Nurse Aide Training Bill Could Diminish Quality of Care for Nursing Home Residents

The Nurses CARE Act of 2021, currently pending in Congress, reflects misguided public policy. The aim of the bipartisan bill is to address staffing shortages in long-term care facilities that have been felt most acutely during the coronavirus pandemic. The proposed means for accomplishing this worthwhile goal, however, will inevitably diminish the quality of care nursing home residents receive.

Current federal law requires that within four months of working at a nursing home, new nurse aides complete a minimum of 75 hours of training, including 16 hours of clinical training under the direct supervision of a registered or licensed practical nurse.[1] Due to the public health emergency (PHE) that emerged with COVID-19, the Centers for Medicare & Medicaid Services (CMS) temporarily waived these training requirements in order to combat staffing shortages.[2] The American Health Care Association (AHCA), the for-profit nursing home association, promptly developed a free eight-hour training program for a new category of direct care worker that AHCA called Temporary Nurse Aides (TNAs).[3] Many states used the AHCA program to approve temporary workers during the pandemic.[4]

The Nurses CARE Act, sponsored by Representatives Fred Keller (R-PA) and Susan Wild (D-PA), would allow a TNA, supported with only eight-hours of online training, to be considered qualified as a nurse aide in nursing homes if the individual has clocked 80 hours of work in a facility. Furthermore, in a guidance memo issued on April 8, 2021, CMS is potentially paving the way for training requirements to be scaled down permanently. While confirming that nurse aide training requirements will be reinstated when the waiver is lifted, CMS recommends that states “consider allowing some of the time worked by the nurse aides during the PHE to count toward the 75-hour training requirement.”[5] The Center for Medicare Advocacy has been reporting on this issue throughout the pandemic (find past Alerts here and here).

Why These Changes Matter

The Nurses CARE Act essentially formalizes a work-around for federal nurse aide training requirements. If passed, it would partially roll back essential progress that was made over three decades ago in the Nursing Home Reform Act of 1987, which established standards of care fundamentally important to securing the safety of our nation’s older adults. It is also potentially unfair to those working as nurse aides and could even exacerbate the staffing shortage issue.

Adults in the United States are living longer with more complex health care needs. Now, more than ever, nurse aides need more training – not less – to equip them with the skills they need to effectively navigate the challenges of caring for a frail, vulnerable population. Staff shortages in nursing homes were an issue before the pandemic, largely due to poor pay and poor training mixed with physically and psychologically demanding work. The answer lies in fixing these root issues, such as increasing wages, not adding to them by lowering the training bar. The Nurses CARE Act will not help nurse aides in the long run, and it will certainly not help our nation’s nursing home residents receive the quality care they desperately need.

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[1] Requirements for approval of a nurse aide training and competency evaluation program, 42 CFR § 483.152.
[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] The Center for Medicare Advocacy issued an Alert, https://medicareadvocacy.org/whos-providing-care-to-nursing-home-residents/, and a Report, “Who’s Providing Care for Nursing Home Residents? Nurse Aide Training Requirements during the Coronavirus Pandemic” (Jul. 29, 2020), https://medicareadvocacy.org/wp-content/uploads/2020/07/Report-Nurse-Aide-Training.pdf, about states’ authorization of temporary nurse aides.
[5] CMS, “Updates to Long-Term Care (LTC) Emergency Regulatory Waivers issues in response to COVID-19” Centers for Clinical Standards and Quality/Quality, Safety & Oversight Group (April 8, 2021).