Nevada caregiver training: topics before the first client, 8 hours a year after

A copy of the rules

Each attendant must "obtain a working knowledge of the provisions of this chapter which govern the licensing of agencies before providing personal care services to the clients of the agency", and "The agency must provide a copy of those provisions to an attendant before the attendant may provide personal care services to the clients of the agency." (NAC 449.3977(1)(a)).

Which copy. The compiled code on the Legislature’s website does not yet show R089-24’s changes of February 27, 2026 (compiled NAC 449; R089-24). By our reading, a copy that leaves those changes out would mislead attendants about medication, nail care and appointments, so give them the compiled text together with R089-24, or a version that includes it. CareRulebook’s manual gives the compiled text with the R089-24 sections that changed it.

Signed or not. HCQC’s workbook is not consistent. Its index asks you to "Include Attendants’ Signed Statement they have received, read and understood the provisions of this chapter." (workbook index, P0150), while the tag itself accepts a policy or an acknowledgement form and adds "Signed statement not required." (tag P0150). Our suggestion: have each attendant sign a short acknowledgement; it satisfies both readings.

Competency evaluation

"Each attendant of an agency must be evaluated and determined to be competent by the agency in the required areas of training" set out in NAC 449.3977(1)(c) (NAC 449.3977(2)). For this tag HCQC’s workbook expects "Competency Evaluation or Examination after initial PCA training." (workbook, P0155).

Experienced hires. The administrator or designee "shall evaluate the competency of an attendant in each competency area required by the agency if the attendant provides written proof of his or her current or previous training", and after that first evaluation, further training can be limited to the areas where the attendant needs to improve (NAC 449.3976(3)). By our reading, earlier training still needs to fall within the 12 months before the first client to count toward NAC 449.3977(3), and CareRulebook’s manual counts it only then. The evaluation itself is Policy 4.7.

First aid and CPR

Each personnel file holds proof that the attendant is certified in first aid and CPR within 6 months of starting work (NAC 449.3976(1)(f), as amended by R089-24). Since February 27, 2026, the course can be:

• in person;
• blended, with the hands-on skills part in person; or
• fully virtual, "if interactive, hands-on skills training or skills verification is not prerecorded." (R089-24 section 2(1)).

The Division accepts certificates from the American Red Cross, the American Heart Association, the Health and Safety Institute or a similar nationally recognized organization (R089-24 section 2(2)). Staff whose CPR certification did not meet the new rule had 180 days from February 27, 2026 (to late August 2026) to recertify. (R089-24 section 88(2))

Six months, or before the first client?

The initial training program also includes first aid and CPR training "that culminates in the attendant being certified in first aid and cardiopulmonary resuscitation" (NAC 449.3977(1)(c)(5), as amended by R089-24), and that program comes before the attendant works alone (NAC 449.3977(1)(b)). By our reading, the 6 months is the outside limit for the file, and the safer course is certification before the first client. CareRulebook’s manual does that. Whether HCQC reads the two rules the same way is on our list of questions for HCQC.

HCQC’s workbook is older. It still says the course "must have in-person skills demonstration component" (HCQC workbook). The workbook is dated 12.2024, before R089-24; by our reading, a fully virtual course with live, interactive skills verification now meets the rule. If you want no argument at a survey, choose a course with in-person skills.

Protection in an emergency. An agency employee who has completed a CPR or first aid course and in good faith gives emergency care to an elderly person or a person with a disability, in line with that training, is not liable for civil damages short of gross negligence. (NRS 449B.470)

Elder abuse training

NRS 449B.225 covers everyone in the chain:

• The applicant. The applicant (for a company, the person in charge) completes training to recognize and prevent abuse of older persons before the license is issued, then yearly before each renewal. (NRS 449B.225(1)-(3)) An applicant who completed the training within the year before applying, and includes evidence with the application, has met the before-licensing requirement. (NRS 449B.225(1))
• The administrator and every caregiver. The administrator before the agency provides care, and every employee who provides care before their first client, then every year. The agency pays for it. (NRS 449B.225(4)-(7)) HCQC’s workbook lists "Initial and Annual Elder Abuse training(NRS 449.093)" before client contact, under the section’s old number (HCQC workbook).
• What it covers. The training covers recognizing and responding to abuse of older persons, including sexual abuse and the NRS 200 offenses, and the laws on elder abuse and on personal care agencies, with any changes. (NRS 449B.225(6))
• Where to take it. HCQC’s Training & Education page links an Elder Abuse/Adult Protective Services course. (HCQC, Training & Education) The statute does not require that course; any training that covers the topics meets it, by our reading.
• Enforcement. The licensee makes sure everyone required completes the training, and the Division may take disciplinary action for any violation. (NRS 449B.225(8)) Each renewal includes a statement that the licensee, administrator and employees have completed it (NRS 449B.210(2)).

