State Nurse Aide Training: 
Program Information And Data 
August 2002 
OEI-05-01-00031 
Office of Inspector General 
Office of Evaluation and Inspections 
Region V  S U M M A R Y  
This report contains information about the State nurse aide training programs.  Today more than

1.6 million elderly and disabled persons reside in nursing homes.  The Federal Government and

the States regulate more than 17,000 nursing homes. These nursing homes must comply with

Federal and State standards to receive Medicare and Medicaid reimbursement for the care

they provide to residents enrolled in the Medicare and Medicaid programs. In Fiscal Year

2000, Medicare and Medicaid paid more than  $45 billion to nursing homes. 

Most of the daily care furnished to nursing home residents is rendered by the nearly 696,000

nurse aides employed by nursing homes.  For many nursing home residents, the nurse aide may

be the only person with whom they have regular daily contact.

Before passage of the Omnibus Budget Reconciliation Act of 1987 (OBRA 87), only a handful

of States required training of nurse aides. Passage of OBRA 87 required each State to

establish State-approved nurse aide training programs and to establish minimum requirements

for nurse aide competency.  This report provides information as to what the States have done

to implement the nurse aide training requirements specified in

OBRA 87. 

All of the information in this report was obtained from State program officials. We visited a

total of eight States to obtain information about their nurse aide training programs.  The

remaining 42 States and the District of Columbia were asked to complete a mail survey. 

Overall, 48 States and the District of Columbia provided information about their nurse aide

training programs. Two States did not return our survey. We did not verify the data submitted

by State nurse aide training program representatives.  Additional information about State nurse

aide training programs can be found in our report entitled, Nurse Aide Training (OEI-05-01-

00030).

i  T A B L E  O F  C O N T E N T S  
PAGE 
SUMMARY .................................................................. i

INTRODUCTION ............................................................. 1

FEATURES OF STATE NURSE AIDE TRAINING PROGRAMS  ................... 4

Application for State Approval ............................................... 4

Curricula  ............................................................... 4

Hours of Training ......................................................... 5

Practical/Clinical Exposure  ................................................. 6

Program Re-certification .................................................... 6

Training Sites ............................................................ 7

Instructors  .............................................................. 8

Exams and Certification .................................................... 9

Nurse Aide Registries .....................................................1 0

In-Service Training ....................................................... 11

TABLES: KEY ELEMENTS OF STATE PROGRAMS ........................... 13

DIRECTORY, STATE NURSE AIDE TRAINING PROGRAM CONTACTS .......... 24

ACKNOWLEDGMENTS ..................................................... 30

ii  I N T R O D U C T I O N  
PURPOSE 
To describe the State nurse aide training programs. 
BACKGROUND 
Today more than 1.6 million elderly and disabled persons reside in nursing homes.  The vast 
majority of these nursing homes comply with Federal and State standards to receive 
reimbursement for the care they provide to residents enrolled in the Medicare, Medicaid, and 
other government programs. The Federal Government and the States regulate more than 
17,000 nursing homes, and in Fiscal Year 2000, Medicare and Medicaid paid more than $45 
billion to nursing homes. 
Most of the daily care furnished to nursing home residents is rendered by the nearly 696,000 
nurse aides employed by nursing homes. Nurse aides assist nursing home residents in bathing, 
dressing, eating, toileting, and other tasks.  Nurse aides also provide residents with 
psychological, social, and spiritual support. The actual scope of work a nurse aide performs 
varies from State to State and from nursing home to nursing home. For many nursing home 
residents, the nurse aide may be the only person with whom they have regular daily contact. 
Before passage of the Omnibus Budget Reconciliation Act of 1987 (OBRA 87), only a handful 
of States required training of nurse aides. Passage of OBRA 87 established the Nurse Aide 
Training and Competency Evaluation Program (NATCEP).  This Federal law required each 
State to establish State-approved nurse aide training programs and established minimum 
requirements for nurse aide competency. Enactment of OBRA 87 required that all nurse aides 
employed in nursing homes take a State-approved nurse aide training course.  Upon 
completion of training, all nurse aide trainees must pass a State exam within 120 days to 
become certified to work in a nursing home. 
Federal Training Requirements 
Federal regulations require that nurse aides have no less than 75 hours of training prior to 
receiving their certification.  At least 16 hours of a training program must be supervised 
practical (clinical) training. Training must be performed by, or under the general 
1
 supervision of, a registered nurse who has a minimum of 2 years of nursing experience.  At least 
1 year of the 2 years must be long-term care nursing experience. By law, training must include: 
<  Basic nursing skills,

<  Personal care skills,

<  Mental health and social service skills,

<  Caring for cognitively-impaired residents,

<  Basic restorative skills, and

<  Residents rights.

