Kansas caregiver training: competency in 10 areas, then every year

The manager is present until then

The competency rule doubles as a supervision rule: until a worker has shown competency, they do not serve a client "without the manager being present" (K.A.R. 28-51-117(c)). The manager is an employee who supervises caregivers and has at least a year of experience in home health, HCBS or supportive care services (K.A.R. 28-51-100(aa)); who can be your manager is on Kansas administrator and manager rules.

• Plan the first weeks. By our reading, "present" means at the visit, so a new worker’s early shifts need the manager there. A small agency with one manager should plan training visits before taking on clients the new worker will serve.
• Provisional hires. A worker hired provisionally while the KDADS check is pending is supervised by an employee who has completed all required training (K.A.R. 28-51-103(e)). Until they have shown competency, the manager must be present at their client visits in any case, so the manager can be that supervisor.
• After competency. Supervision continues: a manager available to workers at all times, and on-site supervision at least every three months, including client satisfaction and adherence to the plan of care (K.A.R. 28-51-117(e)).

Gait belts, lifts and oxygen tanks

Some of the 16 assigned duties may be done only after specific training. Each is a line on the competency checklist before the worker does the task.

• Gait belts. "A gait belt may be used in a transfer as a safety device for the supportive care worker if the supportive care worker has been properly trained in the use of a gait belt." (K.A.R. 28-51-117(g)(14))
• Adaptive and safety equipment. "Adaptive and safety equipment may be used in a transfer if the client and the supportive care worker are fully trained in the use of the equipment and the client, client’s family member, or guardian can direct the transfer step-by-step." Examples in the rule are wheelchairs, tub seats and grab bars (K.A.R. 28-51-117(g)(14)). Note that the client must be trained too.
• Lift devices. "Any supportive care worker with training and demonstrated competency may assist a client in a transfer involving a lift device." But the same paragraph says "A supportive care worker shall not perform assistance with a transfer if the client is unable to assist with the transfer." (K.A.R. 28-51-117(g)(14)). By our reading, a lift transfer is allowed only for a client who can still assist with it, and CareRulebook’s manual says so. KDHE’s view on training: "KDHE maintains that training is required to use a lift and must be conducted by an individual with knowledge of the device, beyond reading the user manual." It added that training on one lift does not carry over to another (KDHE, Questions and Feedback, April 2026). Our suggestion: train and check each worker on each model of lift they will use, with someone who knows that device, such as the supplier.
• Oxygen tanks. "Any supportive care worker may set a client’s oxygen flow according to written instructions when changing tanks", "if the supportive care worker has been specifically trained and has demonstrated competency for setting a client’s oxygen flow" (K.A.R. 28-51-117(g)(16)). Respiratory care stays out of scope (K.A.R. 28-51-117(g)(15)). Whose written instructions count (the prescriber’s, the supplier’s, or your written assignment) is not stated, and is on our list of questions for KDHE.
• Masks and cannulas. "Any supportive care worker may temporarily remove and replace a cannula or mask from a client’s face for the purposes of shaving or washing the client’s face." (K.A.R. 28-51-117(g)(16)). The rule names no special training for this; CareRulebook’s manual trains every worker on it anyway.

Both the lift and the oxygen permissions are in KDHE’s sights: what the draft would change.

Every year

• Competency, again. The licensee "shall reevaluate each supportive care worker on an annual basis in the following subject areas" listed above (K.A.R. 28-51-117(c)). When providers objected to yearly hands-on checks in KDHE’s draft, KDHE answered: "Demonstrating competencies on an annual basis is not a new regulation." (KDHE, Questions and Feedback). The rule does not say whether "annual" means within 12 months or once each calendar year; CareRulebook’s manual uses 12 months.
• Ongoing training. It is provided "annually or more often as needed to adequately provide the supportive care services needed by the clients served by the home health agency". "Ongoing training shall include training on the supportive care services provided and the equipment used by the home health agency." "The subject matter and date of the ongoing training provided shall be documented in each manager’s and supportive care worker’s file." (K.A.R. 28-51-117(d)). It covers managers as well as caregivers.
• Abuse, neglect and exploitation. The agency must "provide in-service training recognizing the signs and symptoms of abuse, neglect, or exploitation to home health agency employees and contracted personnel at the time of hire or contract and annually thereafter", documented in each personnel file (K.A.R. 28-51-103(g)(1)). What to teach about reporting is on the hub guide.
• In-service education. The administrator must "provide orientation for new staff, regularly scheduled in-service education programs, and opportunities for continuing education of the staff" (K.A.R. 28-51-103(b)(1)(F)).
• Performance evaluations. Personnel files hold "performance evaluations made within six months of employment and annually thereafter" (K.A.R. 28-51-103(d)(4)). The manual’s evaluation form is in Policy 2.4.

Our suggestion: pick one month a year for the yearly items, so the competency re-check, ongoing training, abuse training and evaluation fall together and nothing slips past 12 months.

