States are Weakening Training Standards for Nursing Facility Aides – CMS is silent!

2021 Nursing/Hospital lobbying ($1 million or more)

The Centers for Medicare & Medicaid Services (CMS) has turned a blind eye to yet another corporate push to lower wages, increase profits, and in this case, endanger the elderly at the same time.

During the early days of the COVID-19 wave, the feds allowed nursing homes to designate “temporary nurse aides”, instead of requiring professionals who received 75 hours of training in the first four months of employment and then pass testing.

That training must be performed by or under the general supervision of a registered nurse with at least two years of nursing experience, at least one  must be in a nursing facility.

When the emergency regulations end, the nursing facility lobby now wants “grandfathering” of temporary (untrained) nurse aides into permanent (trained) certification and the Joe Biden administration agrees.

Through a guidance document, CMS now “recommends that states evaluate their nurse aide training and testing programs, and consider allowing some of the time worked by the nurse aides during the public health emergency to count towards the 75-hour training requirement.”

Toby Edelman, of the Center for Medicare Advocacy (CMA), blasted CMS for its inaction:

This is a public policy mistake, as illustrated by the flimsy mechanisms used by some states to claim that past work in likely understaffed facilities during the pandemic was actually meaningful and comprehensive training. In some states, these mechanisms allow for certification with no actual training, aside from the aide’s initial on-line (eight-hour) class.

Edelman said that nurses deserve “more respect and support for their difficult, vital work.”

That respect is best shown by increasing wages, benefits, sick leave, and opportunities for professional advancement.

Reducing nurse aide training requirements — by claiming after the fact that training was completed during routine work hours in likely understaffed facilities — is counterproductive, and harmful to nursing facility residents and staff.

CMS should require the real training required by the relevant regulations, and states should withdraw their procedures that allow work to be retroactively and perfunctorily classified as “training.” In practice, this will require CMS to assert its oversight authority on this issue, rather than looking away.

Federal regulations require nurse aides within their first four months of employment to complete at least 75 hours of training in specified topics, and then to pass tests of knowledge and hands-on competence in order to gain permanent status.

Edelman explained that of the total 75 hours, at least 16 hours must be provided before the aide has any direct contact with residents.

This initial training must include communication and interpersonal skills, infection control, safety/emergency procedures (including the Heimlich maneuver), promoting residents’ independence, and respecting residents’ rights.

Subsequent training (the remaining 59 or more hours) must include basic nursing skills, personal care skills, mental health and social service needs, care of cognitively impaired residents, basic restorative services, and residents’ rights. For these topics, the federal regulations specify that the training must address 36 separate sub-topics.

The CMS guidance document, along with continued CMS silence, has already allowed states to weaken nurse aide training standards in violation of longstanding federal law.

For example, New Jersey has eliminated virtually all of the training hours claiming that it would require additional hours “if so required by the CMS.” There has been no response from the federal government.

Edelman offered this analysis of current training changes, but noted other states are also undergoing changes to reduce professional standards.

Toby Edelman, of the Center for Medicare Advocacy, can be reached at

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