Not far into the onslaught of the pandemic, when it became clear that COVID-19 was hitting long term and post-acute care facilities especially hard, the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) advocated for special waivers that would help the sector to better meet the needs of its residents and patients.

One of these waivers allowed for temporary nurse aides (TNAs) to assist with frontline care. The federal government declared a national public health emergency, and on March 30, 2020, the Centers for Medicare & Medicaid Services (CMS) issued blanket waivers that allowed for the training and hiring of TNAs.

AHCA/NCAL immediately launched two free online TNA training courses, one taking eight hours and the other 16 hours. The swift and consequential response to these two courses has surpassed all expectations.

A Needed Program

More than 182,890 people have registered, and more than 136,300 have completed and passed these courses since their launch in April, numbers that continue to rise every day. Skilled nursing and assisted living communities around the country have hired TNAs, or similarly named positions, to alleviate the staffing challenges that already existed but were made even more significant by COVID-19.

In addition, while many people around the country were losing their jobs—in retail or the food service industry for example—the TNA program has provided a way for them to receive free training, find work quickly, and begin new careers in long term care while making a significant contribution.

“The impact of having the TNA program available to use during the public health emergency has been huge,” says Julie Adair, vice president of home care and sector support at the Iowa Health Care Association. More than 1,500 Iowans have completed the TNA course, making it possible for them to gain valuable skills and experience working at a long term care facility.


How the Program Works

TNAs work side-by-side with and receive supervision from certified nurse assistants (CNAs), registered nurses, and other staff. Tasks include helping with activities of daily living, infection control and prevention, positioning, moving and restorative care, nutrition and elimination, and comfort care

Students are introduced to the skills and procedures required for the job in the online TNA courses, then gain skills competency training on the job. The videos and other materials used in the online courses are adapted from AHCA’s well-known training curriculum, How To Be a Nurse Assistant., an AHCA partner that offers one of the few hybrid CNA trainings available, sponsored the TNA courses and assisted in getting the material prepared for a quick launch.

In a recent survey* of those who completed the TNA course, 54 percent said they had found a job as a TNA, and 48.6 percent said they took the TNA course because they wanted to begin a new career in health care.

Katherine Midgette completed the online TNA course in November and then began working at a center in Salisbury, Md. She is currently in a CNA training class and will continue her new health career in the years to come. “I plan to be a travelling RN,” she explains.

James Benson of Michigan felt that the training prepared him and helped him feel more confident on the job. “It really expanded my scope of practice and helped me with proper use of PPE [personal protective equipment] and end-of-life care,” he says. Benson will begin school for a nursing degree this spring.

Future Needs

Workforce shortages already posed a major challenge to the sector prior to the pandemic, but the added stresses that COVID-19 created brought the workforce crisis to a whole new level. Staffing shortages were so severe over the past several months that states like Minnesota, California, Pennsylvania, and Indiana called in the National Guard for help.

The question of what will happen when the waivers expire looms large. As of Jan. 21, 2021, the U.S. Department of Health and Human Services extended the public health emergency until April 21, allowing for the continued use of TNAs for 90 more days and giving the long term and post-acute care sector more time to figure out how best to tackle this problem.

Once the waivers expire, providers could be faced with even more dire staff shortages, and the thousands of people who just joined the health care workforce could lose their jobs, unless they get the additional training needed to become a CNA.

Making things even more challenging, many in-person training programs and state testing sites remain closed or are operating at reduced capacity due to COVID-19.

Online nurse assistant training serves as an excellent option, and more and more, providers are stepping up to take advantage of that opportunity.

Genesis Takes Next Step

Genesis HealthCare, which has post-acute care companies and skilled nursing and assisted living communities in 24 states across the country, has been working with to train and certify CNAs for the past two years. Genesis immediately began training newly hired TNAs in its buildings through so that it would be in a position to hold onto and grow its workforce even after the COVID-19 health crisis has passed.

“Genesis’ goal from the start was to transition temporary nurse aides that were committed and dedicated to a career pathway toward certification and licensure,” explains Debbie Rowe, vice president of nursing workforce development.

“ has been very positive. It offers hybrid nurse aide training that complies with state and federal requirements and limits students’ and residents’ exposure in a pandemic environment.”

Currently, Genesis utilizes to offer classes in Colorado, Massachusetts, Vermont, and West Virginia and plans to expand to more states.

TNAs have gotten tremendous clinical practice and hands-on experience while under supervision from more experienced and qualified staff. Having TNAs has also allowed providers to ensure quality of care for residents.

“Working side by side with a CNA, [TNAs] gave the residents additional attention in meeting their needs,” says Kimberly Gerst, Center nurse executive at the Willows Center in Parkersburg, W.Va. “It really supported the personal touch, which was particularly important during the holidays.”

Providers Assess Staffing Needs

Many providers have taken an all-hands-on-deck approach and asked their current staff to take the TNA course so they could help out in caring for residents.

This approach to dealing with staffing shortages may continue even after the current health crisis is over. “We believe that all provider facilities will enhance their professional workforces by adapting a universal caregiver model,” says John Reinhart, president and chief operating officer of “By utilizing online technology for CNA training and licensing of their entire team, facilities will have enhanced flexibility for staffing.

“We work with individual facilities who want to have their own facility-based program,” he says. “This gives them the ability to take more control over their clinical workforce.”

Danielle LevitanThe impact that the TNA program has had on the sector during the pandemic offers hope and fresh excitement. People have come together, stepped up, and even found their calling at a critical time, people like Rachael Loretan in Pennsylvania who has loved being a TNA.

“This experience really opened my eyes to the nursing field, and I loved working directly with the residents. They made such an impact on me, and it deepened my desire to enter the nursing profession,” she says. “My experience was nothing but amazing!”

Danielle Levitan is senior director, marketing, with the American Health Care Association.


*Survey of those who have successfully completed the TNA courses with 7,477 respondents. Conducted by AHCA from December 11, 2020 – January 8, 2021.