Lawmakers, state agencies and providers press for fixes to nurse aide training, testing and staffing

Members of the Pennsylvania House Health Committee and the Committee on Aging and Older Adult Services convened a joint informational hearing to examine the nurse aide training and competency program and longstanding problems with testing access and staffing for long‑term care on May 1, 2025.

The hearing focused on three linked problems: a shrinking network of approved training programs, delays and cancellations in skills testing managed by the vendor Credentia, and a broader workforce shortfall that has left nursing homes unable to staff licensed beds.

In opening remarks, Rep. Rapp, chair of the House Health Committee, said lawmakers were seeking concrete improvements because "we cannot continue to allow qualified nurse aid candidates to get lost in a bureaucratic system as our nursing homes struggle to meet staffing demands." The panel heard testimony from officials at the Department of Education (PDE), the Department of Health (DOH), the Department of Human Services (DHS), the State Board of Nursing, long‑term care trade groups, a bedside nurse aide, and Credentia representatives.

Judd Pittman, director of the Bureau of Career and Technical Education at PDE, summarized the state’s role in program approvals and curriculum oversight. He noted federal law — the Omnibus Budget Reconciliation Act of 1987 (OBRA) and related Centers for Medicare & Medicaid Services (CMS) requirements — requires states to review and approve nurse aide training and maintain a registry. Pittman told the committee PDE currently approves about 22 programs per approval cycle, and that there are roughly 75 approved training programs in Pennsylvania, down substantially from prior years. He said PDE is turning approvals around in roughly 70 days on average and has introduced new guidance, effective May 1, 2025, allowing virtual delivery of the classroom (theory) portion of nurse aide training and permitting asynchronous vendor content where state curriculum requirements are met.

Jean Parisi, deputy secretary for quality assurance at DOH, said DOH maintains the nurse aide registry and manages the state’s contract with Credentia. "We currently have about 80,000 people that are active on the list with about 1,300 that are ineligible," Parisi said, adding the registry gained roughly 11,000 entries this year through testing and reciprocity with other states.

Kimberly Barge of DHS described DHS’s oversight of testing administration under the contract with Credentia and the department’s role in a directed corrective action plan. Barge said agencies began escalating concerns last fall and required Credentia to submit remediation steps; the plan sets near-term deadlines, including items due by the end of June.

Representatives of long‑term care providers described consequences at the bedside. Zach Schamberg, president and CEO of the Pennsylvania Healthcare Association, said providers are repeatedly blocked from filling beds by the inability to hire nurse aides and by testing bottlenecks. "We cannot wait weeks or months for a corrective action plan. We need action today," he said. Austin Cawley of Leading HPA told the committee that many providers must rely on agency staff, limiting continuity of care and prompting facilities to cap admissions or close wings.

Frontline testimony underscored personal strain. Cesar Nieves, a nurse aide of 23 years, told lawmakers the workload and unpredictable schedules push experienced caregivers out of the field: "I love my people. I love my residents. They've become part of our families," he said, and described long shifts, mandatory overtime and pay pressures that make staying in the job difficult.

Committee members pressed agencies about staffing ratio rules and enforcement. DOH witnesses said Pennsylvania uses shift‑based ratios that many providers say are hard to meet; DOH officials said most facilities comply but some continue to struggle, and the department has granted very few exceptions. Providers and advocates urged additional administrative flexibility and sustained budgetary support to shore up Medicaid reimbursement.

Credentia's senior director of client relations, Brenda Scofiro, acknowledged earlier operational problems after an ownership and system change, and described steps the company has taken to increase reliability. "We have reduced cancellations significantly," Scofiro said, adding that cancellations related to evaluators had fallen to seven in the last four months and that the vendor is expanding full‑time evaluator coverage and piloting a virtual skills evaluation platform used in other states.

Witnesses discussed other near‑term and policy steps: PDE said it is moving NATSEP application and monitoring to an integrated online system, eliminating some duplicate paperwork, and considering allowing corporate "umbrella" program approvals for chains of facilities; DHS and DOH described the corrective action plan and evaluations of virtual skills testing pilots; provider groups urged the legislature to consider measures in Senate Bill 114 and House Bill 1310 to standardize training and adjust nursing home reimbursement to improve provider stability.

No formal votes or motions were taken at the hearing. Committee chairs said they expect follow‑up work with state agencies and stakeholders to monitor the vendor remediation timeline and the implementation of virtual training and testing pilots.

The hearing record shows the agencies and provider groups agreed on two overarching needs: faster, more reliable access to competency testing and longer‑term strategies to recruit and retain nurse aides, including potential program restructures, better funding and expanded training pathways for high‑school and postsecondary students.

The committees asked agencies for regular updates on the corrective action deadlines and on PDE’s technology migration; Credentia said most remediation items carry deadlines before the end of June and additional items that require state approvals are targeted for later in June.

The committee concluded with an agreement to continue oversight, and members called for legislative and administrative follow‑up to ensure testing availability and to address the workforce shortage that is limiting nursing‑home capacity across Pennsylvania.