Upon completion of the training, a nurse aide trainee must pass a State exam to become 
certified to work in a nursing home.  The State exam includes a written or oral component and 
a skills-demonstration component. Candidates for nurse aide certification must pass both 
components before a State can enter their name in the State registry of nurse aides who have 
successfully completed their training requirements.  States also use their nurse aide registry to 
help nursing homes and other employers ensure that potential employees meet Federal and 
State requirements for employment, and that no adverse actions exist that would prohibit the 
hiring of a certain individual. 
SCOPE AND METHODOLOGY 
This inspection provides information about the State Nurse Aide Training and Competency 
Evaluation Programs (NATCEPs). 
We visited the States of Florida, Louisiana, Minnesota, New York, and Washington to gather 
in-depth information about their nurse aide training programs.  We selected these States based 
on their geographic location, nursing home population, and State budgets for nursing home 
care.  Missouri, Ohio, and Wisconsin were also visited during the early stages of this study. 
During our visits to all of these States, we met with NATCEP program officials to discuss their 
nurse aide training programs. Our visits were conducted during May, June and July of 2001. 
In the remaining 42 States and the District of Columbia, we mailed a survey to the person 
responsible for the oversight of the States nurse aide training programs.  We asked them to 
provide specific information about their State nurse aide training programs. The survey 
contained both open and closed-ended questions dealing primarily with how each State had 
implemented Federal requirements for nurse aide training. 
2
 Overall, 48 States and the District of Columbia provided information about their nurse aide 
training programs. Two State NATCEP directors did not respond to our survey. All 
information in this report is based on the State responses. All information was self-reported 
and was not independently verified. 
Our review was conducted in accordance with the Quality Standards for Inspections issued 
by the Presidents Council on Integrity and Efficiency. 
3
 F E A T U R E S  O F  S T A T E  N U R S E  A I D E  
T R A I N I N G  P R O G R A M S  
Each State is responsible for ensuring that the nurse aide training programs offered in their State 
meet minimum Federal requirements. Federal law also prescribes specific areas that must be 
included in all State-approved nurse aide training programs. We asked States to report on 
their nurse aide training programs. All information was self-reported and was not independently 
verified. 
Application for State Approval 
Nursing homes and other entities that wish to sponsor a nurse aide training program must obtain 
State approval. Nearly all of the States provide prospective sponsors of nurse aide training 
programs with an application and materials to guide them in developing a curriculum that will 
meet State approval. Ten States indicated that they charge nursing homes a fee for this service. 
All States report that they review each sponsors application and examine course materials to 
ensure that the sponsors nurse aide training program meets Federal and any existing State 
requirements. All State respondents report that their application process is designed to ensure 
that the training programs will be under the supervision of instructors who meet Federal 
requirements. The application and review process also helps the State determine whether the 
training program seeking State approval contains all of the skill requirements mandated by 
Federal and State law. 
Applications for State approval of a nurse aide training program are reviewed by the State 
nurse aide training and competency program director.  In some States, this responsibility is 
shared or delegated to other staff. In some cases, another State agency or a subcontractor may 
be contracted to review and approve nurse aide training programs. In many States, the 
NATCEP director may have other duties and responsibilities besides the oversight of the nurse 
aide training programs.  Moreover, the number of staff persons assigned to assist them may be 
limited. 
Curricula 
The OBRA 87 requires that each State ensure that the nurse aide training programs they 
approve meet Federal requirements pertaining to basic nursing skills, personal care skills, 
restorative skills, mental health, and social service skills. Besides these basic patient care 
4
 skills, State-approved training programs must also ensure that nurse aides know how to care 
for cognitively-impaired residents and are knowledgeable about residents rights. 
Responses to our survey reveal that about half the States have elected to establish a single 
statewide curriculum for nurse aide training.  All of the nurse aide training programs approved 
by these States are required to include the State core curriculum. Seven States encourage 
sponsors of nurse aide training to use a State-approved core curriculum, but they do not 
mandate its use.  The remaining States leave the development of nurse aide training curricula 
totally to the discretion of the sponsor.  These States do not encourage the use of a core 
program nor do they endorse the use of any nurse aide training programs.  Sponsors are free to 
develop their own nurse aide training programs, and the States appear to approve all programs 
that meet Federal and State criteria. 
Determining how many uniquely different nurse aide training curricula exist is difficult.  Many 
sponsors of training programs purchase their course curriculum and training materials from 
vendors, others develop their own curriculum and course materials, and others adapt material 
from different programs. 
Nurse aide training programs not approved by the States also exist. In two States we visited, 
we were told that nurse aide training programs not approved by the State were being offered to 
persons interested in becoming a nurse aide. These non-approved programs are both facility-
based (e.g., nursing home) and non-facility based.  Seventeen States require that all persons 
taking the State nurse aide exam complete a State-approved nurse aide training program. The 
remaining States permit certain individuals, who have not graduated from a State-approved 
nurse aide training program, to take the State exam. The most common exception is made for 
nursing students and nurses. 
Hours of Training 
Number of Training Hours 
Federal law requires that State-approved nurse
 States reporting...  Number  % 
aide training programs consist of at least 75

Minimum of 75 hours  23  47 
hours of classroom and clinical instruction. Half

of the States report that their nurse aide training
 > 75 to 100  13  26.5 
programs exceed the Federal requirement of 75

Greater than 100  13  26.5 
hours. One out of every three States report

that they require 100 or more hours of nurse

aide instruction. State nurse aide training programs range from 75 hours, the minimum required

by Federal law, up to 175 hours.  Twenty-three States only require that the training programs

they approve meet the Federal minimum requirement of 75 hours. At the discretion of the

training sponsor, the actual amount of time a student spends in training can exceed the required

minimum length.

5
 Practical/Clinical Exposure 
All of the States that responded to our survey report that they require clinical exposure during

nurse aide training. More than half report that they require more than the minimum 16 hours of

supervised practical training required by OBRA 87.  One-third of the States reported that they

require more than 37 hours of supervised practical training. The actual number of clinical hours

required by the States ranges from 16 hours, the Federal minimum, up to 100 hours.  Four of

the 49 States that responded to our survey reported that they do not specify precisely how

many hours of a nurse aides training must be in supervised clinical practice. Other than

prescribing the minimum number of hours of clinical experience, States have few, if any,

requirements pertaining to practical training. 

Federal law defines supervised practical training as  Clinical Hours

experience gained . . . in a laboratory or other

setting in which the trainee demonstrates knowledge
 States reporting...  Number  % 
while performing tasks on an individual under the
 Minimum of 16 hours  16  32.7 
direct supervision of a registered nurse or a licensed

> 16 less than 37  6  12.2 
practical nurse. Many nurse aide training

programs provide practical or clinical exposure by
 37 or more  23  46.9 
arranging for their students to practice the skills they

Not specified  4  8.2 
have learned in the classroom on nursing home

At least one-half of  15  33.3 
residents.  Other training programs use a laboratory

training devoted to 
setting designed to simulate the nursing home

practical 
environment. 

Federal regulations prohibit nurse aide trainees from

actual clinical experience until they have had at least 16 hours of classroom training.  Other than

this Federal requirement, States do not prescribe at what point in the training students should be

exposed to the actual job requirements. States also do not specify how clinical training should

be conducted or when students should be exposed to actual clinical practice. 

