What Staff Training Do CMS Rules Require in Nursing Homes?

Nursing homes that take part in Medicare or Medicaid must run a training program for staff under 42 CFR 483.95. The program covers new and existing staff, individuals providing services under contract, and volunteers, consistent with their expected roles. The amount and type of training are set by the facility assessment in 42 CFR 483.71. Healthcare privacy training is covered separately in HIPAA training in healthcare.

Required training topics. Section 483.95 lists these areas:

• Effective communications for direct care staff.
• Resident rights and facility responsibilities.
• Abuse, neglect, exploitation and misappropriation of resident property, including procedures for reporting and dementia management and resident abuse prevention.
• Quality assurance and performance improvement.
• Infection control, including the facility's written standards, policies and procedures.
• Compliance and ethics, with annual training required if the operating organization runs five or more facilities.
• Behavioral health, in line with the facility assessment.

Nurse aide in-service. Nurse aides must receive in-service training of at least 12 hours per year. It must be enough to keep aides competent, must address areas of weakness found in performance reviews, and must include dementia management and resident abuse prevention training. Aides serving residents with cognitive impairments also need training on their care (42 CFR 483.95(g)).

Paid feeding assistants. A paid feeding assistant must complete a training program approved by the state before feeding residents (42 CFR 483.95(h)).

The facility assessment link. Section 483.71 requires a facility-wide assessment of the resources needed to care for residents, reviewed and updated as needed and at least annually. The assessment must inform staffing decisions and include a plan for recruitment and retention of direct care staff. Because training under 483.95 must be based on the assessment, the two sections work together. Section 483.71 was added and section 483.95 was amended by the May 10, 2024 minimum staffing rule, and the facility assessment must also solicit input from residents, resident representatives and family members.

Staffing rule repeal. CMS's 2024 minimum staffing standards for long-term care facilities were repealed in an interim final rule with comment period (90 FR 55687, December 3, 2025, effective February 2, 2026). The training requirements in 483.95 were not part of that repeal. The Learn Laws® news item on the staffing repeal has the background.

Documentation. Survey review can include training records, in-service hours for each aide, and evidence that content matches the facility assessment. Facilities should keep sign-in sheets, curricula and completion dates for each topic and each staff group. Workforce programs are covered in the news item on the nurses for nursing homes program.