NYS plan to cut training for certified nurse aides sparks concerns

A state Department of Health proposal to reduce the minimum training hours required to become certified nurse aides by 25% will jeopardize the complex health needs of elderly and vulnerable New Yorkers, according to some nursing home advocates, while supporters contend the plan will improve hiring for a dangerously understaffed position.

Last month, the Health Department announced a proposed regulatory change lowering the number of hours of classroom and clinical training required to become a CNA from 100 to 75. CNAs generally assist residents with eating, bathing, dressing, toileting and mobility, largely in nursing homes.

The move, state officials said at the time, would align the state's training requirements for CNAs with those set by the federal government nearly 40 years ago while helping to attract more prospective candidates to the position.

"This regulation furthers the department’s effort to expand the healthcare workforce by easing the requirements for CNA candidates," the department said in its June 17 memo announcing the proposed change. "This regulation will increase the pool of qualified CNAs to deliver needed services to nursing home residents."

Critics: More training needed

But critics contend the proposal ignores decades of research from national experts who argue that more training, not less, is needed to prepare CNAs for the workforce.

"Nursing home residents today have increasingly complex medical, cognitive and behavioral needs," said Richard Mollot, executive director of the Long Term Care Community Coalition, a Manhattan-based group that advocates for elder care residents. "This is a time to strengthen the preparation of caregivers — not reduce it."

Mollot, whose organization submitted formal comments opposing the proposal, said New York was not alone in mandating more training than was required by the federal government.

As of 2023, 29 states and the District of Columbia all required more than the 75 hours of training for CNAs, according to a report released by the coalition.

In a statement to Newsday, state Health Department spokeswoman Danielle DeSouza said the agency "takes great care in advancing initiatives that support the evolving needs of the healthcare workforce while meeting existing federal requirements and ensuring healthcare professionals are equipped with the skills and knowledge they need to deliver high quality services in communities across New York State."

Nursing homes, the department said, are required to develop and maintain training programs based on its residents' needs and implement the types of necessary training to maintain compliance.

CNAs, the department added, are required to be constantly reevaluated for competency and must meet an annual requirement for 12 hours of continuing education.

The department is accepting public comment on the proposal through Aug. 17. If the department decides to move forward with the proposal, it could go into effect in the coming months.

'Workforce crisis'

Stephen Hanse, president and chief executive of the New York State Health Facilities Association, which represents the nursing home industry, said the regulatory change is desperately needed to address a "workforce crisis" in attracting CNAs and other long-term care employees to the industry.

"If you don't have a passion for long-term care, you've got other options in the labor force," said Hanse, adding that 100 hours of training is difficult to sustain for individuals trying to enter a relatively low-paying field and who may still need to work while going through their training. "So by reducing it and mirroring federal requirements, we are cautiously optimistic that it will incentivize individuals to come into long-term care."

LeadingAge New York, a Latham-based nursing home trade group that represents nonprofit and public facilities, agreed and said the change will not hurt the quality of care of seniors.

Sebrina Barrett, president and chief executive of LeadingAge, said her organization will "continue to advocate for ... regulatory reforms that would facilitate recruitment and retention of a skilled and compassionate workforce without sacrificing safety and quality. Nursing homes and other nurse aide training program providers could, of course, provide additional training beyond the minimum required."

Becky Preve, executive director of the Albany-based Association on Aging in New York, which focuses on home and community-based services for the elderly, said her organization was not taking a stance on the proposal.

"There is a massive shortage of CNAs and part of the reason is the cost to train and retain staff," Preve said. "On the other hand, having appropriately trained staff is paramount to patient safety."

Others believe the federal 75-hour training standard is not enough to prepare CNAs for the grueling and increasingly more complicated field.

A $5.5 million jury verdict

A 2022 report from the National Academies of Sciences, Engineering, and Medicine concluded that improving nursing home quality requires increasing the federal minimum training requirement to 120 hours — the same conclusion reached by the Institute of Medicine in a 2008 report.

John Dalli, a Mineola-based elder care attorney, recently obtained a $5.5 million jury verdict against a Uniondale nursing home after a 70-year-old patient there died due to sepsis caused by pressure ulcers — also known as bedsores — that he contends was linked to poor CNA care and training.

"Cutting CNA training hours is going to make the bad situation that we have right now — because we have a lot of inexperienced people — much, much worse," Dalli said. "If training hours are reduced, we're going to have CNAs that are more inadequately trained than they are now ... We're going to have a lot more bad outcomes. A lot more falls. A lot more pressure injuries in nursing homes."

Mollot said the Health Department's CNA proposal is difficult to reconcile with the state's broader approach toward mandating intense training for other occupational licensing.

"How can our state leaders support reducing training for certified nurse aides — who care for frail older adults and people with disabilities — to a mere 75 hours," he said, "while requiring 250 hours for people who provide manicures and 1,000 hours of training before someone can be a hairstylist?"

By Robert Brodsky

robert.brodsky@newsday.com@BrodskyRobert

Robert Brodsky is a breaking news reporter who has worked at Newsday since 2011. He is a Queens College and American University alum.