Health conditions that affect cognitive impairment; Health conditions that affect mental illness; Early identification and intervention for cognitive impairment; Early identification and intervention for mental illness; and Procedures for reporting cognitive, behavioral, and mood changes; Effective communication including: The effect of cognitive impairment on expressive and receptive communication; The effect of mental illness on expressive and receptive communication; Effective verbal, non-verbal, tone and volume of voice, and word choice techniques; and Environmental stimuli and influences on communication; and Behavioral intervention including risk factors and safety precautions to protect the individual and other residents. Ongoing training in cognitive impairment and mental illness shall be provided annually and consist of, at a minimum: 2 hours for employees who are licensed, certified, or registered under the Health Occupations Article, Annotated Code of Maryland, or who assist residents with activities of daily living; and 1 hour for all other employees. The training that is described in this chapter may be provided through various means including: Classroom instruction; In-service training; Internet courses; Correspondence courses; Pre-recorded training; or Other training methods. When the training method does not involve direct interaction between faculty and the participant, the facility shall make available to the participant during the training a trained individual to answer questions and respond to issues raised by the training.