Program Re-certification 
Federal law (OBRA 87) requires sponsors of State-approved nurse aide training programs to 
notify the State when they make substantive changes to their training program.  The law also 
requires that the States must review programs that report changes to ensure that the training 
program remains in compliance with Federal requirements. 
6
 All of the States in our survey reported that they  Program reviews 
periodically review and re-certify all of their 
approved nurse aide training programs.  Most  States reporting  Number  % 
program reviews are 
States require that training sponsors provide 
conducted ... 
updated information about their nurse aide 
training programs at least every other year. One  yearly  10  16.3 
State reported that they review each new 
every 2 years  36  75.5 
program within a year of approval.  Ten States 
at other intervals  3  16.3 
require annual updates. A few States said that 
they re-certify nurse aide training programs every  when  7  8.2 
3 to 4 years or as time permits.  problems/complaints 
arise 
The program re-certification process requires 
that State-approved training programs provide 
updated information about their nurse aide training program. States review the updated 
information to ensure that sponsors have not made changes that would put the training program 
out of compliance with Federal or State requirements.  Part of the review process is designed 
to help States ensure that an approved program continues to: 
<  have an approved supervisor that meets Federal and State requirements, and 
<  provide a curriculum that meets Federal and State training requirements. 
Several States said that they would deviate from their established program review and  re-
certification schedule if they receive complaints about a program, or if students from a particular 
program have unusually high failure rates on State exams. In addition, all States report that they 
periodically conduct onsite visits to nurse aide training sites. State health department employees 
conduct the vast majority of these onsite visits.  In four States, these onsite visits are conducted 
by the State Department of Education. Two States have contracted with a private firm to visit 
the programs in their State. 
Training Sites 
Based on State-reported information, we estimate that there are more than 12,500 State-
approved nurse aide training programs in the United States.  Approximately 60 percent of the 
State-approved training programs are facility-based and sponsored primarily by nursing homes. 
Most students who enroll in a facility-based program attend classes in a nursing home. Overall, 
the States have approved more than 7,500 facility-based nurse aide training programs. 
The remaining 5,000 nurse aide training programs are non facility-based.  These 
7
 programs are not sponsored by a nursing home and classes are usually not held in a nursing 
home. Non facility-based training programs are sponsored by not-for-profit and for-profit 
entities and can be found in local high schools, community colleges, and private schools. Some 
nurse aide training programs are affiliated with welfare-to-work programs. Some are 
supported by labor unions and others are sponsored by non-profit organizations such as the 
American Red Cross and the Department of Veterans Affairs. 
Alaska and Louisiana report that they have more non facility-based programs than facility-
based training programs.  Idaho and the District of Columbia report that they have no State-
approved facility-based programs. All of the nurse aide training programs in Idaho are 
sponsored by vocational/technical schools. The programs in the District of Columbia are 
conducted by privately owned companies and a local college. 
Laws and regulations in three States make it difficult, if not impossible, for nursing homes to 
sponsor a nurse aide training program.  These three States rely primarily on private schools or 
community-based schools and colleges to train nurse aides. 
Instructors 
Federal law requires that, [t]he training of nurse aides be performed by or under the general 
supervision of a registered nurse. This registered nurse must have a minimum of 2 years nursing 
experience, at least 1 year of which must be in the provision of long-term care facility services. 
Instructors must have completed a course in teaching adults or  have experience in teaching 
adults or supervising nurse aides.1 
Federal law permits other health personnel (e.g., pharmacists, therapists) with at least one year 
of experience in their field to supplement the instructor.  From our in-person interviews, we 
learned that nurse aide students may often have more than one instructor. We spoke with 
licensed practical nurses and other nursing home personnel (e.g., dieticians) involved in nurse 
aide training. We were told that equipment manufacturers, pharmacists, and other health 
specialists also routinely participate in nurse aide training. During one of our visits we had the 
opportunity to observe a class taught by a physical therapist. 
Eighteen States report that they do not require that nurse aide instructors in their State complete 
a course in teaching adults. These States waive this requirement when the instructor can 
establish that they have current adult teaching experience or current valid State-issued teaching 
credentials in adult education.  The remaining 29 States require that nurse aide instructors take 
an adult education course.  One State requires that all nurse 
1 
42 CFR 483.152(a)(5)(i) and 483.152(a)(5)(ii). 
8  aide training instructors take (and show proof of successful completion) a train-the-trainer or 
adult education course every 2 years. 
Most States review the primary or supervising instructors credentials when an application is 
made for initial State approval of a nurse aide training program.  States report that these 
credentials are reviewed each time the State renews a nurse aide training program to ensure 
they have not changed from the previous period. While it is clear that the primary or 
supervising instructors credentials are verified to ensure that they meet Federal requirements 
for nurse aide instructors, we did not determine whether States require supplemental personnel 
to have adult education experience. 
Five States report that they go beyond a paper review to ensure compliance and make some 
effort to evaluate instructor effectiveness or assess the quality of their State-approved nurse 
aide training programs. One State reported that they use student evaluations of the instructor 
when deciding whether they will renew a sponsors program.  Three States report that they 
conduct random visits to observe how classes are conducted. One State reported that they 
look at how well students perform on the State written and competency exams when deciding 
whether an instructor should be permitted to continue teaching a nurse aide training class. 
Exams and Certification 
In addition to successfully completing a State-approved nurse aide training course, nurse aides 
must successfully pass a States written and competency examinations.  Only when a nurse aide 
has completed training and passed the competency exam are they considered certified nurse 
assistants. Federal law permits, and States use, both written and oral nurse aide exams. 
All of our State respondents indicated that they offer the State nurse aide exam at multiple 
locations throughout their State.  Students have the option of taking the exam at the site nearest 
to them or traveling to another county or location if they do not want to wait until the examiner 
visits the site nearest to them.  Thirty-two States hire private subcontractors to administer their 
State nurse aide exams. Seventeen States use their own staff or work with other State entities 
to administer the State exams. In most States, the class instructor is prohibited from 
participating in the State examination of their students. 
Exams are usually scheduled whenever there are a sufficient number of students in an area to be 
tested.  Passing scores and the content of the State written and skill competency exams varies 
from State to State.  Passing exam scores on the written exams range from 70 percent to 80 
percent. Acceptable scores on the clinical skills portion of State exams range from 70 percent 
to 100 percent. Several States only report whether a student has passed or failed their State 
nurse aide written or clinical exam. 
9
 Most States charge students a fee to take their State nurse aide exams.  Eighteen States charge 
a single fee for both the written and clinical exam, and 26 States charge a separate fee for each 
section of the exam. State nurse aide exam fees range from a low of $10 to a high of $200. 
Most States require students who fail either the written or clinical portion of their State exam to 
pay additional fees each time they retake the exam. 
Nursing homes are required to pay the State exam fees for students who complete their facility-
based training programs. Students who complete non facility-based programs and take a job 
as a nurse assistant may have part, or all, of their training expenses and exam fees reimbursed 
by the State. The OBRA 87 requires the States to . . . provide for the reimbursement of costs 
incurred in completing the [nurse aide] program on a pro rata basis during the period in which 
the individual is employed as a nurse aide. 
Nurse Aide Registries 
Federal law requires that each State establish and maintain a registry of nurse aides who have 
successfully passed the States competency exams. At a minimum, the State nurse aide registry 
must contain information about each individual who has successfully completed a nurse aide 
training and competency program, or is found by the State to be competent. The registry must 
contain: 
<  the name of the individual;

<  identifying information;

<  date the individual became eligible for placement in the registry; and, 

<  information on any finding by the State of abuse, neglect or theft.

