State regulations typically require on orientation for new staff and annual in-service training. Training requirements can be very general or specific. Ten states require direct care staff to successfully complete an approved course. Other states specify the areas to be covered during training, some specify the number of hours to be spent in training, and many states include requirements for both topic areas and number of hours. Training requirements can be grouped into five domains:
- Direct care,
- Health related,
- Knowledge areas,
- Safety and emergency issues, and
Thirty-five states require training on resident rights, the most common of all issues described in state rules. Direct care skills are covered as training in personal care or direct care skills (26 states), as areas that are appropriate or related to the tasks or duties of staff (17 states), and more generally as tasks necessary to meet the needs of consumers (13 states). There is considerable overlap between these areas as fifteen states require training in two or all three of the areas. Other direct care areas included nutrition/food preparation (18), dementia or Alzheimer's care (15), mental health and emotion needs (16), general requirements (13), principles of assisted living (12), housekeeping/sanitation (14), hygiene (11), and training related to the use of restraints (7).
Safety and emergency issues are also important components of training in these facilities. Thirty-three states require training in fire, safety, and emergency procedures. Twenty-three cover first aid, while 15 require CPR training. Infection prevention and control is also required in 24 states.
The most common health related topics were medication administration and assistance (23 states) and observation or reporting skills (14 states). Preventive or restorative nursing services and basic nursing skills is required in three states.
Fewer states address aging process (11), communication skills (9), assessment skills (8), psychosocial needs (6), care plan development (5), and death and dying (4).