Daycare, Camps, and Recreational Programs: State Laws and Regulations
Even though federal laws provide protection for children with disabilities, state law often impacts whether non-nursing staff at a daycare or other programs can provide insulin injections and emergency glucagon injections. These provisions take the form of laws, regulations, or state Board of Nursing policies or guidelines and enable staff at daycare and other programs to meet the needs of children with diabetes. Parents and other advocates can use this information to educate a daycare, camp, or other organization about how the organization can ensure that a child with diabetes can safely and equally enjoy the program.
Every state has laws that affect who can provide diabetes care, but only those laws that specifically authorize or require an entity to provide medication or services are listed here. Sometimes the law is difficult to interpret.
Contact us to learn more about a child’s rights or for assistance with a daycare, camp, or recreational program discrimination issue.
Legislation, regulations, or nursing policies in the following states address who at a daycare, camp, or other program may administer diabetes care: Arizona, Arkansas, California, Colorado, Connecticut, the District of Columbia, Florida, Georgia, Hawaii, Indiana, Iowa,Kansas, Kentucky, Maine, Maryland, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Vermont, Virginia, Washington, West Virginia, and Wyoming. If your state is not listed here, it means that your state has not passed laws that specifically authorize or require an entity to provide medication or services related to diabetes.
- Applies to child care facilities and states that in an emergency, staff at a child care facility may give an injection to a child according to Arizona Statutes § 32-1421(A)(1) and § 32-1631(2). This can apply to severe low blood glucose emergencies and glucagon.
- States that medical rules limiting who can give medication do not apply to any person giving medical assistance in an emergency.
- States that nursing rules limiting who can give medication do not apply to assistance in cases of emergency.
- States that nursing rules limiting who can provide nursing services do not apply to a person responding to an emergency. This means that a person who administers glucagon to a child experiencing severe low blood sugar is not violating nursing rules.
- Individuals will not be liable for good faith efforts to assist in an emergency.
- A daycare may administer prescription medication.
- A child care facility "exception" is a written authorization issued by the California Department of Social Services to allow the child care facility to use alternative means which meet the intent of a specific regulation and that are based on the unique needs or circumstances of a specific child or staff person.
- The California Department of Social Services has the ability to grant exceptions to child care facilities so that the facility can use alternate concepts, programs, services, procedures, techniques, equipment, space, personnel qualifications or staffing ratios, or the conduct of experimental or demonstration projects, in order to provide safe and adequate services. This can include exceptions to allow child care staff to administer glucagon or, potentially, insulin via an insulin pump.
- Nurses may train and allow unlicensed child care staff to administer injections of insulin or glucagon.
- If a child is capable of self-administering, a nurse may train and allow unlicensed child care staff to verify insulin dosages via pump or pen.
- An individualized health plan (IHP) will be developed for any child receiving insulin at the child care facility describing the diabetes care the child care staff will provide, and child care staff will follow the IHP when providing diabetes care. The IHP may include, for example:
- activation or suspension of an insulin pump;
- usage of insulin pens;
- glucagon administration;
- non-routine, correction dosages of insulin
- carbohydrate counting
- blood glucose testing
- Child care centers and day care organizations may not refuse to admit a child who needs glucagon in an emergency
- Within three weeks of a child's enrollment, the organization shall train staff so that someone is available at all times to administer glucagon to the child.
- If a child with diabetes is enrolled in a child care center or day care organization, the organization shall train staff to provide finger stick blood glucose tests and ensure that trained staff are available to do so when the child is present.
- The child care center or day care organization shall keep a written plan on file, which will include: a list of trained staff, a written doctor’s order, an authorization form, any diet restrictions, and other information. See full regulation for required list of information to be included in the written plan.
- Any person who provides emergency medical assistance without the expectation of payment shall not be liable for any harm resulting from the assistance, unless caused by gross negligence.
- Child development facilities shall create a written individualized care plan for any enrolled child with special needs. The plan shall address:
- special training or qualifications required of one or more staff members to properly care for the child in light of his or her special needs
- nutrition and feeding, including feeding schedule and special training or qualifications required of staff members who may feed the child
- administration of medication
- use and maintenance of medical equipment and/or adaptive devices
- procedures and instructions for medical emergencies
- Any person who, without payment and in good faith, gives emergency care or treatment in any place with proper equipment (such as administering glucagon) shall not be held liable for any civil damages as a result of such care or treatment or as a result of any act or failure to act so long as the person acts as an ordinary reasonably prudent person would have acted under the circumstances.
Florida Administrative Code, Title 65, Chapter 65C-20.004(3)(a) (2009) (child care)
Florida Administrative Code, Title 65, Chapter 65C-22.008(4)(a) (2009) (school age child care)
- With the permission of a parent or guardian, child care center staff and school age child care staff may administer prescription medication.
- Any person who in good faith renders emergency care during an emergency is not liable for civil damages.
