§ 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 experts. Supplemental personnel must have at least 1 year of experience in their fields;
( 6 ) Contain competency evaluation procedures specified in § 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 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.