[Code of Federal Regulations]

[Title 42, Volume 3]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR483.152]



[Page 546-548]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 483_REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES--Table 

of Contents

 

 Subpart D_Requirements That Must Be Met by States and State Agencies: 

    Nurse Aide Training and Competency Evaluation, and Paid Feeding 

                               Assistants

 

Sec. 483.152  Requirements for approval of a nurse aide training and 

competency evaluation program.



    (a) For a nurse aide training and competency evaluation program to 

be approved by the State, it must, at a minimum--

    (1) Consist of no less than 75 clock hours of training;

    (2) Include at least the subjects specified in paragraph (b) of this 

section;

    (3) Include at least 16 hours of supervised practical training. 

Supervised practical training means training in a laboratory or other 

setting in which the trainee demonstrates knowledge while performing 

tasks on an individual under the direct supervision of a registered 

nurse or a licensed practical nurse;

    (4) Ensure that--

    (i) Students do not perform any services for which they have not 

trained and been found proficient by the instructor; and

    (ii) Students who are providing services to residents are under the 

general supervision of a licensed nurse or a registered nurse;

    (5) Meet the following requirements for instructors who train nurse 

aides;

    (i) The training of nurse aides must be performed by or under the 

general supervision of a registered nurse who possesses a minimum of 2 

years of nursing experience, at least 1 year of which must be in the 

provision of long term care facility services;

    (ii) Instructors must have completed a course in teaching adults or 

have experience in teaching adults or supervising nurse aides;

    (iii) In a facility-based program, the training of nurse aides may 

be performed under the general supervision of the director of nursing 

for the facility who is prohibited from performing the actual training; 

and

    (iv) Other personnel from the health professions may supplement the 

instructor, including, but not limited to, registered nurses, licensed 

practical/vocational nurses, pharmacists, dietitians, social workers, 

sanitarians, fire safety experts, nursing home administrators, 

gerontologists, psychologists, physical and occupational therapists, 

activities specialists, speech/language/hearing therapists, and resident 

rights



[[Page 547]]



experts. Supplemental personnel must have at least 1 year of experience 

in their fields;

    (6) Contain competency evaluation procedures specified in Sec. 

483.154.

    (b) The curriculum of the nurse aide training program must include--

    (1) At least a total of 16 hours of training in the following areas 

prior to any direct contact with a resident:

    (i) Communication and interpersonal skills;

    (ii) Infection control;

    (iii) Safety/emergency procedures, including the Heimlich maneuver;

    (iv) Promoting residents' independence; and

    (v) Respecting residents' rights.

    (2) Basic nursing skills;

    (i) Taking and recording vital signs;

    (ii) Measuring and recording height and weight;

    (iii) Caring for the residents' environment;

    (iv) Recognizing abnormal changes in body functioning and the 

importance of reporting such changes to a supervisor; and

    (v) Caring for residents when death is imminent.

    (3) Personal care skills, including, but not limited to--

    (i) Bathing;

    (ii) Grooming, including mouth care;

    (iii) Dressing;

    (iv) Toileting;

    (v) Assisting with eating and hydration;

    (vi) Proper feeding techniques;

    (vii) Skin care; and

    (viii) Transfers, positioning, and turning.

    (4) Mental health and social service needs:

    (i) Modifying aide's behavior in response to residents' behavior;

    (ii) Awareness of developmental tasks associated with the aging 

process;

    (iii) How to respond to resident behavior;

    (iv) Allowing the resident to make personal choices, providing and 

reinforcing other behavior consistent with the resident's dignity; and

    (v) Using the resident's family as a source of emotional support.

    (5) Care of cognitively impaired residents:

    (i) Techniques for addressing the unique needs and behaviors of 

individual with dementia (Alzheimer's and others);

    (ii) Communicating with cognitively impaired residents;

    (iii) Understanding the behavior of cognitively impaired residents;

    (iv) Appropriate responses to the behavior of cognitively impaired 

residents; and

    (v) Methods of reducing the effects of cognitive impairments.

    (6) Basic restorative services:

    (i) Training the resident in self care according to the resident's 

abilities;

    (ii) Use of assistive devices in transferring, ambulation, eating, 

and dressing;

    (iii) Maintenance of range of motion;

    (iv) Proper turning and positioning in bed and chair;

    (v) Bowel and bladder training; and

    (vi) Care and use of prosthetic and orthotic devices.

    (7) Residents' Rights.

    (i) Providing privacy and maintenance of confidentiality;

    (ii) Promoting the residents' right to make personal choices to 

accommodate their needs;

    (iii) Giving assistance in resolving grievances and disputes;

    (iv) Providing needed assistance in getting to and participating in 

resident and family groups and other activities;

    (v) Maintaining care and security of residents' personal 

possessions;

    (vi) Promoting the resident's right to be free from abuse, 

mistreatment, and neglect and the need to report any instances of such 

treatment to appropriate facility staff;

    (vii) Avoiding the need for restraints in accordance with current 

professional standards.

    (c) Prohibition of charges. (1) No nurse aide who is employed by, or 

who has received an offer of employment from, a facility on the date on 

which the aide begins a nurse aide training and competency evaluation 

program may be charged for any portion of the program (including any 

fees for textbooks or other required course materials).

    (2) If an individual who is not employed, or does not have an offer 

to be



[[Page 548]]



employed, as a nurse aide becomes employed by, or receives an offer of 

employment from, a facility not later than 12 months after completing a 

nurse aide training and competency evaluation program, the State must 

provide for the reimbursement of costs incurred in completing the 

program on a pro rata basis during the period in which the individual is 

employed as a nurse aide.