Care homes win new reprieve from training requirement


The Biden administration plans to provide additional wiggle room to nursing homes that cannot ensure their uncertified health care aides meet mandatory federal training requirements by the Oct. 7 deadline.

The revised guidelinesissued by the Centers for Medicare & Medicaid Services on Monday and obtained by Bloomberg Law, could give temporary health care aides hired during the Covid-19 pandemic until the public health emergency ends to complete the 75 hours of training required and pass a state certification test.

The agency said it will issue state-wide and county-wide waivers, as well as those for individual facilities. The public health emergency is scheduled to end on October 15, but Health and Human Services Secretary Xavier Becerra is expected to extend it for another 90 days.

The industry, still reeling from a severe labor shortage, says the updated guidelines will help it overcome a shortage of state training and testing slots, while allowing struggling facilities to keep their doors open and continue to provide care.

“With such a great need for certified caregivers, we are relieved to get the information from CMS,” said Janine Finck-Boyle, vice president of health policy at LeadingAge, which represents healthcare providers. non-profit aging.

The organization “has been pushing for these details for months as we approach the October deadline,” it said in a statement.

Holly Harmon, senior vice president of quality, regulatory and clinical services for the American Health Care Association and the National Center for Assisted Living, the industry’s leading trade group, said, “We appreciate CMS recognizing that Temporary caregivers should have a more realistic opportunity. to get certified as the next step in their long-term care career path.

“However, the concern remains that the nationwide training and testing backlogs could extend well beyond the public health emergency – possibly even for years – which ultimately , will limit career advancement opportunities for these heroic caregivers,” she said in a statement.

Staff, resident safety is a concern

But patient advocates say the waiver is too broad and puts the safety of staff and residents at risk by allowing undertrained workers to continue working with frail patients.

“We know that nursing staff is one of those professions where there are high rates of injury among staff and if you are not properly trained in how to transfer and move people, use the equipment and interacting with people of varying conditions, then that puts everyone at risk,” said Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care.

More than 300,000 temporary health care aides have received abbreviated training, and most are seeking full certification, Harmon said previously. But that has created a blockage for state agencies that provide training and testing.

“We recognize that there may be instances where the volume of aides who must complete a state-approved ‘nurse aide training and assessment program’ exceeds the capacity available to enrollees at a training program or on the exam. This can lead to delays in the certification of nurse aides,” the updated CMS guidelines state.

While a “State or facility cannot obtain or maintain a waiver longer” than the declared public health emergency, CMS “will grant such waivers for as short a period of time as possible, and CMS will only grant such waivers only during the declaration of a COVID-19 public health emergency is still in effect. If the PHE ends during or before the waiver period granted for a facility, state, or county, the waiver also ends. ”, read the revised guidelines.

To maintain nursing home staffing levels at the start of the pandemic, the Trump administration renounced a rule that limited the employment of uncertified orderlies to just four months. Under the waiver, some states required little additional training beyond an eight-hour online course, according to a report by the Center for Medicare Advocacy.

But to ensure better resident care, the Biden administration reinstated the training requirement, effective June 7. Uncertified temporary health care aides had until Oct. 7 to complete the 75-hour training and pass a state certification test. Those hired after June 7 had four months from their date of hire to complete the training.

Requesting State and County Waivers

Caregiver training encompasses many areas including: medication side effects, skin integrity, caring for people with dementia, how to respond to emergencies, infection control, basic skills in nursing and personal care and the rights of residents.

State agencies can request statewide or countywide waivers “when there are widespread barriers to training/testing that are statewide or in a particular county d ‘one State’, according to the updated guidelines. The agency must document problems with the health care aide training program and provide a “plan to remedy the situation.”

“At a minimum, the plan to remedy the situation must include steps the state will take to improve the rate at which assistants are certified and a target date for all assistants to be certified,” the guidelines state.

Individual facility waivers may be requested when local barriers to training and testing occur in a state or county that is not covered by a waiver. Institutions should document the caregiver’s or caregivers’ efforts to enroll, the barriers they face, and the institution’s efforts to overcome those barriers.


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