Health assessments and TB

Each personnel record holds a health record, and the assessment and TB test come before the employee works with clients (K.A.R. 28-51-103(d)(6)):

1. A self-reported health history.
2. A health assessment: "a current health assessment performed by a physician, nurse practitioner, clinical nurse specialist, physician assistant, or registered nurse certifying that the employee is physically able to perform job functions" (K.A.R. 28-51-103(d)(6)(B)).
3. A TB test: "a current two-step tuberculosis skin test following the U.S. centers for disease control and prevention testing guidelines for healthcare workers taken before working with clients or patients" (K.A.R. 28-51-103(d)(6)(C)).

After hire. Further assessments follow your own policy, with "a subsequent health assessment at least every two years or following a significant health event" (K.A.R. 28-51-103(d)(7)). "‘Significant health event’ means any occurrence that affects the ability of an employee to perform the employee’s job duties." (K.A.R. 28-51-100(xx)). Whether a short illness counts is not stated; CareRulebook’s manual reads it as not counting when the worker recovers fully, and that reading is on our list of questions for KDHE.

• Who does the assessment. A supportive care agency may not provide nursing of any kind, and KDHE’s attestation form says that includes a nurse supervising or doing assessments (KDHE attestation form). By our reading, the employee health assessment should come from an outside provider, such as the employee’s own doctor or a clinic, not a nurse on your staff.
• Repeat TB tests. The rule sets no interval, and does not say how long a test stays "current". CareRulebook’s manual accepts a two-step test read within the 12 months before client work; how long KDHE accepts is on our list of questions for KDHE.
• A positive test. The rule is silent. KDHE’s personnel file list names "TB Test/Chest X-ray" (Instruction Guide, Personnel Records). Our suggestion: keep the worker away from clients until a provider confirms in writing that they do not have active TB.
• Office staff. The rule puts the health record in every employee’s file, "before working with clients or patients". Whether KDHE expects it for staff who never work with clients is on our list of questions for KDHE; CareRulebook’s manual asks every employee for it.

What KDHE asks to see

KDHE reviews your documents before it licenses you, folder by folder (the Kansas license application). For training and health it asks for:

• Policies with templates: "Competency (Policy and Template) (16)" and "Tuberculosis (TB) Testing and Screening (Policy and Template) (15)" in the personnel policies (Instruction Guide, Personnel Policies).
• Training materials: "Training documents and or template used to train managers and supportive care workers to deliver the plan of care (12)", and a competency checklist template and policy, in the provision of services folder (Instruction Guide, Provision of Services).
• Evidence in the personnel files: Application, resume, signed job description, credential checks, interview and reference checks before hire, evaluations, health history, health assessment, TB test, criminal record check evidence, orientation, competency, supervisory visit and ANE training records. (Instruction Guide, Personnel Records). Surveyors later look for personnel records that show all training received (K.A.R. 28-51-104(d)(2)).

A new agency may have only its administrator, alternate and manager on staff when it applies. Whether KDHE accepts blank caregiver templates in place of completed files is on our list of questions for KDHE. The full list of required policies is on Kansas policies and procedures.

What is not required

• Hours. The rules set competency topics and annual ongoing training, not a minimum number of hours, for supportive care workers. (Home health aides under a Skilled Services license need CNA certification plus a 20-hour course.) (K.A.R. 28-51-117(d); 28-51-113(a))
• Certification. "Certified Nursing Assistant (CNA) and/or Home Health Aide positions are excluded with a Supportive Care Service license." A CNA can work for you as a supportive care worker, without using their skilled tasks (KDHE attestation form). KDADS certifies nurse aides and home health aides and keeps the registry (KDADS); none of that applies to your caregivers.
• A state test or approved course. The rules name none for supportive care workers. The KDHE-approved course KDHE links is for administrators (KDHE).
• CPR or first aid. K.A.R. 28-51 does not mention either. Recognizing emergencies and your emergency procedures is a competency area, so our suggestion is to decide what your workers do in an emergency and train that.
• Nurse delegation. Not available: a supportive care agency may not provide nursing services, including nurse supervision (KDHE attestation form). Training cannot add skilled tasks to the license.

What KDHE’s drafted rewrite would change

KDHE has drafted a rewrite of K.A.R. 28-51 and told providers it is in the early phases (KDHE). Nothing below is a rule. We found no Notice of Hearing, but we could not search the 2026 Kansas Register on rules.ks.gov, which blocks automated access.

• One training section for every agency type: "Added orientation, training, and competency requirements including an annual requirement for orientation, training, and competencies which shall be completed before providing unsupervised care to patients or clients." (Summary of Changes, Sept 2025)
• No lifts: "Removed the ability to use lifts" (KDHE slides, Oct 2025). In April 2026 KDHE said: "Based on feedback from agencies, this regulation is being reviewed further." (KDHE, Questions and Feedback)
• No setting oxygen flow: "Removed the ability to set oxygen flow" (KDHE slides). KDHE’s reason: "As oxygen is considered a medication, it must be handled and managed by or under the supervision of a healthcare professional." (KDHE, Questions and Feedback)
• Health screening: The drafted rewrite would drop the two-yearly health assessment, replace the self-reported health history with a health status form, and accept a TB blood test as well as the two-step skin test. It is a draft, not a rule. (Summary of Changes; KDHE slides, TB testing)

Until a change is adopted, train to the current rule. If you offer lift transfers or oxygen tank changes, plan for the possibility of dropping them.