Dementia training requirements for care home staff depend on your state, so a brochure that promises "dementia-trained" caregivers is only as strong as your state's rule. Small residential care homes and assisted living are licensed and regulated at the state level, and federal researchers say those staff-training rules vary considerably. In Oregon, for example, every caregiver in an adult foster home licensed to serve older adults has to finish dementia training before giving direct care. In Pennsylvania, a personal care home must keep a record of each staff member's training, with copies of any certificates, so it's fair to ask the home to show it to you.

In This Guide

Who Sets Dementia Training Requirements for Care Home Staff?

It's natural to assume there's one national standard behind the word "trained." For nursing homes, federal law does set one. A federal statute, 42 U.S.C. 1395i-3, directs federal health officials to include dementia management training in the curriculum for nurse aides in skilled nursing facilities. The federal nursing home rule at 42 CFR 483.95 requires nurse aides to get at least 12 hours of in-service training a year, including dementia management. The federal nursing home training rule applies to homes that take part in Medicare as skilled nursing facilities or in Medicaid as nursing facilities.

Small care homes work differently. A board and care home, also called a residential care facility or group home, is a small private home that usually has 20 or fewer residents, and in many states it is licensed or certified and must meet state criteria. The Office of the Assistant Secretary for Planning and Evaluation (ASPE), the planning office at the U.S. Department of Health and Human Services (HHS), says residential care settings "are licensed and regulated at the state level," and that although states cover the same areas, such as staff training, "their requirements vary considerably."

So the question to ask isn't "is there a law?" It's "what does this home's state license require, and has this home met it?"

Why a Dementia-Trained Promise Isn't Proof

The Administration for Community Living (ACL), the federal agency for older adults, describes dementia care settings carefully. It says specialized staff training, secured exits and enhanced visual cues "can be part of" a memory care facility. That's a description of what's possible, not a promise that every home calling itself dementia-friendly has it.

That gap is where families get hurt. A brochure line costs nothing to print. A training record is something a home either has or doesn't, and in Pennsylvania, for example, the law says exactly what a personal care home's record must show: the staff person trained, the date, source, content and length of each course, and copies of any certificates. You aren't being difficult by asking. You're doing what a good advocate for your parent does.

Dementia Training Requirements for Care Home Staff in 7 States

The table below covers seven states Brevy has verified against state law. Each row is a different type of home, so read the "type of home" column first. It is not a nationwide list: if your state isn't here, check your state's licensing agency. "Not verified" means Brevy hasn't confirmed that cell against a source, not that the state has no rule.

State Type of home Who must be trained How much Deadline Yearly refresher
California Every RCFE; most have 6 to 15 beds All direct care staff 12 hours of dementia care training 6 hours before working independently with residents; 6 more within the first 4 weeks 8 hours of in-service a year on serving residents with dementia
Oregon Adult foster homes for 5 or fewer adults, licensed to serve older adults Every caregiver, substitutes included ORS 443.743 sets the topics, not a number of hours Before giving direct care Not verified
Washington Adult family homes for 2 to 6 residents Provider and resident manager; every long-term care worker Specialty training with a competency test; the Washington State Department of Social and Health Services (DSHS) Dementia, Level 1 class is 8 hours Provider and manager: before admitting a resident with dementia (120 days if the need arises later). Workers: within 120 days of hire 12 hours of continuing education a year for providers, resident managers and certified aides
Kansas Home plus, 12 or fewer residents Staff who serve residents with dementia The statute names no hour figure Not verified Annual dementia care training
Minnesota Every licensed assisted living facility Direct care staff, supervisors and other staff Direct care: 8 hours on dementia plus 2 on mental illness and de-escalation. Non-direct-care staff: 4 hours on dementia Direct care: within 160 working hours (80 in assisted living with dementia care) 2 hours on dementia plus 1 on mental illness and de-escalation each year
Pennsylvania Personal care homes, 4 or more residents Direct care staff Initial training that covers dementia care, plus a state-approved course and competency test; the rule gives no hour figure for the initial training Before giving unsupervised help with daily activities At least 12 hours a year that must include dementia care; staff in a secured dementia unit get 6 more dementia hours
Georgia Certified memory care centers inside a personal care home or assisted living community All staff; direct care staff All staff: 4 hours of dementia orientation. Direct care: 16 hours of dementia training Orientation within 30 days of starting; direct care training within 30 days of caring for residents independently 8 hours a year for direct care staff

What Each State's Rule Means for Your Family

Each note below links to Brevy's fuller guide for that state.

California: every RCFE, whatever the size

Under Health and Safety Code 1569.626, all RCFEs must give all direct care staff 12 hours of training devoted to the care of people with dementia: 6 before a staff member works independently with residents and 6 within the first four weeks. California RCFE direct care staff then get 8 hours of in-service training a year on serving residents with dementia. The California rule reaches the small homes too, since most of California's licensed RCFEs have 6 to 15 beds. The California Department of Social Services licenses them. For your family, that means a caregiver who has been at a California RCFE for four weeks should have all 12 hours, and a newer one shouldn't be working on their own with your parent before finishing the first 6. More in Brevy's California memory care guide.

