Training Requirements

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:

• The curriculum for Arizona’s state-sponsored personal care aide training program covers core fundamental skills for personal care aides and has population-specific modules. The effectiveness of the training is demonstrated through standardized test results.
• California requires certified nursing assistants in residential care facilities to receive 12 hours of additional dementia care training.
• Colorado requires direct care staff in skilled nursing facilities, assisted living residences, and adult day care facilities to receive at least four hours of dementia training upon hire and at least two hours of continuing education every two years thereafter.
• Georgia established dementia training requirements for all direct care workers and other long-term care staff in memory care centers.
• In 2022, Idaho appropriated $5 million for job training and apprenticeships for in-demand professions including key dementia care roles such as certified nurse assistants, medical assistants, licensed practical nurses and registered nurses.
• Illinois established minimum training requirements for employees of home health agencies providing services for people with Alzheimer’s Disease and dementia.
• Indiana law requires registered home health aides to complete dementia training. Assisted living facilities providing memory care services must complete a disclosure form outlining how they provide dementia-specific care, staffing levels and transfer/discharge policies.
• Kentucky requires all staff in the Dementia Care Unit of an assisted living facility complete at least eight hours of dementia-specific training within their first 30 days of working in the unit. Direct care staff in the unit must complete at least 16 hours of dementia-specific training within their first 30 days of working and eight hours annually thereafter.
• Minnesota provides scholarships and student loan repayment for nursing facility staff, including nursing assistants.
• In 2020, Mississippi provided short-term tuition, vouchers and health care credentials to unemployed and underemployed certified nursing assistants.
• Montana’s updated assisted living facility regulations require direct care staff to receive a minimum of two hours of training in dementia care upon hire and then annually.
• Oregon outlines specific training on dementia care for direct care workers.
• Pennsylvania’s updated skilled nursing facility regulations require dementia training as part of all staff orientation.
• The Tennessee Quality Improvement in Long-Term Services and Supports is a value-based payment program allowing direct care workers to earn a series of competency-based micro-credential badges, earn college credit and advance along clearly articulated career pathways.
• Virginia has updated regulations for staff training in memory care and assisted living settings to require a certain number of hours in dementia training for various personnel. The measure does not cover nursing homes, where an estimated 48% of residents overall have Alzheimer’s or other types of dementia.
• Washington requires 75 hours of entry-level training, along with 12 hours of continuing education for personal care aides, to prepare individuals working in all long-term care settings as “universal workers.” Analysts suggest the program could be the basis for developing a cross-setting professional caregiver occupation.

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.