Enhancing the Care of Elder Communities: California Code of Regulations Section 72517

The California Code of Regulations Title 22, Section 72517 details staff development requirements for Congregate Living Health Facilities (CLHFs) and Skilled Nursing Facilities (SNFs). Meant to protect the aging population from challenges in these care systems, the code used to only have the following requirements:

1. Each facility shall have a continuous education program to develop critical skills and knowledge for all personnel providing care. The program must include coverage of the following topics:

• Problems and needs of aged, chronically ill, acutely ill, and disabled patients.
• Prevention and control of infections.
• Interpersonal relationship communication skills.
• Fire prevention and safety.
• Accident prevention and safety measures.
• Confidentiality of patient information.
• Preservation of patient dignity, including provisions for privacy.
• Patient rights and civil rights.
• Signs and symptoms of cardiopulmonary distress.
• Choking prevention and intervention.
• Cardiopulmonary resuscitation training.

2. Staff development program records shall be maintained and include the name of the presentation, the title of the subject presented, a description of the content, and the signatures of all attendees.
3. Every care facility must have a written orientation program for newly hired employees. Every new employee will be trained on the facility, job description and duties, the patient population, and other pertinent information.
4. Consultants working in the facility are required to participate in staff development programs.

This code of conduct was put into place to protect elderly people in long-term care facilities. However, in 2017, an amendment was added.

The 2017 Amendment

Six years ago, a requirement surrounding LGBT training for facility staff was added to Section 72517. It demands that all CLHFs and SNFs provide LGBT training once every two years. Every registered nurse, licensed vocational nurse, certified nurse assistant, and medical director employed by the facility must receive training that is designed to rid facilities of discrimination based on actual or perceived sexual orientation, gender identity, and gender expression.

New hires must receive this training within 6 months of hire unless they have previously been trained in accordance with the guidelines at a prior facility. For posterity, the definitions addressed in these trainings are as follows:

1. “Gender expression” is a person’s gender-related appearance or behavior. This does not have to align with stereotypes associated with the person’s birth-assigned sex.
2. “LGBT” stands for lesbian, gay, bisexual, and transgender.
3. “Sexual orientation” refers to whether a person is heterosexual, homosexual, or bisexual.
4. “Transgender” is a term that describes a person whose gender expression varies from the gender expression stereotypically associated with their assigned sex at birth. 
5. “Gender identity” is determined based on the individual’s stated gender identity, regardless of their physical appearance, surgical history, genitalia, legal sex, sex assigned at birth, or name and sex as it appears in medical records.

Training Requirements

The training must take place in-person or online. In-person training must have proof of the attendance of all participants. This “proof” is a certificate that is signed by the participants themselves and the participant’s supervisor. If the training is conducted online for accessibility purposes, it must ensure that each participant completes the training in its entirety, utilize a unique identification number that confirms each participant’s identity, and display a printable statement at the end of the training that can be signed by the participant and their supervisor.

The training must be taught by a person or training entity that has proven experience in identifying and addressing the legal and social challenges that the LGBT community faces regularly. They must also understand the supplemental challenges faced by LGBT persons who are living in care facilities.

The training needs to cover a variety of topics, ensuring it is thorough enough to address all necessary considerations of challenges facing LGBT patients. These topics include, but are not limited to:

1. Definitions of common terms that are outlined above.
2. How to communicate with or about LGBT patients.
3. Health and social issues facing older LGBT persons with an emphasis on discrimination in healthcare settings.
4. The importance of being professional in medical settings. Caretaker attitudes impact healthcare access and a patient’s willingness to participate in these settings; this impact must be addressed and understood by the trainees.
5. How to create a safe and affirming environment.
6. Legal obligations for healthcare providers to treat all patients without discrimination.
7. The penalties for failing to abide by legal and professional standards set in the training.
8. Legal issues faced by LGBT people, including patients’ rights, civil rights, marriage and partnership laws, and the Nursing Home Reform Act.

Today’s Reality

With the above training in mind, we encourage long-term care facilities and their providers to understand why it’s so important. According to the UN’s World Population Aging Report, 20% of people will be over 65 by 2050, and of those, 2.4 million people in the US identify as LGBT. Compared to their heterosexual counterparts, LGBT persons receive inferior care, have worse mental health outcomes like depression and anxiety, and are at a higher risk of suicide.

We’ve seen history showcase gaps in care for the LGBT community with the AIDS epidemic, but we see it more recently in today’s care landscape, too. It’s up to healthcare providers to go above and beyond to protect their patients facing healthcare disparities, no matter their age.

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