- Nursing rules allow nurses to train and enable non-nurses (“unlicensed assistive personnel”) to administer certain medications, including pre-measured doses or nurse-measured doses of subcutaneous injectible medication (such as insulin and glucagon injections).
- Any person who provides good faith emergency care without pay shall not be liable for any civil damages except for those caused by gross negligence or wantonness.
- Rules regarding nursing care do not prohibit individuals from providing nursing care in an emergency, such as administering glucagon in an emergency.
- Rules regarding nursing care do not prohibit individuals from performing health tasks such as insulin administration and glucagon administration if they have been trained and given authorization to do so by a health care professional, such as a nurse.
- Any person who in good faith renders emergency care (such as administering glucagon) without compensation shall not be liable for any civil damages unless the care is reckless or involves willful and wanton misconduct.
- Rules regarding nursing care do not prohibit individuals from providing assistance, such as glucagon, in an emergency.
- Nurses may delegate tasks that do not require independent nursing judgment. (Insulin and glucagon can be administered according to written doctor’s orders and so meet this requirement).
- Any person who gives emergency treatment or rescue assistance to a person who is unconscious, ill, injured or in need of rescue assistance, shall not be liable for damages, unless they result from intentional, wanton, or reckless behavior, or by gross negligence.
- Rules regarding nursing care do not forbid nurses from training and allowing a lay person to perform nursing tasks so long as they do not become a routine part of the lay person’s job (emergency glucagon fits this requirement).
- Rules regarding nursing care do not forbid a child care provider licensed as a family day care facility or child care center from providing care (such as insulin and glucagon administration).
- Any person who has been trained to provide first aid may give emergency care according to the training and shall not be liable for damages except for those caused by gross negligence, or willful or wanton acts.
- If an emergency arises in a daycare, a daycare employee, owner, or operator may administer medicine to a child if:
- a medical practitioner has given written authorization
- or a medical practitioner, emergency service provider, or 911 responder verbally directs the employee, owner, or operator of the day care facility to immediately administer a medicine to the child.
- Staff or operators of a child care facility may administer medication by a route other than inhalation, oral, into the eyes, ears, or nose, or topical (such as insulin and glucagon injections) when a caretaker or licensed health care professional has written that the child care staffperson or operator is competent to administer the medication and a licensed health care professional has stated in writing that this can safely be done for the particular child.
- Except in an emergency, only one person at a child care facility may administer medications to children.
- Any person who renders emergency care or assistance in an emergency (such as glucagon administration), without payment and in good faith, is not liable for any civil damages unless the person acts with gross negligence.
- Any person who, in good faith, gives emergency care (such as glucagon administration) without willful or wanton negligence, is not liable for civil damages for giving care.
- Child care programs shall allow children to carry insulin and keep it in their possession while at the program so long as the child’s health care practitioner has given written authorization and the parents give written consent.
- However, children under 6 years of age may not carry insulin.
Child care centers will provide reasonable accommodations, including administering medication or performing health care procedures to a child with special needs, if failing to administer the medication or procedure would endanger the health of the child or prevent the child from attending.
- The parent must provide written consent for the center to administer medication, and a written statement from the child’s health care provider with instructions.
- Before administering a health care procedure, such as administering a blood glucose test, the center shall ensure that the staff who will perform the blood glucose test have been trained by the child’s parent or another appropriate person.
- Any person who provides emergency care or assistance (such as administering glucagon) shall not be liable for civil damages except when the person acts with gross negligence.
New York Codes, Rules and Regulations, Title 18, Chapter 2, Subchapter C, Article 2, Part 414, § 414.11(g)(5)(2) (School-Age Child Care) (2009)
- A school-age child care provider may not administer medication by injection except for a child with special health care needs (such as diabetes), where the parent, day care provider and the child's health care provider have agreed on a plan pursuant to which the provider may administer medications by injection (such as insulin and glucagon).
- A daycare provider may not administer medication by injection except for a child with special health care needs (such as diabetes), where the parent, day care provider and the child's health care provider have agreed on a plan pursuant to which the provider may administer medications by injection (such as insulin and glucagon).
- A parent may give a child care provider standing authorization for up to six months to administer prescription medication to a child, when needed, for chronic medical conditions.
- Rules regarding who may perform nursing care do not forbid a person authorized by a physician or nurse from performing patient-care services which are routine, repetitive, limited in scope and do not require the professional judgment of a nurse (such as blood glucose testing and insulin administration).
- Rules regarding who may perform nursing care do not forbid any person from assisting in the event of an emergency (such as administering glucagon due to severe hypoglycemia).
- A nurse may train and allow non-nurses (“unlicensed assistive persons”) to administer a specific medication for a specific child if it is routine and regularly scheduled (such as insulin).
- Any person who provides aid or assistance in an emergency (such as administering glucagon due to severe hypoglycemia) cannot be found liable for practicing medicine or nursing without a license.
- Any person who provides aid or assistance in an emergency cannot be sued for personal injury related to the emergency aid or assistance, and cannot be found liable, unless the person acted with intentional misconduct or gross negligence.