Entries for individuals who have performed no nursing or nursing-related services for 24 
consecutive months are to be removed from the registry.  However, information about 
individuals with documented findings of abuse, neglect, or theft cannot be removed from the 
registry. 
Most States report that they periodically verify that the nurse aides listed in their registry are still 
active in nursing.  Most verify nursing activity by requiring nurse aides to attest or provide 
information (e.g., W-2 form, letter from employer, pay stub) showing that they have worked at 
least 8 hours in nursing care during the past 24 months. Several States require that nursing 
homes and other nurse aide employers periodically report information about nurse aide 
employment to the State.  Some States rely on nursing homes to verify that the nurse aide they 
hire has been active in providing nursing care. 
10
 In practice, most States do not remove names from their registry. They simply place individuals 
in an inactive file if they do not receive information showing that a nurse aide has been active in 
nursing or nursing-related services in the prior 24 months.  As a result, information provided by 
the States reveals that nurse aide registries contain information on more than 2.8 million 
individuals.  We did not receive information from four States on the number of nurse aides in 
their registry.  Twenty-one States that provided information about the number of nurse aides in 
their registry did not provide information on the number of active nurse aides in their State. 
Based on information provided by the remaining 30 States, we estimate that approximately 1.4 
million of the nurse aides listed in State registries are active in nursing or nursing related 
services. The General Accounting Offices report entitled, Nursing Workforce, Recruitment 
and Retention of Nurses and Nurse Aides Is a Growing Concern (GAO-01-750T) 
indicates that, in 1999, more than half (695,570) of the active nurse aides worked in a nursing 
home. The remaining nurse aides worked in home health care and in hospitals. Data on the 
number of nurse aides providing services in other settings (e.g., personal care givers) is not 
known. 
In-Service Training 
Requirements for initial nurse aide training are found in Subpart D of 42 CFR 483.150 
through 483.158 dealing with nurse aide training and competency evaluation programs. 
Federal requirements for on-going nurse aide training, commonly referred to as in-service, are 
found in Subpart B of 42 CFR 483.75 --Requirements for Long Term Care Facilities. 
Federal law requires that each nurse aide have no less than 12 hours of in-service training per 
year.2 
The Federal regulations pertaining to in-service require that all nursing homes complete a 
performance review of every nurse aide at least once every 12 months.  Nursing homes must 
also provide regular in-service training designed to address problems documented in nurse aide 
performance reviews.  In-service training should address specific nurse aide skill deficiencies or 
issues related to specific resident care needs. 
While Federal regulations require 12 hours of in-service training annually, 4 States require more 
than 12 hours of in-service training. Sixteen State NATCEP respondents reported that their 
State required that specific topics be covered during in-service training.  Topics mentioned as 
being required include fire prevention and response, emergency procedures and preparedness, 
residents rights, infection control and prevention, proper use of restraints, confidentiality of 
resident information and care of the cognitively-impaired.  Training on these topics is required 
as a Medicare/Medicaid Condition of Participation for nursing homes. 
2 
42 CFR 483.75(e) 
11
 The remaining 32 States did not report having specific topics for in-service training.3 Seven 
State respondents specifically mentioned that in-service topics should be based on nurse aide 
weaknesses identified by the nursing home.  One of these States reported that in-service 
training, . . . should be based on the needs of the nurse aide, but most nursing homes do it 
based on the needs of their resident population. 
3 
One State did not respond to our in-service questions. Two States did not return our survey. 
12  STATE NURSE AIDE TRAINING PROGRAMS

