Many long-term care facilities continue to face critical staffing shortages as COVID-19 sickens residents and workers in facilities nationwide. Nursing homes in need of more direct-care workers have received a big boost from federal regulators. To assist in addressing staffing shortages due to the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) issued a blanket waiver that includes an allowance for nursing facilities to temporarily employ those who have completed alternative training paths.

A March 28 memo from CMS waived the rule that new nurse aides cannot work longer than four months without becoming certified. On May 15, CMS added training requirements for paid feeding assistants to the waiver and modified the requirement to be a minimum of one hour of training instead of eight hours. CMS is not waiving any other requirements under 42 CFR §483.60 (h), 42 §483.160(a)(1)-(8), or §483.60(h)(2)(i).

Some states have also provided flexibility on hiring and training practices for caregivers in nursing facilities during the COVID-19 emergency. These state health departments have issued guidance and clarifications relating to nurse aide training state requirements and paid feeding assistants programs.

The federal and state waivers and clarifications are important to giving health care providers the ability to expedite training and focus on providing quality care to older adults.

The CMS waiver also opens the door for providers to train basic care aides to assist residents; aides may also be known as a hospitality aide, concierge, community support assistant, or cross-trained staff. These aides assist residents with personal cares, including dressing, grooming, oral care, and bathroom needs, as well as provide resident support and services, such as mobility, positioning assistance, vital signs, bedmaking, nutrition, hydration, and emergency preparedness. The availability of these workers has been fueled by unemployed professionals who have surged into the aging services sector, ranging in backgrounds from customer service, hospitality, and restaurant workers.

Competency Requirements

CMS noted that despite the waiver, nurse aides must still be proven competent to provide nursing and nursing-related services. Providers must ensure that nurse aides are able to demonstrate competency in skills and techniques necessary to care for residents’ needs identified through resident assessments and described in the plan of care.

Competency, as defined in §483.35, is “a measurable pattern of knowledge, skills, abilities, behaviors, and other characteristics that an individual needs to perform work roles or occupational functions successfully.” Methods of evaluating competencies include:

  • Lecture with return demonstration for physical activities;
  • A pre- and post-test for documentation issues;
  • Demonstrated ability to use tools, devices, or equipment that were the subject of training and used to care for residents;
  • Reviewing adverse events that occurred as an indication of gaps in competency; or
  • Demonstrated ability to perform activities that are in the scope of practice an individual is licensed or certified to perform.

Competencies for the most common activities a nurse aide performs include:

  • Obtaining vital signs and other measurements
  • Blood pressure
  • Temperature
  • Pulse
  • Respirations
  • Oxygen saturation/pulse oximetry
  • Weight
  • Height
  • Infection control
  • Hand hygiene
  • Donning and doffing personal protective equipment (PPE)
  • Linen handling
  • Procedures regarding transmission-based precautions (including COVID-19 procedures)
  • Activities of daily living
  • Bathing assist: bed bath, shower, tub bath
  • Oral care, denture care
  • Dressing
  • Grooming: shaving, hair care, nail care
  • Peri-care, catheter care, colostomy care, assist with bedpan or urinal
  • Make occupied and unoccupied bed
  • Feed dependent resident; set up meal tray
  • Assist resident with ambulating
  • Transfer resident using a gait belt, and using a mechanical lift
  • Turning and repositioning resident, bed mobility

Note: This list does not replace or supersede the need for the facility to follow their state’s regulatory requirements for nurse aide training and work requirements. Facility leaders should check with their state’s department of health to determine if state waivers of changes in the requirements have been granted for nurse aide training and work requirements.


Amid the COVID-19 pandemic, the need is greater than ever for facilities to be able to conduct “fast tracking” courses for people interested in becoming certified nursing assistants.

If you have questions or if Health Dimensions Group can assist you in your COVID-19 staff training, preparedness, and response, please contact us at or 763.537.5700.

Additionally, to assist our clients, managed communities, and other providers in preparing for and responding to COVID-19, Health Dimensions Group created a Skilled Nursing & Senior Living COVID-19 Response & Resource Guide that is available for your download and use.