The statute says "employee". The NAC training rules apply to every attendant, and an attendant can be an employee or a contractor (NAC 449.3963). By our reading, contracted attendants should take elder abuse training too; CareRulebook’s manual includes them. How to report abuse is on the Nevada hub guide.

Infection control training

Each unlicensed caregiver completes evidence-based infection control training from a nationally recognized organization every year, covering hand hygiene, PPE, cleaning and disinfection, the goals of infection control, how pathogens spread and source control. (R063-21 section 4(1))

• Who. For the infection control training, an unlicensed caregiver is a person who gives care and is not required to hold, and does not hold, a professional license or certificate under title 54 of NRS. (R063-21 section 2) Personal care attendants usually hold no such license, so it applies to them.
• Proof. Each caregiver gives proof of completing the infection control training to the administrator or other person in charge. (R063-21 section 4(2)) The administrator documents each caregiver’s completion in the personnel file and makes sure the best practices taught are used at the agency where appropriate. (NRS 449B.220(3)(a)-(b))
• Free courses. HCQC offers two free options with certificates: its own course or listed CDC modules. It says "the unlicensed caregiver infection control training requirement is based on topics, not a set number of hours" (HCQC, Unlicensed Caregiver Infection Control Training). HCQC says its own infection control course needs a NEOGOV account, which may take a few days, and takes under 30 minutes. (same page)
• When for new hires. The rule says "annually" and does not say whether a new caregiver must finish it before the first client. CareRulebook’s manual sets it within 12 months of starting work, and its Recommended practice books it in the first weeks.

A different, longer course for one person. HCQC’s workbook also expects a named infection control staff member and designee with 15 hours of training, citing NAC 449.0109 (HCQC workbook). That section is written for facilities for the dependent, not personal care agencies (NAC 449.0109), so we label it as HCQC’s survey expectation rather than a rule.

Cultural competency training

Staff who give care or support with direct client contact at least weekly on average, and their supervisors, complete an approved cultural competency course within 90 days of hire and at least 2 hours every two years. Staff who take such a course for their own license renewal are exempt. (NAC 449.011931(1), as amended by R004-24; NRS 449B.280(2)-(3))

• Phone contact counts. Direct client contact means contact "which is in person or using telephone, electronic mail or other electronic means, except that the term does not include incidental contact" (NRS 449B.280(7)). By our reading, a scheduler who phones clients every week needs the course as well as the attendants.
• What it covers. The training helps staff understand clients of different racial, ethnic and religious backgrounds, sexual orientations and gender identities or expressions, children and seniors, and people with disabilities. (NRS 449B.280(1))
• Approved courses only. The course must be approved by the Nevada Health Authority. HCQC lists approved third-party courses, and an agency may apply to have its own course approved. (NRS 449B.280(4), (6)) The Authority must approve or deny an agency’s own course within 10 business days of receiving the application (NRS 449B.280(6)).
• No borrowing. HCQC says courses approved for a particular facility are approved for that organization only and cannot be used elsewhere. (HCQC, Cultural Competency) Use a course on HCQC’s third-party list, or your own once approved.
• Proof. HCQC says facility inspectors check employee files for proof of cultural competency training. (HCQC, Cultural Competency) Keep proof of completion, or of the professional license that makes someone exempt, in the personnel file (NAC 449.011931(3)-(4)).

The 8 hours a year

Each attendant must "receive annually not less than 8 hours of training related to providing for the needs of the clients of the agency" (NAC 449.3975(6)).

• What counts. The rule says only "related to providing for the needs of the clients". It does not say whether the yearly elder abuse, infection control or medication courses count toward the 8 hours, and HCQC has not published guidance. By our reading they do, because each relates to clients’ needs; CareRulebook’s manual counts them and adds hours if HCQC says otherwise.
• Which year. The rule says "annually" without saying whether that means a calendar year or 12 months from the start date. CareRulebook’s manual uses each attendant’s anniversary of starting work.
• How to record it. For each course: a description of the content, the date, the hours, the instructor’s name and signature, and a certificate of completion (NAC 449.3976(1)(i), (2)).