Oregon: adult foster homes for older adults, before any direct care

Oregon's statute, ORS 443.743, says all caregivers in an adult foster home licensed to serve older adults, substitute caregivers included, must finish dementia training before giving direct care. The statute spells out what the training covers: how the disease progresses, managing behavioral symptoms, meaningful activities, and safety issues such as wandering. ORS 443.743 doesn't give a number of hours. The Oregon Department of Human Services must approve the training. Oregon adult foster homes care for five or fewer adults. Because substitutes are covered, ask an Oregon adult foster home for older adults about the person who fills in on the provider's days off, not just the provider. See Brevy's Oregon adult foster homes guide.

Washington: adult family homes, before a resident with dementia moves in

Under RCW 70.128.230, a Washington adult family home's provider and resident manager must complete specialty training, and pass a competency test, before admitting a resident with dementia. If a resident develops dementia after moving in, a Washington adult family home's provider and resident manager have 120 days to complete dementia specialty training. In a Washington adult family home that serves residents with special needs, each long-term care worker must finish specialty training within 120 days of hire and, until then, can't give personal care to a resident with special needs without direct supervision, with some exceptions for licensed nurses and certified aides. The 8-hour figure in the table is the length of the Washington DSHS class called Dementia, Level 1, and any other dementia specialty curriculum Washington DSHS approves must require no fewer hours. Before your parent moves into a Washington adult family home, ask whether the provider and resident manager have already completed dementia specialty training, since the rule requires it before admission. See Brevy's Washington memory care guide.

Kansas: home plus, trained every year

A home plus in Kansas cares for no more than 12 people. State law, K.S.A. 39-923, says Kansas home plus staff who serve residents with dementia "shall be required to take annual dementia care training," without naming a number of hours. Homes are licensed by the Kansas Department for Aging and Disability Services (KDADS). Because the statute names no hours, ask a Kansas home plus how long its yearly dementia training is and who teaches it: that answer comes from the home, not from the law. See Brevy's Kansas memory care guide.

Minnesota: every assisted living facility, and a written description you can ask for

Minnesota's dementia training rule, section 144G.64, applies to every licensed assisted living facility. Minnesota assisted living direct care staff need 8 hours of initial dementia training plus 2 hours on mental illness and de-escalation within 160 working hours; in a Minnesota assisted living facility with dementia care, the 8 dementia hours are due within 80 working hours. Until then, a new Minnesota assisted living staff member can't give direct care unless a trained colleague is on site. Every staff member in a Minnesota assisted living facility then gets 2 hours of dementia training and 1 hour on mental illness and de-escalation each year. A Minnesota assisted living facility must give consumers a written description of its training program. The Minnesota Department of Health licenses these facilities. Ask for that written description before you sign, and compare it with what staff tell you on the tour. If the home holds a different Minnesota license, ask what that license requires. See Brevy's Minnesota memory care guide.

Pennsylvania: personal care homes, with records you can see

In a Pennsylvania personal care home, direct care staff can't give unsupervised help with daily activities until they've practiced under supervision, passed a state-approved course and competency test, and completed initial training that includes caring for residents with dementia (55 Pa. Code 2600.65). Pennsylvania personal care home direct care staff then need at least 12 hours of training a year, and the topics must include dementia care. Staff in a Pennsylvania personal care home's secured dementia care unit need 6 more hours of dementia training a year. A Pennsylvania personal care home must keep training records, including copies of certificates. The Pennsylvania Department of Human Services licenses these homes. That record is the most concrete thing you can ask to see: it should show who was trained, when, the source, and the content and length of each course. See Brevy's Pennsylvania memory care guide.

Georgia: certified memory care centers

The Georgia hours in the table come from the state's rules for certified memory care centers, a unit inside a personal care home or assisted living community that needs a certificate from the Georgia Department of Community Health. In a Georgia certified memory care center, all staff get 4 hours of dementia orientation within 30 days, direct care staff get 16 hours of dementia training within 30 days of caring for residents on their own, and then 8 hours a year. During waking hours, a Georgia certified memory care center must have at least one dementia-trained direct care staff member for every 12 residents, based on a monthly average. If the home is certified, ask how many dementia-trained staff are on duty during the day, and compare the answer with that minimum. If the home you're considering isn't a certified memory care center, ask the department what applies to it. See Brevy's Georgia memory care guide.

Questions to Ask the Home About Dementia Training

You don't need to be an expert to ask these. A good home will be glad you did, and how it answers tells you a lot.