Table Comparisons of Key Elements of State Training Programs 
13
 STATE  RESPONSIBLE MINIMUM MINIMUM MORE THAN  1 FACILITY TRAINING FACILITY NON CURRICULA 
 DEPARTMENT TRAINING CLINICAL APPROVED BASED PROGRA BASED FACILIT CONTENT
HOURS HOURS CURRICULUM APPLICATION M REVIEW SITES Y  SITES
REQUIRED FEE
AK COMMERCE & 140 80 YES *  YES 2 YEAR 20 28 A,B,C,D,E,F
ECONOMIC
DEV 
AL DOH 75 16 YES * NO 2 YEAR 142 98 A,B,C,D,E,F
AR DOH 75 16 NO NO 2 YEAR 56 78 A,B,C,D,E,F
AZ BD OF 120 16 YES / ~160 NO  2 YEAR 70 90 A,B,C,D,E,F
NURSING 
CA DOH 150 100 YES ** YES 2 YEAR 300 486 A,B,D,F
CO BD OF 75 16 YES * NO 2 YEAR 102 59 A,B,C,D,E,F
NURSING
CT DOH 100 50 YES ** NO 2 YEAR 92 74 A,B,C,D,E,F
DC CONTRACT  120 not specified NO NO YEARLY 0 5 A,B,C,D,E,F
University of DC
DE DOH 75 37.5 NO NO 2 YEAR 17 11 A,B,C,D,E,F
FL DOEduc 120 40 YES** YES YEARLY see  note 1 586 A,B,C,D,E,F
KEY
*  Can be individualized within OBRA requirements
** Has a core set of requirements that must be included in each curriculum. 
*** State has an approved model used by most programs
CURRICULA CONTENT
A = Basic nursing skills
B = Personal care skills
C = Mental health and social service skills
D = Caring for cognitively impaired residents
14 STATE  TRAIN THE  INSTRUCTOR  STUDENTS  EXAM  COMPENSATION  IN- AIDES ON  NUMBER OF 
TRAINER  RECRUITMEN  TAKING  FEES  FOR NON- SERVICE  STATE  ACTIVE 
REQUIRED  T PROBLEMS  EXAM 01/01/01- FACILITY BASED  MINIMUM  REGISTRY  NURSE 
03/31/01/ NUMBER  TRAINING  HOURS  AIDES 
WHO PASSED 
AK  YES  NO  90 / 69  40  NO  24  7381  2469 
AL  YES  NO  1872 / 1425  80  YES  12  68329  DK 
AR  YES  DK  DK / DK  70  UNCERTAIN  12  19414  19000 
AZ  NO  YES  902 / DK  90  DK  12  25000  25000 
CA  NO  YES  DK / DK  85  YES  24  105194  DK 
CO  YES  NO  DK / 530  105  YES  12  19796  DK 
CT  NO  NO  1000 / 909  92  NO  12  61732  31486 
DC  NO  NO  DK / DK  63  DK  12  DK  DK 
DE  YES  YES  171 / 116  85  NO  12  11053  5872 
FL  NO  YES  NR  NR  YES  18  270000  DK 
KEY 
DK indicates that the respondent did not know. 
15
 STATE  RESPONSIBLE  MINIMUM  MINIMUM  MORE THAN 1  FACILITY  TRAININ  FACILIT  NON  CURRICULA 
DEPARTMENT  TRAINING  CLINICAL  APPROVED  BASED  G  Y BASED  FACILIT  CONTENT 
HOURS  HOURS  CURRICULUM  APPLICATION  PROGRA  SITES  Y SITES 
REQUIRED  FEE  M 
REVIEW 
GA  GA Medical  85  16  NO  NO  YEARLY  93  251  A,B,C,D,E,F 
Foundation 
HI 
IA  INSPECTIONS &  75  30  YES / 4  YES  AS TIME  36  30  A,B,C,D,E,F 
APPEALS  PERMITS 
ID  BD OF  120  40  NO  NO  YEARLY  0  45  A,B,C,D,F 
NURSING 
IL  DOH  120  40  NO  NO  2 YEAR  78  161  A,B,C,D,E,F 
IN  DOH  105  75  NO  NO  YEARLY  216  67  A,B,C,D,E,F 
KS  DOH  90  45  NO  NO  2 YEAR  129  43  A,B,C,D,E,F 
KY  DOH  75  16  NO  NO  2 YEAR  152  105  A,B,C,D,E,F 
LA  DOH  80  40  YES *  NO  YEARLY  86  118  A,B,C,D,E,F 
MA 
KEY 
*  Can be individualized within OBRA requirements 
**  Has a core set of requirements that must be included in each curriculum 
***  State has an approved model used by most programs 
CURRICULA CONTENT 
A = Basic nursing skills 
B = Personal care skills 
C = Mental health and social service skills

D = Caring for cognitively-impaired residents

E = Basic restorative skills

F = Residents rights

16
 STATE  TRAIN THE  INSTRUCTOR  STUDENTS  EXAM  COMPENSATION  IN- AIDES ON  NUMBER OF 
TRAINER  RECRUITMEN  TAKING  FEES  FOR NON- SERVICE  STATE  ACTIVE 
REQUIRED  T PROBLEMS  EXAM 01/01/01- FACILITY BASED  MINIMUM  REGISTRY  NURSE 
03/31/01/ NUMBER  TRAINING  HOURS  AIDES 
WHO PASSED 
GA  YES  NO  DK / DK  DK  YES  12  DK  DK 
HI 
IA  NO  NO  552 / 476  60  YES  12  30605  DK 
ID  YES  NO  DK / DK  37  YES  12  29868  11263 
IL  YES  NO  DK / DK  50  YES  12  DK  DK 
IN  YES  NO  5000 / DK  60  YES  12  104297  DK 
KS  NO  YES  945 / 891  10  NO  12  29850  29850 
KY  YES  NO  DK/ DK  75  YES  12  73157  28281 
LA  YES  NO  DK / 1300  110  NO  12  113827  36500 
MA 
KEY 
DK indicates that the respondent did not know. 
NR indicates that the respondent did not respond to the question. 
17
 STATE  RESPONSIBLE  MINIMUM  MINIMUM  MORE THAN 1  FACILITY  TRAINING  FACILIT  NON  CURRICULA 
DEPARTMENT  TRAINING  CLINICAL  APPROVED  BASED  PROGRA  Y BASED  FACILIT  CONTENT 
HOURS  HOURS  CURRICULUM  APPLICATIO  M REVIEW  SITES  Y SITES 
REQUIRED  N FEE 
MD  BD OF  100  40  YES / 4  NO  2 YEAR  894  107  A,B,C,D,E,F 
NURSING 
ME  DOEduc  150  50  NO  NO  2 YEAR  91  33  A,B,C,D,E,F 
MI  DOH  75  16  YES **  NO  2 YEAR  165  135  A,B,C,D,E,F 
MN  DOH  75  37.5  YES / 2  NO  2 YEAR  100  46  A,B,C,D,E,F 
MO  AGING  175  100  NO  NO  2 YEAR  397  95  A,B,C,D,E,F 
MS  DOH  75  16  NO  NO  2 YEAR  64  89  A,B,C,D,E,F 
MT  DOH  75  25-30  NO  NO  2 YEAR  59  16  A,B,C,D,E,F 
NC  DOH  75  16  YES ***  NO  PRIORITY  103  547  A,B,C,D,E,F 
BASIS 
ND  DOH  75  16  NO  NO  2 YEAR  44  14  A,B,C,D,E,F 
NE  DOH  76  not specified  YES ***  NO  2 YEAR  79  18  A,B,C,D,E,F 
KEY 
*  Can be individualized within OBRA requirements 
**  Has a core set of requirements that must be included in each curriculum 
***  State has an approved model used by most programs 
CURRICULA CONTENT 
A = Basic nursing skills 
B = Personal care skills 
C = Mental health and social service skills

