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Wisconsinís Feeding Assistant Training Program Requirements Ė Status Update

PDF Version of BQA 03-016 (PDF, 125 KB)

DATE: December 29, 2003 DSL-BQA-03-016

TO: Nurse Aide Training Programs NATP - 05, Nursing Homes NH 10

FROM: Susan Larsen, Interim Chief, Caregiver Regulation and Investigation Section

Via: Michael J. Steinhauer, Resident Care Review Section, Bureau of Quality Assurance; Susan Schroeder, Director, Bureau of Quality Assurance

Cross Reference: BQA-01-049, BQA-01-033, BQA-01-022, BQA-00-066

Federal Feeding Assistant Regulations

On September 26, 2003, the Centers for Medicare and Medicaid Services (CMS) published the final rule for Requirements for Paid Feeding Assistants in Long Term Care Facilities in the Federal Register. These regulations allow States to develop program requirements for nursing homes to hire trained feeding assistants to help residents without complicated feeding problems to eat and drink. CMS no longer considers the kind of tasks a feeding assistant may perform as "nursing or nursing-related" duties. Nursing homes have been required to rely on nurse aides or other health care professionals to assist residents with eating and drinking. Volunteers and family members are also allowed to assist with these tasks. As a result of these new federal regulations, the Department is no longer required to phase out single task workers in Wisconsinís nursing homes.

CMS changed their regulations due to continued reports of nurse aide recruitment and retention difficulties. Also, the increasing number of assisted living facilities providing care to individuals with minimal medical needs has resulted in a more frail nursing home population. This population is more dependent on nursing staff for basic needs, such as feeding and personal care. CMS agrees that some nursing home residents only need encouragement or minimal assistance with feeding, which does not require nurse aide training.

The federal feeding assistant regulations require the successful completion of a State-approved training course of at least eight hours, and the use of feeding assistants must be consistent with State law. It is expected the feeding assistants will relieve some of the pressure on nurses, nurse aides and other staff, by allowing them more time to provide more complex tasks such as bathing, toileting and changing dressings.

Wisconsin Feeding Assistant Training Program Development

Wisconsin's "single task worker" model is frequently referenced in the CMS rule. However, in analyzing the federal feeding assistant requirements, BQA has determined there are many areas where the federal training and employment requirements vary from protocols established under Wisconsin's single task worker program.

As Wisconsin is considered the pioneer on this issue and other states are watching closely, BQA has reconstituted the previous "Single Task Worker Workgroup" established several years ago to discuss single task worker, workforce recruitment and retention issues. This workgroup includes representatives from BQA, for profit and not-for-profit nursing homes, workforce associations, the Board on Aging and Long Term Care Ombudsman Program, the Department of Public Instruction, the Department of Workforce Development and the Wisconsin Technical College System. The workgroup has reviewed and compared the previously established single task worker policies and procedures to determine recommendations for Wisconsinís feeding assistant program requirements, such as:

  • Minimum training requirements
  • Testing requirements
  • Instructor qualifications
  • Resident population
  • Grandparenting of current single task workers
  • Training transportability

The workgroup has met several times to review, discuss and provide feedback to BQA regarding these issues.

Interim Phase

When Wisconsinís feeding assistant requirements are finalized and approved, BQA will issue a memo detailing the training and testing requirements; a formalized program application process; employment requirements; and survey protocols. It is anticipated this detailed memo will be released in early 2004.

BQA is not yet accepting new applications for feeding assistant training programs. Nursing homes previously approved by BQA to utilize single task workers may continue to do so. The Bureau has compiled a list of providers with such approval. In the course of a routine survey, if a single task issue arises, surveyors will check with the Regional Field Office Director (RFOD) to determine whether the facility has been approved. Facilities that are not currently approved for single task workers should not use such workers for unapproved duties. In this interim phase, BQA will conduct business as usual including annual surveys, complaint investigations, verification visits, etc.

If you have further questions at this time, please contact Susan Larsen, Caregiver Regulation and Investigation Section at (608) 243-2084.

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