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PRESS RELEASE: States' Home Health Aide Training Requirements Lag Far Behind Nurse Aide Requirements Despite Trend Toward Home and Community-Based Care

December 7, 2011

Federal Minimum Training Standards Unchanged After Two Decades, Though Institute of Medicine Recommends Enhancements

New York, NY — A new PHI analysis found that only 15 states require home health aides to have more training hours than are federally mandated, yet twice that number require certified nurse aides — who typically work in nursing homes — to have more training hours than the federal requirements.

In 1987, the federal government set a training standard of 75 hours, including a minimum of 16 hours of clinical training, for both home health aides and certified nurse aides who are employed by Medicare-certified nursing homes or home care agencies. Today, both home health clients and nursing home residents have more complex health conditions, making additional training crucial to quality care.

"Our analysis shows that state home health aide training requirements have not kept pace with their nursing home aide training requirements, even though these direct-care workers provide essentially the same care and services," said Steve Edelstein, PHI national policy director.

"Although it is clearly time to revisit the federal standards, having states move ahead on their own to upgrade training requirements is a step in the right direction."

The PHI findings show, for example, that Missouri requires the federal minimum of 75 hours of training for home health aides but 175 hours of training for certified nurse aides.

Home health aides provide their services without the close supervision that nursing assistants receive in a facility setting.

In Retooling for an Aging America, a 2008 report, the Institute of Medicine (IOM) recommends that the federal minimum training requirement be raised to at least 120 hours for both certified nursing assistants and home health aides, and that competency in elder care be demonstrated as a criterion for certification.

Other Findings

The PHI analysis found that of the 15 states that exceed the federal training minimum for home health aides, only four states meet the 120-hour standard recommended by the IOM.

Yet 14 of the 30 states that exceed the federal training minimum for certified nurse aides meet the IOM recommended training standard.

The analysis also found that 13 states require more than the federal minimum requirement of 16 hours of clinical training for home health aides, and that the number of hours these states required ranged from 20 to 80 hours.

Of the states that exceed the federal training standard, nine states require home health aides to be certified nurse aides and four states allow certified nurse aides to become home health aides with supplementary training.

Trend Toward Home and Community-Based Care

Today, the majority of direct-care workers, including personal care aides, are employed in home and community-based settings (pdf) — not institutional settings such as nursing care facilities or hospitals.

By 2018, home and community-based direct-care workers are likely to outnumber facility workers by nearly two to one.

"Current federal training standards have not kept pace with changes in public policy and services delivery and do not adequately prepare the direct-care workers who provide the lion's share of paid hands-on long-term care," Edelstein said.

"The federal government must modernize training requirements for direct-care workers to help them gain the skills and knowledge they need to help elders with chronic and complex medical conditions live as independently as possible where they prefer — in their homes and communities."

To compare the training requirements for home health aides and certified nurse assistants in each state, visit the PHI PolicyWorks website.

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PHI ( is a national organization that works to improve the lives of people who need home or residential care — and of the direct-care workers who provide that care. PHI's work is grounded in the philosophy that quality jobs for direct-care workers will lead to quality care for long-term care consumers.

Deane Beebe, PHI Media Relations Director
718-928-2033; 646-285-1039 (cell)

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