  • Who on tonight's shift has finished the required dementia training? Ask by name, not in general.
  • Can I see the training record? Pennsylvania personal care homes must keep training records with copies of certificates. In a Minnesota assisted living facility, ask for the written description of the training program the law requires the facility to provide.
  • How do new caregivers work before they're trained? In a Washington adult family home, a worker who hasn't finished specialty training generally can't give personal care to a resident with dementia without direct supervision (certified aides and licensed nurses have exceptions). Ask who supervises a new hire, and when.
  • Who is awake at night? ACL says a board and care home has at least one caregiver on the premises at all times. Oregon's rules for adult foster homes serving older adults require "awake caregivers as necessary" to meet each resident's 24-hour needs. If your parent wanders or wakes confused, ask whether the night caregiver is awake or asleep on call.
  • When did each caregiver last take a refresher? California, Kansas, Minnesota, Pennsylvania and Georgia all require yearly dementia training for at least some staff in the homes the table covers, so a home should be able to answer.,,,,

For the wider checklist on choosing a dementia setting, see Brevy's guide to choosing a memory care facility, and for what good dementia care looks like day to day, the guide to managing dementia behaviors.

How to Check a Home's License and Inspection Record

Start with the license. The National Consumer Voice for Quality Long-Term Care advises finding out whether a facility is licensed, because a licensed facility gives the resident more protections and a place to turn with a complaint. It also advises reviewing the facility's survey (inspection) reports and comparing them with other facilities. If a home has no license at all, Brevy's guide to unlicensed care homes explains what that can mean.

Some states put the lookup online:

In other states, search for your state's licensing agency for the type of home, or use Brevy's dementia care resources by state.

If the Answers Don't Add Up

Maybe the home can't say who's trained, or the record doesn't match what the brochure promised. That's worth acting on, and you don't have to sort it out alone.

Start with your state's licensing agency: Consumer Voice notes that a licensed facility gives you a place to turn if you want to file a complaint. The long-term care ombudsman is the other door. Under the Older Americans Act, the ombudsman program serves residents of board and care homes and similar adult care homes, assisted living included, and ACL says state ombudsman programs work to resolve problems with residents' health, safety, welfare and rights. To find yours, Consumer Voice keeps a state directory of ombudsman programs. Brevy's long-term care ombudsman guide explains what they can do.

Frequently Asked Questions

Do caregivers in a small care home have to be trained in dementia care?

In some states, yes: caregivers in small care homes must be trained in dementia care, and what's required depends on the home's license. In a Kansas home plus, which serves 12 or fewer people, staff who serve residents with dementia must take dementia care training every year. In a Washington adult family home that serves residents with special needs, each long-term care worker must finish specialty training within 120 days of hire. Because small care homes are licensed by the states, check what your state requires for the type of home you're considering.

Can a new caregiver look after my parent before finishing the training?

Usually only within limits, and the limits depend on the state and the type of home. In a California RCFE, direct care staff complete 6 hours of dementia training before working independently with residents. In a Minnesota licensed assisted living facility, a staff member who hasn't finished initial training can't give direct care unless a trained colleague is on site. In a Pennsylvania personal care home, direct care staff can't give unsupervised help with daily activities until their initial training is done. Wherever you are, ask the home who supervises a new hire with your parent.

Does a home that advertises memory care have to meet a special standard?

It depends on the state. In Georgia, a personal care home or assisted living community can't operate a memory care center without a certificate from the Georgia Department of Community Health, and a certified center must meet the training hours in the table above. Kansas's adult care home licensing law, K.S.A. 39-923, lists the license types, and memory care isn't one of them, so a Kansas facility advertising memory care holds one of those licenses, and what it owes a resident with dementia depends on which one. ACL describes specialized staff training as something that "can be part of" a memory care facility, not a feature every one has. So ask which license or certificate the home holds.

Do substitute caregivers and other staff have to be trained too?

In some states, yes. Oregon's dementia training law covers all caregivers in an adult foster home licensed to serve older adults, substitute caregivers included. In a Minnesota licensed assisted living facility, staff who don't give direct care, such as housekeeping and food service staff, must complete at least 4 hours of initial dementia training. Elsewhere, ask whether the home's training covers everyone who may be alone with your parent, including weekend and overnight fill-ins.

My state isn't one of the seven. What should I do?

Ask the home which license it holds, then ask your state's licensing agency what that license requires. Your state's long-term care ombudsman program can also give information about finding a facility and getting quality care.

Learn More

Care TypesBoard and Care Homes: What They Are, Cost and Who PaysBoard and care homes are small homes, usually 20 or fewer residents, with meals, personal care and 24-hour staff. What they cost, who pays, and how to vet one. Care TypesHow to Choose a Memory Care FacilityHow to choose a memory care facility: check which dementia features it really has, ask the right questions on two visits, and read the contract before signing. Care TypesUnlicensed Care Homes: How to Tell, and What the Law Says by StateAn unlicensed care home can be legal or illegal, depending on the state. How to check a care home's license, spot warning signs and report one in 7 states. Care TypesLong-Term Care Ombudsman: What They Do and How to Reach OneEvery state has a free, confidential long-term care ombudsman for nursing home and assisted living residents. What they do, whose side they're on, how to call. Care TypesMemory Care by State: Costs, Rules, and Your State's GuideMemory care is specialized assisted living for dementia. What it costs, who pays (Medicare doesn't), and how the rules change by state, with a guide to yours. CaregiverDementia Care Resources by StateMedicaid waivers, respite, adult day, and Alzheimer's support for dementia caregivers vary by state. See how they differ and open a full guide for your state.

Find personalized help checking a care home's license and dementia training at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.