D = Caring for cognitively-impaired residents

E = Basic restorative skills

F = Residents rights

18
 STATE  TRAINING  INSTRUCTOR  STUDENTS  EXAM  COMPENSATION  IN- AIDES ON  NUMBER OF 
PROGRAM  RECRUITMEN  TAKING  FEES  FOR NON- SERVICE  STATE  ACTIVE 
REVIEW  T PROBLEMS  EXAM / NUMBER  FACILITY BASED  MINIMUM  REGISTRY  NURSE 
WHO PASSED  TRAINING  HOURS  AIDES 
1ST QUARTER 01 
MD  YES  YES  NR / 419  86  DK  12  15164  15164 
ME  YES  NO  300 / DK  20  YES  12  35789  12674 
MI  YES  YES  2314 / 1805  176.50  YES  12  36552  DK 
MN  YES  YES  2176 / 1693  110-150  YES  12  117605  45253 
MO  YES  NO  1470 / 1393  25-200  YES  12  99035  58211 
MS  YES  NO  DK / DK  88  NO  12  13204  DK 
MT  NO  NO  483 / 458  96  YES  12  8801  8801 
NC  NO  YES  DK / 3466  VARIES  YES  12  213445  87906 
ND  NO  NO  DK / 342  110  YES  12  22366  9518 
NE  NO  NO  DK /DK  DK  YES  12  50149  DK 
KEY 
DK indicates that the respondent did not know. 
NR indicates that the respondent did not respond to the question. 
19
 STATE  RESPONSIBLE  MINIMUM  MINIMUM  MORE THAN 1  FACILITY  TRAINING  FACILIT  NON  CURRICULA 
DEPARTMENT  TRAINING  CLINICAL  APPROVED  BASED  PROGRA  Y BASED  FACILIT  CONTENT 
HOURS  HOURS  CURRICULUM  APPLICATIO  M REVIEW  SITES  Y SITES 
REQUIRED  N FEE 
NH  BD OF  100  60  YES / 53  NO  YEARLY  39  14  A,B,C,D,E,F 
NURSING 
NJ  DOH  90  40  NO  YES  2 YEAR  383  30  A,B,C,D,E,F 
NM  DOH  75  no answer  NO  NO  2 YEAR  83  32  A,B,C,D,E,F 
NV  BD OF  75  not specified  NO  YES  2 YEAR  14  7  A,B,C,D,E,F 
NURSING 
NY  DOH  100  30  NO  NO  2 YEAR  280  300  A,B,C,D,E,F 
OH  DOH  75  16  NO  YES  YEARLY  305  220  A,B,C,D,E,F 
OK  CONTRACTED  75  16  YES / 10  YES  2 YEAR  346  70  A,B,C,D,E,F 
OR  BD OF  150  75  NO  YES  2 YEAR  40  36  A,B,C,D,E,F 
NURSING 
PA  DOEduc  75  37.5  YES *  NO  2 YEAR  512  356  A,B,C,D,E,F 
RI  DOH  100  20  YES **  YES  2 YEAR  68  13  A,B,C,D,E,F 
KEY 
*  Can be individualized within OBRA requirements 
**  Has a core set of requirements that must be included in each curriculum 
***  State has an approved model used by most programs 
CURRICULA CONTENT 
A = Basic nursing skills 
B = Personal care skills 
C = Mental health and social service skills

D = Caring for cognitively-impaired residents

E = Basic restorative skills

F = Residents rights

20
 STATE  TRAIN THE  INSTRUCTOR  STUDENTS  EXAM  COMPENSATION  IN- AIDES ON  NUMBER OF 
TRAINER  RECRUITMEN  TAKING  FEES  FOR NON- SERVICE  STATE  ACTIVE 
REQUIRED  T PROBLEMS  EXAM 01/01/01- FACILITY BASED  MINIMUM  REGISTRY  NURSE 
03/31/01/ NUMBER  TRAINING  HOURS  AIDES 
WHO PASSED 
NH  YES  NO  200 / 190  75-125  YES  12  10000+/- 10000 
NJ  YES  NO  1100 / 575  80  YES  24/2 YEARS  30000+/ DK 
NM  YES  NO  683 / NR  100  NO  12  20222  20222 
NV  YES  YES  DK / DK  90  YES  24/2 YEARS  14413  4632 
NY  YES  NO  DK / DK  115  YES  12  249369  99726 
OH  YES  NO  DK / DK  102  YES  12  164691  71443 
OK  NO  NO  DK / 2100  DK  YES  24  45000  DK 
OR  YES  YES  977 / 634  96  YES  12  54676  15492 
PA  YES  NO  2870 / 2190  93  YES  12  152351  99848 
RI  NO  NO  323 / 279  45  YES  12  28400  14000+/
KEY 
DK indicates that the respondent did not know. 
NR indicates that the respondent did not respond to the question. 
21
 STATE  RESPONSIBLE  MINIMUM  MINIMUM  MORE THAN 1  FACILITY  TRAINING  FACILIT  NON  CURRICULA 
DEPARTMENT  TRAINING  CLINICAL  APPROVED  BASED  PROGRA  Y BASED  FACILIT  CONTENT 
HOURS  HOURS  CURRICULUM  APPLICATIO  M REVIEW  SITES  Y SITES 
REQUIRED  N FEE 
SC  DOH  80  40  NO  NO  2 YEAR  18  55  A,B,C,D,E,F 
SD  DOH  75  16  YES / 2  NO  2 YEAR  100  3  A,B,C,D,E,F 
TN  DOH  75  35  YES ***  NO  2 YEAR  184  85  A,B,C,D,E,F 
TX  DOH  75  24  NO  NO  2 YEAR  540  323  A,B,C,D,E,F 
UT  STATE AGENCY  80  16  NO  YES  2 YEAR  37  43  A,B,C,D,E,F 
VA  BD OF  120  40  YES / 242  NO  YEARLY  91  151  A,B,C,D,E,F 
NURSING 
VT  BD OF  75  16  YES **  NO  2 YEAR  32  13  A,B,C,D,E,F 
NURSING 
WA  DOH  85  50  NO  NO  3-4 YEARS  110  110  A,B,C,D,E,F 
WI  DOH  75  16  YES / 60  NO  2 YEAR  84  54  A,B,C,D,E,F 
WV  DOH  120  55  NO  NO  2 YEAR  74  67  A,B,C,D,E,F 
WY  BD OF  75  48  YES / 4  NO  2 YEAR  41  14  A,B,C,D,E,F 
NURSING 
KEY 
*  Can be individualized within OBRA requirements 
**  Has a core set of requirements that must be included in each curriculum 
***  State has an approved model used by most programs 
CURRICULA CONTENT 
A = Basic nursing skills

