Training 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.


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.

2023-24 Updates

Enhancing Training & Education

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.