Under the federal Nursing Home Reform Law (1987), nurse aides may not work for more than four months unless they are trained in a training program of at least 75 hours and determined to be competent.[1] On March 20, 2020, as part of a long list of waivers and flexibilities granted to nursing facilities, CMS waived the four-month rule, but not the competency requirement.[2]
Shortly after Centers for Medicare & Medicaid Services (CMS) announced the waivers in March, the American Health Care Association (AHCA), the trade association of mainly for-profit nursing facilities, reported that it had been advocating for such a waiver. Simultaneously, AHCA announced that it had developed a free eight-hour on-line training course for a “temporary position intended to address the current state of emergency.”[3]
A number of states now expressly authorize use of AHCA’s temporary nurse aide training program, including Connecticut[4], Delaware[5], Georgia[6], Illinois[7], Indiana,[8] Iowa[9], and Kansas[10].
Other states authorize other types of waivers of nurse aide training requirements. Florida created new temporary Personal Care Attendant program “to help long-term care facilities fill staffing shortages. The program provides an 8-hour training on assisting with direct care so that personal care attendants can temporarily perform additional duties.”[11]
Other states recognize that CMS has waived the 75-hour training requirements but impose different requirements. California allows a nurse assistant who is enrolled in an approved certification training program to “continue to be employed throughout the declared emergency . . . but is encouraged to complete the program as training programs resume.”[12] Colorado waives the nurse aide training requirements, but not the competency requirement, during the emergency,[13] and authorizes facilities to use “uncertified staff” to perform “direct health care tasks.”
On https://educate.ahcancal.org/tna, the American Health Care Association identifies additional states as allowing ACHA’s eight-hour training course. The Center was unable to find material about those states.
Questions and Discussion
With staff infected by COVID-19 and unable to work, new staff members are undoubtedly needed. But there are many questions about these workers that need answers.
How prevalent is the use of these temporary aides? Is CMS tracking who they are, how many there are, which facilities they are working in, what tasks they are performing and how well?
What happens to temporary aides after the pandemic ends? Some states answer the question, but most are silent.
- Will they be fired?
- Illinois prohibits temporary nurse aides from taking the certified nurse assistant competency exam and says they “will not be employed as an aide after the pandemic emergency.”
- Will they be grandfathered in as permanent certified nurse assistants?
- Pennsylvania providers asked for waiver of nurse aide training and competency evaluation requirements for staff who “worked in this capacity for at least one month during the emergency” and for waiver of the training requirement for workers who worked less than one month during the emergency.[14]
- Will they be required to take the state’s mandated aide training course and pass the state’s competency evaluation test?
- Georgia will allow a period of time, after the emergency is lifted, for temporary aides to complete additional training and pass the state competency test.
- Kansas will require temporary aides to complete the state’s 90-hour training course and to pass the state exam to be certified as a CNA.
Conclusion
Particularly since nurse aides provide most of the direct care to residents, the qualifications of nurse aides and other staff members providing care to residents are critically important. The country cannot return to the time before the 1987 Nursing Home Reform Law when half the states did not require that aides get training and demonstrate competency before providing care to residents.
To read the full report, Who’s Providing Care for Nursing Home Residents? Nurse Aide Training Requirements during the Coronavirus Pandemic, please go to: https://medicareadvocacy.org/wp-content/uploads/2020/07/Report-Nurse-Aide-Training.pdf
July 23, 2020 – M. Edelman, T. Edelman
[1] 42 U.S.C. §§1395i -3(b)(5), 1396r(b)(5), Medicare and Medicaid, respectively; 42 C.F.R. §§483.35(d)(1)(i), (ii), 483.35(c).
[2] CMS, “Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities): CMS Flexibilities to Fight COVID-19” (Mar. 28, 2020), https://www.cms.gov/files/document/covid-long-term-care-facilities.pdf.
[3] AHCA, Temporary Nurse Aide Training & Competency Checklist https://educate.ahcancal.org/products/temporary-nurse-aide.
[4] https://portal.ct.gov/DPH/Facility-Licensing–Investigations/Facility-Licensing–Investigations-Section-FLIS/NEW—Temporary-Nurse-Aide-Certification.
[5] Division of Public Health and Delaware Emergency Management Agency Orders and Waivers and Centers for Medicare and Medicaid Services Blanket Waivers Long Term Care Facilities, https://coronavirus.delaware.gov/wp-content/uploads/sites/177/2020/04/Healthcare-Waivers-4_9_2020.pdf.
[6] Georgia Department of Community Health, “Healthcare Facility Regulation Division COVID-19 Information; Partnership with GHCA on Nurse Aide Training,” with links to the COVID-19 Temporary Nurse Aide Training Program (effective Mar. 20, 2020), https://dch.georgia.gov/healthcare-facility-regulation-division-covid-19-information.
[7]Illinois Department of Public Health Temporary Nursing Assistant (TNA) Training Program, https://www.ihca.com/Files/COMM-COVID-19/TNA%20Training%20Program%20Instructions.pdf.
[8] Indiana State Department of Health, “Sixth Emergency Order Granting Temporary Blanket Waivers for Comprehensive Care Facilities” (issued Apr. 18, 2020, effective Mar. 6, 2020), https://www.coronavirus.in.gov/files/AA%20-%20CCF%20Waiver%20Order%20%236%2020200418%20Temp%20NAs%20Fjnal%20Signed.pdf , https://www.coronavirus.in.gov/2499.htm.
[9] Iowa Department of Inspections and Appeals, COVID-19, Frequently Asked Questions for Health Facilities, p. 9, Question CNA4 (updated Jun .1, 2020), https://dia.iowa.gov/sites/default/files/documents/2020/06/dia-hfd-covid-19-faqs.pdf.
[10] Kansas Department for Aging and Disability Services, “COVID-19 Temporary Nurse Aide Training Program” (effective Apr. 17, 2020), https://www.coronavirus.kdheks.gov/DocumentCenter/View/968/Temporary-Aide-Guidance–PDF—4-17-2020.
[11] The State of Florida Issues COVID-19 Updates (Apr. 19, 2020), www.floridahealth.gov/newsroom/2020/04/042020-1845-covid19.pr.html.
[12] California Department of Public Health, “Suspension of Professional Certification Requirements for Certified Nurse Assistants (CNAs),” AFL 20-35 (Apr. 5, 2020), All Facilities Letter, https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/AFL-20-35.aspx (waiving specified statutory and regulatory requirements, including training requirements for initial certification, at HSC section 1337.5(b)(2)-(3)); California Department of Public Health, “Suspension of Specified Regulatory Requirements for Nurse Assistant Training Programs (NATPs),” AFL 20-40 (Apr. 14, 2020), https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/AFL-20-40.aspx
[13] Colorado Department of Health Care Policy & Financing, ‘Certified Nursing Assistant, Nursing Facilities, Training Requirements, COVID-19, Coronavirus,” Operational memo number: HCPF OM 20-038 (Apr. 8, 2020, effective Mar. 1, 2020), https://www.colorado.gov/pacific/sites/default/files/HCPF%20OM%2020-038%20Temporary%20Training%20and%20Certification%20of%20Nurse%20Aides%20%281%29.pdf.
[14] June 8, 2020 letter to Secretary of the Pennsylvania Department of Education from LeadingAgePA, Healthcare Council of Western Pennsylvania, Pennsylvania Health Care Association, and Pennsylvania Coalition of Affiliated Healthcare & Living Communities, https://www.leadingagepa.org/Portals/0/Documents/Letter%20to%20Sec.%20Rivera%206-8-2020%20(02).pdf?ver=2020-06-08-213637-723.