B = Personal care skills

C = Mental health and social service skills

D = Caring for cognitively-impaired residents

E = Basic restorative skills

F = Residents rights

22
 STATE  TRAIN THE  INSTRUCTOR  STUDENTS  EXAM  COMPENSATION  IN- AIDES ON  NUMBER OF 
TRAINER  RECRUITMEN  TAKING  FEES  FOR NON- SERVICE  STATE  ACTIVE 
REQUIRED  T PROBLEMS  EXAM 01/01/01- FACILITY BASED  MINIMUM  REGISTRY  NURSE 
03/31/01/ NUMBER  TRAINING  HOURS  AIDES 
WHO PASSED 
SC  NO  YES  966 / 604  86  NO  12  18334  DK 
SD  NO  NO  DK / 145  145  YES  12  19929  DK 
TN  NO  NO  1933 / 1305  75  YES  12  30269  DK 
TX  YES  YES  5427 / 4056  69.75  YES  12  91873  DK 
UT  YES  NO  2156 / 1590  60  YES  12  37000  1200 
VA  NO  NO  NR / NR  80  NO  12  32742  DK 
VT  NO  NO  142 / 142  105  DK  12  11649  3996 
WA  YES  YES  NR / 1100  85  YES  12  77348  36323 
WI  YES  YES  3046 / 3046  60-180  YES  12  145161  44383 
WV  YES  NO  410 / 281  100  YES  12  24272  13807 
WY  YES  YES  269/209  35  YES  12  4191  DK 
KEY 
DK indicates that the respondent did not know. 
NR indicates that the respondent did not respond to the question. 
23
 DIRECTORY

STATE NURSE AIDE TRAINING PROGRAM CONTACTS

24
 AK  AL 
Sandra Woods
 James K. Reid

Program Manager, Nurse Aide Registry
 Director, Nurse Aide Program

AK Department of Community and Economic
 AL Department of Public Health

Development
 Division of Health Care Facilities

Division of Occupational Licensing
 201 Monroe Street- RSA Tower 

3601 C Street, Suite 722
 Montgomery, AL 36130

Anchorage, AK 99503
 334-206-5169

907-269-8169

AR  AZ 
Thomas Wingard
 Nathalie Rennell

Program Administrator
 CNA Program Manager

AR Department of Human Services
 AZ State Board of Nursing

Office of Long-Term Care
 1651 E. Morten Avenue, Suite 210

Division of Medical Services
 Phoenix, AZ 85020

P.O. Box 8059
 602-331-8111

Little Rock, AR 72203

501-682-6117

CA  CO 
Lynn Heisler 
 Jan Zubieni

Health Facilities Specialist
 Education Consultant

CA Department of Health Services
 CO Board of Nursing

Professional Certification Branch
 1560 Broadway, Suite 880

1800 Third Street, #210 
 Denver, CO 80202

P.O. Box 942732 
 303-894-2819

Sacramento, CA 94234

916-324-8820

CT  DC 
Wendy Furniss
 Carol Daniels

Supervising Nurse Consultant
 Director, Health Certification & Licensure

CT Department of Public Health
 Programs

Bureau of Regulatory Services
 University of District of Columbia 

Division of Health Systems Regulation
 Division of Continuing Education

410 Capital Avenue
 4340 Connecticut Avenue NW, #B113

P. O. Box 340308
 Washington, DC 20008

Hartford, CT 06134
 202-274-6950

860-509-7400

DE  FL 
Elise P. MacEwen
 Judy B. Conlin

Nurse Aide Registry Coordinator
 State Supervisor, Health Science Education

DE Department of Health and Social Services
 Programs

Division of Long-Term Care Residents
 FL Department of Education

Protection
 Division of Workforce Development

3 Mill Road, Suite 308
 325 West Gaines Street, Room 701

Wilmington, DE 19806
 Tallahassee, FL 32399

302-577-6666
 850-487-4439

25
 GA  HI 
Kathryn Shoemaker
 Lynette Honbo

RN-Education Specialist
 Medical Standards Branch

GA Medical Care Foundation
 601 Kamokila Boulevard

57 Executive Park, South Suite 200
 Kapolei, HI 96707

Atlanta, GA  30329
 808-692-8106 

404-982-7846

IA  ID 
Karen Zaabel
 Vicky Goettsche 
Health Facilities Training Officer
 Associate Director 
IA Department of Inspections and Appeals
 ID Board of Nursing 
321 East 12th Street
 280 N. 8th, Suite 210 
Des Moines, IA 50319
 P.O. Box 83720 
515-242-5991
 Boise, ID 83720 
208-334-3110 
IL  IN 
Anne Conwill
 David Miller

Staff Development Specialist
 RN Training Officer

IL Department of Public Health
 IN Dept of Health

Office of Health Care Regulation 
 Division of Long Term Care

525 W. Jefferson
 2 N. Meridian Street

Springfield, IL 62761
 Indianapolis, IN 46204

217-524-0127
 317-233-7615

KS  KY 
Lesa Roberts
 Vicki R. Barber

Director
 R.N./N.C.I.

