All 50 states & DC
Nursing-home in-service training requirements, state by state
Every skilled-nursing facility in the country runs on the same federal floor for staff in-service education — and then each state builds on it. Below is the floor that applies everywhere, then a directory to the verified specifics for your state.
The federal floor — the same in every state
Under the federal training rule for long-term care, a facility must provide an ongoing in-service program. The parts that apply nationwide:
- Nurse aides: at least 12 hours of in-service a year, addressed to the weaknesses found in performance reviews and, for those caring for residents with cognitive impairment, dementia management and resident-abuse prevention.
- Required topics for all staff: communication; residents’ rights; abuse, neglect and exploitation; QAPI; infection control; compliance and ethics; and behavioral health.
- OSHA safety training: bloodborne pathogens is retrained annually, plus hazard communication and emergency/fire safety.
Sources: 42 CFR §483.95 (long-term-care training requirements) · OSHA 1910.1030. See the full breakdown in our guide to in-service topics and the printable compliance checklist.
States build on the floor, they don’t lower it. Some set a higher bar
(extra hours, specific topics, monthly frequency) or add rules for who may teach the nurse-aide program. The
table links each state to a page with its governing agency, the exact regulatory citations, and links to the
primary sources — always confirm against your state’s current regulations.
Find your state
Select a state for its governing agency, the specific citations, and how the staff-development role works there.
| State | Who governs staff training there |
|---|---|
| Alabama | Alabama Department of Public Health (ADPH) |
| Alaska | Alaska Board of Nursing (Dept. of Commerce, Community & Economic Development |
| Arizona | Arizona State Board of Nursing (AZBN) governs nursing-assistant training programs and their ins… |
| Arkansas | Arkansas Department of Human Services (DHS), Division of Provider Services & Quality Assurance … |
| California | California Department of Public Health (CDPH) |
| Colorado | Colorado State Board of Nursing (Dept. of Regulatory Agencies, DORA) certifies nurse aides and … |
| Connecticut | Connecticut Department of Public Health (DPH) |
| Delaware | Delaware Health & Social Services (DHSS) |
| District of Columbia | District of Columbia Board of Nursing (within the DC Department of Health / DC Health) |
| Florida | Two agencies: the Florida Board of Nursing (within the Dept. of Health) certifies CNAs and regu… |
| Georgia | Georgia Department of Community Health (DCH) |
| Hawaii | SPLIT: Department of Human Services (DHS) |
| Idaho | Idaho Department of Health and Welfare (DHW), Division of Licensing & Certification / Bureau of… |
| Illinois | Illinois Department of Public Health (IDPH) |
| Indiana | Indiana Department of Health (IDOH) |
| Iowa | Iowa Department of Inspections, Appeals, and Licensing (DIAL) |
| Kansas | Kansas Department for Aging and Disability Services (KDADS) |
| Kentucky | Kentucky Cabinet for Health and Family Services |
| Louisiana | Louisiana Department of Health (LDH), Health Standards Section (HSS) |
| Maine | Maine State Board of Nursing (02-380 CMR ch. 5) approves CNA training programs and RN instructi… |
| Maryland | Maryland Board of Nursing (MBON) certifies CNAs/GNAs and approves nursing-assistant training pr… |
| Massachusetts | Massachusetts Department of Public Health (DPH) approves nurse-aide training programs (105 CMR … |
| Michigan | Michigan Dept. of Licensing and Regulatory Affairs (LARA), Bureau of Community and Health Syste… |
| Minnesota | Minnesota Dept. of Health (MDH) |
| Mississippi | Mississippi State Dept. of Health (MSDH), Health Facilities Licensure and Certification |
| Missouri | Missouri Dept. of Health and Senior Services (DHSS), Division of Regulation and Licensure, Sect… |
| Montana | Montana Dept. of Public Health and Human Services (DPHHS), Quality Assurance Division / Office … |
| Nebraska | Nebraska Department of Health and Human Services (DHHS), Division of Public Health |
| Nevada | Nevada State Board of Nursing (certifies CNAs and issues the iCNA instructor approval) |
| New Hampshire | NH Office of Professional Licensure and Certification (OPLC) |
| New Jersey | New Jersey Department of Health |
| New Mexico | New Mexico Health Care Authority (HCA), Division of Health Improvement |
| New York | New York State Department of Health (Division of Nursing Homes and ICF/IID Surveillance |
| North Carolina | North Carolina DHHS, Division of Health Service Regulation (DHSR) |
| North Dakota | North Dakota Department of Health and Human Services (HHS) |
| Ohio | Ohio Department of Health (ODH) |
| Oklahoma | Oklahoma State Department of Health (OSDH) |
| Oregon | Oregon State Board of Nursing (OSBN) |
| Pennsylvania | Pennsylvania Department of Education (PDE), Bureau of Career & Technical Education |
| Rhode Island | Rhode Island Department of Health (RIDOH) |
| South Carolina | South Carolina Department of Health and Human Services (SCDHHS), Division of Long Term Living |
| South Dakota | South Dakota Board of Nursing (SDBON). IMPORTANT: effective September 8, 2025, regulation of ce… |
| Tennessee | Tennessee Health Facilities Commission (HFC), Division of Licensure and Regulation. HFC was cre… |
| Texas | Texas Health and Human Services Commission (HHSC), Long-Term Care Regulation / Nurse Aide Regis… |
| Utah | Utah Department of Health and Human Services (DHHS), Health Facility Licensing/Certification (R… |
| Vermont | Two agencies. (1) The Vermont Dept. of Disabilities, Aging & Independent Living (DAIL), Divisio… |
| Virginia | Two agencies. The Virginia Board of Nursing (Dept. of Health Professions) approves nurse-aide e… |
| Washington | Washington State Board of Nursing (within the WA Department of Health) certifies nursing assist… |
| West Virginia | West Virginia Department of Health (formerly DHHR), Office of Health Facility Licensure and Cer… |
| Wisconsin | Wisconsin Department of Health Services (DHS), Division of Quality Assurance, Nurse Aide Traini… |
| Wyoming | Wyoming State Board of Nursing (WSBN) certifies CNAs and its Education Committee reviews traini… |
One library. Every state’s in-service topics.
The federal topics are the same everywhere, and our in-service library covers all of them — 186 ready-to-teach lessons, each with a lesson plan, handout, quiz, speaker notes and slides. Whatever your state requires you to teach, it’s already written, for $49.
See the lesson library License it for a facility
Free download
Free: the Annual In-Service Compliance Checklist
Every required and recommended staff in-service topic for skilled-nursing and assisted-living facilities, gathered on one printable page — free, plus the occasional DSD tip.