- Rules regarding who can provide nursing care do not forbid non-nurses from providing care during an emergency (such as administering glucagon for severe hypoglycemia)
Ohio Association of School Nurses, Fall Quarter Newsletter, November 2007
The Ohio Association of School Nurses interprets the above mentioned law to allow non-nurses (such as day care staff) to administer glucagon, and to allow nurses to train day care staff to administer glucagon.
- A non-nurse may administer injections (such as insulin and glucagon) once trained and authorized (“delegated”) to do so by a registered nurse.
- Any person who provides aid or assistance in an emergency (such as administering glucagon due to severe hypoglycemia) cannot be found liable for injury resulting from the aid or assistance unless the person acted with gross negligence.
- Child care regulations require that parents provide written authorization in order for a child care provider to provide emergency medical treatment for the child (such as glucagon) and administer medication (such as insulin) to the child.
- A child day care must make reasonable accommodations to facilitate administration of medication or a special diet for a child with special needs as required by federal and state disability laws (including children with diabetes who require insulin and emergency glucagon).
- A child day care staff person who has completed and passed a medications administration course and who has completed and passed a diabetes patient education program within the past 12 months that meets the Standards for Diabetes Patient Education Programs of the Pennsylvania Department of Health is permitted to administer insulin injections.
- Any person who has a current certificate of training in first aid (given by the American Red Cross, the American Heart Association, or approved by the Pennsylvania Department of Health) who renders emergency care, first aid or rescue at the scene of an emergency (such as administering glucagon) shall not be liable for any civil damages related to the emergency care, unless the person intentionally causes harm or acts with gross negligence.
- Child care providers may administer prescribed insulin injections to children in their care.
- Any person who provides emergency assistance (such as administering emergency glucagon) cannot be found liable for civil damages for providing the emergency care, unless the person is grossly negligent or engaged in willful or wanton conduct.
- Any person who provides emergency care (such as administering glucagon) shall not be liable for any civil damages resulting from the emergency care, except damages from gross negligence or wilful or wanton misconduct.
- No person is liable for civil damages resulting from providing good faith emergency care (such as administering glucagon), except damages caused by willful, wanton, or reckless acts.
- Any person who provides emergency care in good faith (such as administering glucagon) without making any direct charge for the emergency care shall not be liability for civil damages except damages caused by the person’s gross negligence.
- According to nursing rules regarding who can legally administer medication, a non-nurse may take any action that a reasonable, prudent non-health care professional would take in an emergency situation (such as administering glucagon).
- A nurse may train and allow a non-nurse to perform tasks that can be properly and safely performed by the non-nurse (such as a daycare staff person testing blood glucose, counting carbohydrates, treating low blood glucose with a snack, or administering insulin according to doctor's orders).
- Rules regarding child care centers state that child care staff may administer medication to children at the child care center, so long as:
- parents must sign an authorization and include times for child-care center employees to administer each medication according to label directions.
- the medication must be in the original container labeled with the child's full name and the date brought to the child-care center.
- it is administered according to the label directions or as amended by a physician.
- it is administered only to the specific child.
- expired medication is not administered.
- A person who provides reasonable assistance to another in an emergency (such as administering glucagon) shall not be liable in civil damages unless the person acts with gross negligence.
Code of Vermont Rules, Agency 13, Sub-Agency 162, Chapter 001, § 13-162-001 (Section K)(7) (2009)
- School-aged daycare may provide prescription medication to a child, so long as the parent has given written permission with dosage, content and schedule.
- If a child with diabetes is enrolled in a Child Day Care Program, there must be someone on staff and physically present in the facility that has received the Medication Administration Training Certification (8-hour program) and training to administer insulin and for emergency administration of glucagon.
- If a child who has been prescribed a medication such as glucagon (should also include insulin per Virginia Board of Nursing Guidelines, above) is enrolled at a daycare, the daycare must have staff trained to administer that medication present at all times that the child attends the program.
- This staff person or independent contractor must have completed a training program in glucagon and insulin administration approved by the Board of Nursing and taught by a registered nurse, licensed practical nurse, doctor, or pharmacist; or administration shall be performed by a staff member or independent contractor who is licensed by the Commonwealth of Virginia to administer medications.
- Child care centers are required to administer medication to children who have disabilities as defined by the Americans with Disabilities Act (which includes children with diabetes).
- Child care staff may administer medications once they have received instruction on specialized medication administration procedures.
- Any person who provides good faith emergency care (such as administering glucagon) without payment shall be liable for civil damages resulting from the care.
Wyoming State Board of Nursing Advisory Opinion, 2006 (currently unavailable on Wyoming State Board of Nursing Website)
- Board of nursing rules regarding who can administer nursing care state that non-nurses may provide routine diabetes care. The non-nurse can be trained by a diabetes educator or physician.
Wyoming State Board of Nursing Advisory Opinion, 2004 (currently unavailable on Wyoming State Board of Nursing Website)
- Nurses may teach non-nurses to administer glucagon.
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