Health Occupations Credentialing
 KY Cabinet for Health Services

KS Department of Health and Environment
 Department for Medicaid Services

1000 SW Jackson, Suite 330
 Long Term Care Division

Topeka, KS 66612
 275 East Main Street, 6WB 

785-296-1281
 Frankfort, KY 40621

502-564-5707

LA  MA 
Lorena Landry
 Peter Bilodeau

NATCEP Director
 Nurses Aide Registry

LA Department of Health & Hospital Standards
 MA Division of Healthcare Quality

500 Laurel Street, 1st floor
 10 West Street

Baton Rouge, LA 70801
 Boston, MA  02111

225-342-5778
 617-753-8000

MD  ME 
Ethel Stanley
 Roanne Seeley

Program Administrator
 Education Specialist

MD Board of Nursing
 ME Department of Education

4140 Patterson Avenue
 23 State House Station

Baltimore, MD 21215
 Augusta, ME 04333

410-585-1990 
 207-624-6742

26
 MI  MN 
Rae Ramsdell
 Dena Dunkel

Manager
 Nursing Assistant Registry Coordinator

MI Department of Consumer & Industry Services
 MN Department of Health

Bureau of Health Services
 Facility and Provider Division

611 W. Ottawa
 Licensing and Certification Program

P.O. Box 30670
 85 East Seventh Place, Suite 300

Lansing, MI 48909
 P. O. Box 64900

517-241-0054
 St. Paul, MN 55164

651-215-8813

MO  MS 
Lois Bonnot 
 Jannifer G. Anderson

Facility Advisory Nurse III
 Nurse III

MO Division of Aging
 MS Department of Health

615 Howerton Court
 Licensure and Certification

Jefferson City, MO 65102 
 570 E. Woodrow Wilson

573-526-8513
 Jackson, MS 39215

601-576-7300

MT  NC 
Roseline Efta 
 Hazel B. Slocumb

Health Care Facility Surveyor
 Assistant Chief, Nurse Aide Training & Registry

MT Department of Public Health and Human
 Administration

Services
 NC Department of Health and Human Services

Certification Bureau
 Division of Facility Services

2501 Colonial Drive, 2nd Floor
 Health Care Personnel Registry Section

Helena, MT 59620
 701 Barbour Drive

406-444-1599
 Raleigh, NC 27603 

919-715-1657

ND  NE 
Carole Klebe
 Nancy Holmgren

Manager
 Nurse Aide Program Manager

ND Department of Health
 NE Department of Health and Human Services

Division of Health Facilities
 Regulation and Licensure, Credentialing Division 

600 East Boulevard Avenue
 301 Centennial Mall SO

Bismarck, ND 58505
 Lincoln, NE 68509

701-328-2352
 402-471-4969 

NH  NJ 
Margaret Walker
 Henry T. Kozek

Program Specialist IV
 Program Manager

NH Board of Nursing
 NJ Department of Health and Senior Services

78 Regional Drive, Bldg B
 LTC Systems, Certification Program

P. O. Box 3898
 120 S. Stockton Street

Concord, NH 03302
 P.O. Box 367

603-271-6282 
 Trenton, NJ 08625

609-633-9706

27
 NM  NV 
Alberta Y. Barnes
 Donald S. Rennie

Coordinator of Nurse Aide Registry
 Associate Executive Director for Licensure &

NM Department of Health
 Certification

Division of Health Improvement
 NV State Board of Nursing

Health Facility License & Certification Bureau
 P.O. Box 46886

2040 S. Pacheco Street, 2nd floor, Room 413
 Las Vegas, NV 89114 

Santa Fe, NM 87505 
 702-486-5800

505-476-9038

NY  OH 
Diane Lenzner Cohen
 Joy Thompson

Director
 OH Department of Health

NY Department of Health
 Division of Quality Assurance

Bureau of Professional Credentialing
 Bureau of Long Term Care Quality

Office of Continuing Care
 246 North High Street

61 Delaware Avenue
 Columbus, OH 43266

Delmar, NY 12054
 614-752-8285

518-478-1060

OK  OR 
Lisa McAlister
 Debra K. Buck

Director of Nurse Aide Registry
 CNA Program Consultant

OK Department of Health
 OR Board of Nursing

1000 NE 10th Street
 800 NE Oregon Street, Suite 465

Oklahoma City, OK 73117
 Portland, OR 97232

405-271-4086
 503-731-4745

PA  RI 
Lyn Forlizzi
 Paula Morrissey

State Coordinator of Nurse Aide Training
 Administrative Officer 

PA Department of Education
 RI Department of Health

333 Market Street--6th Floor
 Health Professions

Harrisburg, PA 17126
 3 Capitol Hill-Room 105

717-783-6974
 Providence, RI 02908

401-222-6305

SC  SD 
Patty Lawrence
 Joan Bachman

Program Coordinator II
 Administrator

SC Department of Health and Human Services
 SD Department of Health

Division of Community and Facility Services
 Office of Health Facilities Licensure and

1801 Main Street
 Certification

Columbia, SC 29201
 615 E. 4th Street

803-898-2590
 Pierre, SD 57501

605-773-3356

28
 TN  TX 
Jacqueline Johnson
 Mary E. Calvin

Program Manager
 Manager, Nurse Aide Registry and Training

TN Department of Health
 TX Department of Human Services

Health Care Facilities
 Long Term Care- Regulatory 

425 5th Avenue North, 1st floor Cordell Hall Bldg
 501 W. 51st Street, PO Box 149030

Nashville, TN 37247
 Austin, TX 78714

615-532-7841
 512-231-5800

UT  VA 
Susan Lewsen
 Paula B. Saxby

Director
 Nurse Aide Education Program Coordinator

Utah Health Technology Certification Center
 VA Board of Nursing

550 E. 300 S.
 Department of Health Professions

Kaysville, UT 84037
 6606 West Broad Street, 4th floor 

801-547-9947
 Richmond, VA  23233

804-662-7310

VT  WA 
Janice Hatch
 Lew Maudsley 

Nurse Assistant Program Coordinator
 Nursing Assistant Program Manager

VT State Board of Nursing
 WA Department of Social and Health Services

81 River Street
 Aging and Adult Services Administration

Montpelier, VT 05609
 Residential Care Services Division

802-828-2819
 640 Woodland Sq Lp SE

P.O. Box 45600

Olympia, WA  98504

360-725-2596

WI  WV 
Sue Larsen
 Kay S. McVey

Supervisor, Caregiver Regulation and Investigation
 Program Manager

Section
 WV DHHR-OHFLAC

WI Department of Health and Family Services
 Nurse Aide Training and Competency Evaluation

Division of Supportive Living
 Program

Bureau of Quality Assurance
 350 Capitol Street, Room 206

1 West Wilson
 Charleston, WV 25301

P.O. Box 2969
 304-558-0688

Madison, WI 53701

608-266-1440

WY 
Mary K. Schaper

Assistant Executive Director

Nursing Practices Consultant

WY State Board of Nursing

2020 Carey Ave, Suite 110

Cheyenne, WY 82009

307-777-7601

29
 A C K N O W L E D G M E N T S  
This report was prepared under the direction of William C. Moran, Regional Inspector General for 
Evaluation and Inspections in Chicago, Brian T. Pattison, Regional Inspector General for Evaluation 
and Inspections in Kansas City, and Natalie Coen, Deputy Regional Inspector General in Chicago. 
Other principal Office of Evaluation and Inspections staff who contributed include: 
John Traczyk, Project Leader  Sandy Khoury, Program Specialist 
Dennis Tharp, Lead Analyst  Bambi Straw, Program Specialist 
Tricia Fields, Program Analyst  Barbara Tedesco, Statistician 
Erin Guay, Program Analyst 
30