Medication assistance and health tasks

Medication (only if you offer it)

Since February 27, 2026, an attendant may assist with medication (including over-the-counter medicines and supplements) if there is a written agreement where the law requires one, the attendant has completed the required training, and the medication is prescribed or ordered and given per the practitioner’s written instructions. (R089-24 section 14(1))

• Before assisting. Before assisting with medication, an attendant completes at least 16 hours of medication management training from a Division-approved course and gets a certificate, then at least 8 hours a year. (R089-24 section 14(2))
• Every year. The attendant must "provide the agency with satisfactory evidence of the content of the training and his or her successful completion of the training" (R089-24 section 14(2)(b)).
• The agency’s part. An agency whose attendants assist with medication develops a training program and keeps a record for each client: medication type, date and time given, refusals or missed doses, and current instructions from the practitioner. (R089-24 section 14(3))
• Which courses. R089-24 ties the attendant medication course to the approved courses for residential facilities for groups (LCB File No. R043-22). HCQC’s medication management page is still written for group homes. (HCQC, Medication Management; R089-24)

More on what attendants may do since R089-24 is on what Nevada attendants may and may not do; CareRulebook’s manual covers it in Policy 2.4.

Vital signs, blood glucose tests and insulin pens

Before doing these tasks, each year after, and whenever the device changes, the attendant is trained and shows understanding, follows the manufacturer’s instructions and meets CLIA rules where they apply. Trainers are a physician, PA, licensed nurse, pharmacist (insulin and glucose) or an experienced trained employee. (NAC 449.39775(1), (7)) These tasks, and weighing a client, are the only ones for which the rules name who may train attendants; medication training instead comes from a Division-approved course. CareRulebook’s manual covers them in Policy 2.3.

Health certificate and TB tests

NAC 449.3976(1)(c) brings the TB rule for health facilities into each attendant’s personnel file (NAC 449.3976(1)(c)).

• Before starting. Attendant files must show the tests and certificates NAC 441A.375 requires: before starting, a physical examination or health care provider certificate that the person is free of active TB and other communicable disease, and a TB screening test within the past 12 months. (NAC 441A.375(3)) If only the first step of a 2-step Mantoux skin test was done in the past 12 months, the second step or another single-step test is given. (NAC 441A.375(3))
• Every year. Then a TB screening test within 12 months after the month the job offer was accepted, and every year after, unless a documented risk assessment allows less often. (NAC 441A.375(4)) The exception is a decision by the facility’s medical director or designee, documented every year. Personal care agencies usually have no medical director, so by our reading the yearly test is the safe course; CareRulebook’s manual tests every year.
• A past positive test. Someone with a documented positive TB screening test has a chest X-ray (or shows one) within 6 months of starting and is declared free of TB disease. (NAC 441A.375(5))
• HCQC’s course. HCQC’s Training & Education page lists a course on tuberculosis testing for Nevada health facilities. (HCQC, Training & Education)

HCQC’s workbook lists "Pre-employment Physical Clearance and TB Testing" among the personnel file items it checks (workbook, P0130). CareRulebook’s manual covers this in Policy 4.5.

Who pays, and the records

• The agency pays. The agency provides or arranges the required training, pays the course cost and, for training away from the agency, the travel cost, and pays staff their wage for training time and the usual travel time. It need not pay the course and travel costs for an employee who attends but fails to complete a course; the wage rule has no such exception (NAC 449.39735(1), (4)). Elder abuse training is the agency’s cost by statute too (NRS 449B.225(7)).
• Training on your premises. An agency that trains on its own premises, meets the rules and pays all costs need not arrange or pay for training elsewhere. (NAC 449.39735(2))
• Medicaid. Nevada Medicaid’s personal care rate already covers basic training, in-service requirements and CPR and first aid; they are not reimbursed separately. (MSM 3503.7)
• The records. Completion documents go in the personnel file (NAC 449.39735(5)), with the content, date, hours, instructor’s name and signature and a certificate for each course (NAC 449.3976(2)). The Division may review personnel files on request (NAC 449.3976(4)).