Long Term CareLong Term CareTraining requirements do not always reflect the necessary skills and competencies needed to address the evolving complexity of direct care jobs. Federal law requires home health aides and certified nursing assistants complete at least 75 hours of training, but there are no federal training requirements for personal care aides. In fact, 26 states have at least one set of training regulations for personal care aides but with no required training hours. States need high-quality training for personal care aides because the demand for these services is expected to increase exponentially in the next decade, and the individuals they serve require higher levels of care. Additionally, the likelihood that these providers experience injuries on the job is 44% higher than the average U.S. worker. Untrained, unpaid family caregivers can face even greater challenges, including chronic stress, which could lead to compromised physical and psychological health and depression.
Five states — New Jersey, New York, Oregon, Rhode Island and Washington State — along with the District of Columbia were deemed to have the highest training requirement scores for personal care aides (PCAs), who support millions of older adults and individuals with disabilities and serious illness, according to a January 2025 report from the University of California San Francisco Health Workforce Research Center on Long-Term Care. Seven states have no requirements for PCA training at all and there is no national standard for PCA training. The other two large segments of the direct care workforce — home health aides and nursing assistants — are subject to federal minimum training requirements through the conditions of participation in Medicare.
Arizona lawmakers required an update to the caregiver, assisted living facility manager and nursing care institution administrator training standards and the formation of an advisory workgroup to inform the efforts. The legislation also sought a recommendation for the appropriate board or agency to oversee the training standards, training program approval and oversight, and a date for the implementation.
Colorado authorized the Department of Public Health and Environment to require operators of assisted living residences to ensure each direct care worker completes direct care training to provide specific services to residents. The training entity is required to provide each trained direct care worker with a certificate of completion of training that may be presented to another assisted living residence to consider for the purposes of satisfying the residence’s training requirements. For a direct care worker who has been issued a certificate of completion, an operator may require an employee to complete new training or may require the completion of a competency test prior to the employee providing direct care services.
Massachusetts legislation created the Long-Term Care Workforce and Capital Fund, which can be used to pay for the administration of a capital loan program and workforce training programs, including program costs, tuition, books and fees related to the cost of education and training for participants in the programs; costs related to obtaining an applicable license, including, but not limited to, examination and licensing fees, stipends for program participants, and stipends for child care and transportation for program participants.
Michigan created a home help caregiver council to provide for additional and relevant training and educational opportunities for individual home help caregivers, including opportunities for individual home help caregivers to obtain certification that documents additional training and experience in areas of specialization; provide for a mandatory orientation program related to employment in providing individual home help services; provide for semiannual compilation and maintenance of a list of the names and contact information of all individual home help caregivers who have been paid to provide individual home help services within the immediately preceding six months. … Maintain a registry of individuals qualified to be individual home help caregivers to promote and coordinate effective and efficient individual home help services. … Provide support to individual home help caregivers through a variety of methods aimed at encouraging competence, achieving quality services for participants, and improving individual home help caregiver retention through improved job satisfaction. … Any funds allocated for the provision of relevant training and education opportunities may be used to provide career education, wraparound support services, and job skills training in areas of specialization for individual home help caregivers. Funds may also be used for program expenses, including, but not limited to, hiring instructors, marketing and recruitment efforts, space rental, and supportive services to help individual home help caregivers attend trainings.
New York established an Alzheimer’s disease outreach and education program focused on identification of dementia in health care facilities, including, but not limited to, hospitals, nursing homes, clinics and assisted living facilities; community support services, including caregiver support groups and services, respite and care management; and resources and information concerning Alzheimer’s disease and other dementia-related matters deemed appropriate.
Dementia training
Several states in 2023 addressed dementia training for direct care workers, including Arkansas, District of Columbia, and New Mexico.
Indiana was among the states that addressed dementia training for home health aides.
Virginia and West Virginia addressed dementia training for law enforcement.
Colorado, Florida and Texas addressed dementia training for staff of long-term care facilities.
Seven states created Dementia Services Coordinator positions in 2023 alone, including Arizona, Arkansas, Connecticut, Indiana, Kansas, Nebraska, Vermont
Colorado addressed training of more geriatric specialists.
Kansas established the Kansas nonprofit apprenticeship grant program, which awards $2,750 per apprenticeship to eligible nonprofit employers and eligible nonprofit healthcare employers to cover administrative costs associated with the apprenticeship.
Kentucky established the Kentucky Healthcare Workforce Investment Fund, which provides healthcare training scholarships funded by public and private partnerships. 65% of the net funds will be used for scholarships. Scholarship recipients will be required to work in KY for each year a scholarship is disbursed, up to two years. If recipients do not meet that requirement, they will be required to pay back the scholarship in full. Up to 35% of the funding is to be used to as a matching incentive to reward performance and excellence among eligible healthcare programs.
Mississippi appropriated American Rescue Plan Act dollars to fund three grants aimed at addressing the healthcare shortage: The MS Nursing Allied Health Grant Program, Physician Residency and Fellowship Start-Up, and Allied Health College and Career Navigator Grant Program.
Washington appropriated funds for the University of Washington’s neurology department to create a telemedicine program to disseminate dementia care best practices to primary care practitioners using the project ECHO model. The state also appropriated $1.29 million in each FY2024 and FY2025 for community-based dementia education and support activities in three areas of the state (expanded from two pilot areas of the state and $750,000 in prior years), including funding dementia resource catalyst staff and direct services for people living with dementia and their caregivers.
Washington required community colleges to design and implement an online nursing curriculum, established a home care aide to licensed practical nurse apprenticeship pathway pilot program, required the workforce training and education board to contract with a firm to develop a marketing plan to communicate available training opportunities and jobs in nursing professions, and required the state board for community and technical colleges to partner with a firm to conduct a salary survey on nurse educator compensation. It also required the DoH and DoL to partner with rural hospitals to create at least two pilot projects wherein high school students training to become nursing assistant-certified are utilized to address workforce shortages.
Wisconsin has WisCaregiver Careers to recruit, train, and provide wraparound supports to nursing assistants, and they’re implementing a Geriatric Career Development Program.
Wisconsin also implemented the Certified Direct Care Professional (CDCP) training program in July 2023. To become certified, direct care workers complete a free, 30-hour online training series developed by the Wisconsin Department of Health Services (DHS) and the University of Wisconsin-Green Bay (UW-GB). The CDCP program has 14 competencies that prepares them to work in various home and community-based settings (HCBS). After this, CDCPs will be able to complete microcredentials in additional courses relevant to their field and interests. As a way of enhancing training and improving language access, Wisconsin is offering the CDCP curriculum and competency test in Spanish.
Researchers have long recommended increasing the 75-hour federal training requirement for certified nursing assistants and home health aides, but it is also important to ensure that the training is competency-based and addresses the full range of skills required for these jobs. Many states have addressed training requirements, including:
Several states adopted permanent or temporary changes to staff training requirements during the COVID-19 pandemic to expand the pool of staff available to work in nursing homes. Wisconsin, for example, lowered from 120 hours to 75 hours the training requirement for nurse aides.