Guidance Information about changes to curriculum in response to COVID-19

The Department of Public Health recognizes that, as a result of concerns related to the spread of COVID 19, your program and others are considering or facing changes to your approved curriculum.

In order to ensure that students are properly trained prior to testing for certification, our office must ensure that training programs meet the applicable requirements in state and federal regulations, including under 105 CMR 156.210(A)(2) arrangements for clinical instruction in a Level II or Level III nursing home.

In order to approve a change to your curriculum under 105 CMR 156.310(A)(2), or a change to either your classroom or clinical training site under 105 CMR 156.200(E), your request for approval must address the following considerations:

  • Classroom Training: In response to recommendations for social distancing, some programs have requested approval for distance learning in place of in-person classroom training.  A request for approval of distance learning must address the following:
    • Method for confirming the identity of individuals participating in the program
    • Method for ensuring participants actively participate in required training hours
    • The program must maintain a minimum classroom ratio of one instructor for every twenty five students, as required under 105 CMR 156.230(D).
  • Clinical Training Site: Clinical training in an appropriate setting is essential, in order to ensure that your students are properly prepared to provide care to nursing home residents and pass the certification exam.
    • Any alternate location proposed to clinical training in a nursing home must specify how the alternate location will provide realistic clinical training to students, which approximates the experience of not only the clinical tasks being taught, but socialization with residents.  
    • Regardless of the clinical training site, the program must maintain a minimum ratio of one instructor for every ten students, as required under 105 CMR 156.230(D).

Training programs are reminded that no changes should be made to an approved curriculum until the Department has reviewed and approved the requested change, and that proposed changes that do not address the above guidance may not be approved.

Should you have additional questions, please contact the Nurse Aide Registry at

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