# COMAR Title 10 — Maryland Department of Health

## Subtitle 07 — Hospitals

### Chapter 14 — Assisted Living Programs

#### Regulation .17 80-Hour Assisted Living Manager Basic Training Course.

*COMAR 10.07.14.17*

A. The 80-hour assisted living manager basic training course shall include the following content:

  (1) Philosophy of assisted living, 2 hours, including:

    (a) Philosophy and background of assisted living and aging in place;

    (b) Objectives and principles of assisted living resident programs;

    (c) Comparison of assisted living to other residential programs;

    (d) Basic concepts of choice, independence, privacy, individuality, and dignity; and

    (e) Normalization of the environment;

  (2) Aging process and its impact, 4 hours, including:

    (a) Physical characteristics of the assisted living residents;

    (b) Psychosocial characteristics of the assisted living residents;

    (c) Basic needs of the elderly and disabled; and

    (d) Activities of daily living;

  (3) Assessment and level of care waiver, 6 hours, including:

    (a) Purpose and process;

    (b) Guidelines for conducting assessments;

    (c) Level of care assessments; and

    (d) Collaboration with the delegating nurse;

  (4) Service planning, 6 hours, including:

    (a) Required services;

    (b) Enhanced scope of services;

    (c) Development of individualized service plans;

    (d) Scheduling of appropriate activities;

    (e) Structure of activities;

    (f) Care notes; and

    (g) Collaboration with the delegating nurse;

  (5) Clinical management, 20 hours, including:

    (a) Role of the delegating nurse;

    (b) Appropriate nurse delegation;

    (c) Concept of self-administration of medications;

    (d) Concept of medication management;

    (e) Assistance with self-administration of medications;

    (f) Administration of medications;

    (g) Coordination of services and care providers;

    (h) Collaboration with the delegating nurse;

    (i) Preventing medication errors;

    (j) Patient safety;

    (k) Medication monitoring;

    (l) Pharmacy consultation;

    (m) Medication storage;

    (n) Infection prevention and control to include:

      (i) Standard and contact precautions;

      (ii) Bloodborne pathogens;

      (iii) Standard hand hygiene practices;

      (iv) Safe injection practices;

      (v) Use of personal protective equipment; and

      (vi) Cleaning and disinfection of equipment and the environment;

    (o) Appropriate staffing patterns;

    (p) Pressure sores;

    (q) Effective pain management;

    (r) Basic first aid taught by a first aid instructor certified by a national organization;

    (s) Basic cardiopulmonary resuscitation (CPR), including a hands-on component, taught by a CPR instructor certified by a nationally recognized organization;

    (t) Substance abuse;

    (u) Trauma-informed care; and

    (v) A trauma-informed approach to care delivery;

  (6) Admission and discharge criteria, 4 hours, including:

    (a) Overview of criteria for admission and discharge;

    (b) Resident contracts;

    (c) Resident rights;

    (d) Financial management of resident’s funds; and

    (e) Working with families of residents;

  (7) Nutrition and food safety, 8 hours, including:

    (a) Menu and meal planning;

    (b) Basic nutritional needs;

    (c) Safe food handling;

    (d) Preventing food-borne illnesses;

    (e) Therapeutic diets; and

    (f) Dehydration;

  (8) Dementia, mental health, and behavior management, 12 hours, including:

    (a) An overview consisting of:

      (i) Description of normal aging and conditions causing cognitive impairment;

      (ii) Description of normal aging and conditions causing mental illness;

      (iii) Risk factors for cognitive impairment;

      (iv) Risk factors for mental illness;

      (v) Health conditions that affect cognitive impairment;

      (vi) Health conditions that affect mental illness;

      (vii) Early identification and intervention for cognitive impairment;

      (viii) Early identification and intervention for mental illness; and

      (ix) Procedures for reporting cognitive, behavioral, and mood changes;

    (b) Effective communication consisting of:

      (i) Effect of cognitive impairment on expressive and receptive communication;

      (ii) Effect of mental illness on expressive and receptive communication;

      (iii) Effective communication techniques, including verbal, nonverbal, tone and volume of voice, and word choice; and

      (iv) Environmental stimuli and influences on communication, including setting, noise, and visual cues;

    (c) Behavioral intervention consisting of:

      (i) Identifying and interpreting behavioral symptoms;

      (ii) Problem solving for appropriate intervention;

      (iii) Risk factors and safety precautions to protect other residents and the individual;

      (iv) De-escalation techniques; and

      (v) Collaboration with the delegating nurse;

    (d) Making activities meaningful consisting of:

      (i) Understanding the therapeutic role of activities;

      (ii) Creating opportunities for activities, including productive, leisure, and self-care; and

      (iii) Structuring the day;

    (e) Staff and family interaction consisting of:

      (i) Building a partnership for goal-directed care;

      (ii) Understanding family needs; and

      (iii) Effective communication between family and staff; and

    (f) Managing staff stress consisting of:

      (i) Understanding the impact of stress on job performance, staff relations, and overall facility environment;

      (ii) Identification of stress triggers;

      (iii) Self-care skills;

      (iv) De-escalating techniques; and

      (v) Devising support systems and action plans;

  (9) End of life care, 4 hours, including:

    (a) Advance directives;

    (b) Hospice care;

    (c) Maryland Medical Orders for Life-Sustaining Treatment (MOLST) order form;

    (d) Power of attorney;

    (e) Appointment of a health care agent;

    (f) Living will;

    (g) Pain management;

    (h) Providing comfort and dignity; and

    (i) Supporting the family;

  (10) Management and operation, 4 hours, including:

    (a) Role of the assisted living manager;

    (b) Overview of accounting, accounts payable, and accounts receivable;

    (c) The revenue cycle and budgeting;

    (d) The basics of financial statements;

    (e) Hiring and training of staff;

    (f) Developing personnel policies and procedures;

    (g) Census development; and

    (h) Marketing;

  (11) Emergency planning, 4 hours, including:

    (a) Fire, disaster, and emergency preparedness;

    (b) Occupational Safety and Health Administration (OSHA) requirements;

    (c) Maintaining the building, grounds, and equipment;

    (d) Elopements;

    (e) Transfers to the hospital;

    (f) Evacuations;

    (g) Power outages;

    (h) Severe weather;

    (i) Fire;

    (j) Emergency response systems; and

    (k) Security systems;

  (12) Quality assurance, 4 hours, including:

    (a) Incident report processes; and

    (b) Quality improvement processes; and

  (13) Survey process, 2 hours, including:

    (a) State statutes and regulations;

    (b) What to expect during a survey; and

    (c) Documentation.

B. A person seeking to offer the assisted living manager training course shall request and obtain approval by the Department by:

  (1) Submitting the proposed curriculum and training materials to the Department; and

  (2) Being available for an in-person or telephone interview by the Department.