DHS COVID-19 PROVIDER RESOURCES // OLTL
FAQ: Staffing Resources for Nursing Care Facilities During the COVID-19 Pandemic
Issued: May 13, 2020
The Department of Health (Department) has received questions and requests for guidance from nursing
care facilities on what staffing measures can be implemented or contemplated during the 2019 novel
Coronavirus (COVID-19)pandemic while meeting statutory and regulatory requirements within the
jurisdiction of the Department. On March 6, 2020, the Governor issued a Proclamation of Disaster
Emergency to enable agencies to respond promptly to the pandemic. The Department is providing the
below questions and answersto assist facilities as they plan for staffing needs while the proclamation is
in effect. The Department encourages you to utilize PA CareerLink® and other recruiting outlets to
recruit staff and assist in employing staff that may have lost their job due to this crisis.
What options are available to assist with staffing levels at nursing care facilities?
28 Pa Code 211.12(i) requires a minimum number of general nursing care hours to be provided for each
24-hour period. The total number of hours of general nursing care provided in each 24-hour period
must, when totaled for the entire facility, be a minimum of 2.7 hours of direct resident care for each
The Department understands that during the COVID-19 pandemic nursing care facilities may not be able
to maintain the 2.7 Per Patient Day (PPD) requirement. Facilities must ensure resident quality of care
continues despite shortfalls in the 2.7 PPD. Please document on a monthly report when your facility
drops below the 2.7 PPD, the reason behind the decrease, and how your facility is maintaining quality of
care. Forward the report to the appropriate Department field office by the 10th of each month or until
otherwise instructed by the Department.
What federal regulations or statutory provisions are suspended to assist in hiring Nurse Aides?
Training and Certification of Nurse Aides — To assist in potential staffing shortages caused by the COVID19 pandemic, the Centers for Medicare and Medicaid Services (CMS) hasissued a blanket waiver of the
requirements at 42 CFR 483.35(d) (with the exception of 42 CFR 483.35(d)(1)(i)), which prohibits a
nursing care facility from employing anyone for longer than four months unless they meet the training
and certification requirements in subsection (d). These waivers were issued under the authority of the
federal emergency declaration dated March 13, 2020.
However, to ensure the health and safety of nursing home residents, CMS has not waived §
483.35(d)(1)(i), which prohibits a facility from employing any individual as a nurse aide for more than
four months, on a full-time basis, unless that individual is competent to provide nursing and nursingrelated services. Note that § 483.35(c) has also not been waived. The facility must continue to ensure
that nurse aides are able to demonstrate competency in skills and techniques necessary to care for
residents’ needs, as identified through resident assessments and described in the plan of care.
CMS indicated that anyone can be hired to perform nurse aide work. An individual does not need to be
on the registry or have taken a nurse aide training program. Since CMS has waived § 483.35(d) with the
exception of § 483.35(d)(1)(i), completion of a training and competency evaluation program and registry are not required while this waiverremains in place. The federal waiver still requires the facility to ensure
skill competency for nurse aides.
- Individuals seeking to be hired as nurse aidesshould complete the 8-hour online training by the
American Health Care Association (AHCA) or a comparable program, and successfully pass the
50-question test (correctly answering at least 40 out of 50 questions). There is a competency
skill list on the AHCA website and the training is free. Information can be found at the AHCA
- Any individuals who were trained or in midst of training and have not yet tested may continue
to be employed beyond the 120 days.
- Student nurses are permitted to work as aides if they provide a document to the potential
employer showing evidence of completion of any nursing school course work.
• 28 Pa Code 201.20(b) requires the facility to provide an employee with appropriate orientation
to the facility, the facility’s policies, the position and the duties of the position. The orientation
mustinclude training on the prevention of resident abuse and the reporting of abuse.
NOTE: The facility must track any nurse aides that are employed based on the guidance above during
the COVID-19 pandemic and be prepared to provide the documentation to the Department, if
What happens if a Nurse Aide lapses enrollment in the Pennsylvania Nurse Aide Registry?
Federal regulations at § 483.156(b)(3) require that to remain on the registry, an individual must have
performed nursing-related services during the 24-month registry period. To be eligible for continued
enrollment, an individual is required to work as a nurse aide for at least one documented day (i.e., eight
consecutive hours) for pay in an approved facility (such as a nursing home, personal care home, hospital,
home health setting or intermediate care facility) during the previous 24 months. Self-employment,
private-duty, or employment in doctors’ offices are not acceptable forms of work experience for
- To reactivate a lapsed registry under normal circumstances. It is important for the individual to
update all information on the Pennsylvania Nurse Aide Registry. If an individual was a formerly
active member of the registry, that individual has to take and successfully pass the National
Nurse Aide Assessment Program(NNAAP) Examination. If the individual successfully passesthe
NNAAP Examination, the Nurse Aide Registry status will indicate renewed. If the individual does
not pass the examination, the individual is required to re-train before re-testing. The individual
may not be employed as a nurse aide until they have official notification of enrollment or a
renewed active status. Employers are NOT required to pay the “renewal” examination fee;
however, employers MUST pay when a reimbursement letter is presented.
- To reactivate a lapsed registry during the COVID-19 Pandemic. During this time of crisis, the
renewal requirement is waived as long as an individual was active on the registry within the last
ten years, with no substantiated findings of abuse, neglect or misappropriation on the registry, and competencies are indicated. The individual may work as a nurse aide in a nursing care
facility since the test that is normally offered is currently unavailable due to the pandemic.
What licensing requirements have been suspended or waived due to the COVID-19 pandemic that
could assist facilities in hiring licensed nursing staff?
Governor Wolf and the Pennsylvania Department of State (DOS) have suspended various provisions of
the Professional Nursing Law and the Practical Nurse Law as well as certainState Board of Nursing
regulations, enabling applicants and licensees to practice during the COVID-19 Emergency Disaster
Declaration. Information on those provisions is available on the DOS website at the links below:
- Temporary permits for nurses licensed in other states. Click here for more information.
- Practice permits and fees are waived or extended. Click here for more information.
- Retired registered nurses, CRNPs and clinical nurse specialists can apply to have their license
reactivated. Click here for more information.
- License renewal deadlines are extended for nursing professionals. Click here for more
With the Governor’s authorization as conferred in the proclamation, those DOS suspensed provisions
will remain in place while the proclamation of disaster emergency remains in effect.
Other nursing care facility non-health care staffing needs:
Other than the dietician, there are no special requirements for dietary workers, except that they are
competent to perform the duties. It is expected that dietary employees would be provided with training
upon hire to ensure adequate understanding of the policies and procedures.
There are no special requirements for laundry workers. It is expected that laundry employees would be
provided with training upon hire to ensure adequate understanding of the policies and procedures.
What child care options are available to support nursing care facility staff continuing to work during
the COVID-19 pandemic?
Certain child care providers are approved to operate during the COVID-19 pandemic to support
employees of life-sustaining businesses, including nursing care facilities. A list of approved child care providers is available on the Department of Human Services website