The Centers for Medicare & Medicaid Services (CMS) recently released an interactive set of staff competency assessments that cover a range of topics relating to facility management, registered and licensed practical nursing staff, and certified nurse assistants (CNAs). They were developed by CMS using Civil Money Penalty Reinvestment Program funds with contributions from national associations and subject matter experts.  

CMS explains the purpose of the competency assessments in the following manner:

 “This competency assessment is designed to help you begin to assess staff competency in order to address competency growth areas. However, this competency assessment is not mandated by CMS, and using it does not guarantee compliance with the Requirements of Participation and the Facility Assessment.”

They are available using the following link:

From this site you can download both interactive PDFs and paper forms of the competency assessments for the three types of staff, answer sheets, and instructions for using the toolkit. The interactive PDF assessments have option buttons for answers to each question, and once answers are submitted, a score is generated for the assessment.

The toolkit elements have some important strengths and some limitations that should be kept in mind when using them. A major content strength is that the assessments are all based in a person-centered care framework.  

Given the importance of person-centered care on the new rule, and elder care in general, the assessments can help to determine if staff understand how it applies to care of different residents. 

A second strength is that the tools for each of the three types of staff (management, licensed staff, and CNAs) focus on the different roles of staff in the care process.

For example, while there are 11 resident conditions included for both licensed and CNA staff (dementia, pneumonia, for example), the competency questions differ.

Licensed staff questions appropriately address evaluation of conditions and treatments they provide, whereas CNA questions emphasize observations relating to changes of condition and preferences of relevance to the care they provide.

A third strength is that the competencies include behavioral (e.g., communication), technical (e.g., infection prevention and control), and resident conditions (as described above).

Person-centered orientation; competency/training oriented to different levels of staff; and ensuring competency in behavioral, technical, and relevant resident conditions are all important in competency and training activities.

The limitations of these tools are evident from the stated purpose of the toolkit. No single model of competency testing and training fits all organizations at all times. The challenge, in the face of limited time and resources, is to tailor your competency assessments and training program to your resident and staff needs. 

The facility assessment is a valuable tool for profiling your resident population and care needs. This information across residents can be used to prioritize both competency assessment and training activities for different staff.

Another important consideration is knowing where you have quality concerns, as reflected in results from your Quality Assurance Performance Improvement program. Integrating these activities with competency testing and training programs will yield substantial efficiencies that will facilitate improving quality of care.