28 Pa. Code § 611.55: the complete guide to Pennsylvania's home care competency requirements

Pennsylvania has regulated home care worker competency since 2009, under Chapter 611 of Title 28 of the Pennsylvania Code. Unlike states that publish an approved training list and a compliance deadline, Pennsylvania puts the obligation squarely on the agency: decide how each worker demonstrates competency, review that competency at least once a year, and keep the evidence in the worker's file. There is no deadline to prepare for, because the rule is already in force. Here's what § 611.55 actually says.

Who must comply?

Home care agencies and home care registries licensed under Chapter 611, for each direct care worker they employ or place. The requirement attaches to the worker, not the client — every direct care worker needs their own competency record.

How does a worker demonstrate competency?

Before a direct care worker is assigned to a consumer, the agency or registry must confirm the worker has satisfied one of the routes in § 611.55(a):

1. A valid nurse's license issued in this Commonwealth. §611.55(a)(1)
2. Passing a competency examination that meets the subject-area standards in subsections (b) and (c). The agency may develop this exam itself. §611.55(a)(2)
3. Successfully completing a qualifying training program. §611.55(a)(3) This route covers several accepted programs:
   • A training program developed by the agency or registry that meets subsections (b) and (c);
   • A home health aide training program meeting the federal standard at 42 CFR 484.36;
   • A nurse aide certification program approved by the Pennsylvania Department of Education;
   • Training meeting the standards of a Commonwealth Medicaid waiver program;
   • Another program the Department identifies in the Pennsylvania Bulletin or on its website.

What subjects must an exam or training program cover?

The ten core subject areas

Any competency examination or training program used under § 611.55(a) must cover, at minimum, these subjects: §611.55(b)

1. Confidentiality
2. Consumer control and the independent living philosophy
3. Instrumental activities of daily living
4. Recognizing changes in the consumer that need to be addressed
5. Basic infection control
6. Universal precautions
7. Handling of emergencies
8. Documentation
9. Recognizing and reporting abuse and neglect
10. Dealing with difficult behaviors

Six more for personal care

If a direct care worker provides hands-on personal care, the exam or program must also cover: §611.55(c)

1. Bathing, shaving, grooming, and dressing
2. Hair, skin, and mouth care
3. Assistance with ambulation and transfer
4. Meal preparation and feeding
5. Toileting
6. Assistance with self-administered medication

Ten subject areas for every worker, sixteen for anyone doing hands-on personal care. Which set applies depends on what the worker actually does, so an agency that assigns both kinds of work needs to track both.

The annual competency review

This is the obligation agencies most often miss, because it recurs forever. Under § 611.55(e), the agency or registry must keep documentation in the worker's file showing it has reviewed that individual's competency to perform assigned duties.

Note the trigger in the third bullet. A verbal warning over a quality of care issue is enough to require an off-cycle competency review — which means your disciplinary process and your competency records have to talk to each other.

What has to be in the worker's file?

Under § 611.55(d), the agency or registry must document the worker's satisfactory completion of the competency requirements in that worker's file. In practice, that means the file should hold both halves:

• The initial qualification — a copy of the nurse's license, the passed exam, or the training completion record, depending on which route the worker took;
• Every competency review since — dated, with the method used identified.

Does competency transfer between agencies?

A note on the 2009 phase-in

Subsection (f) gave direct care workers who were already employed when the chapter took effect on December 12, 2009 until December 12, 2011 to come into compliance. That window closed long ago; it's of historical interest only, and no current worker qualifies under it.

What should agencies do now?

1. Pull every current direct care worker's file and confirm which of the § 611.55(a) routes they qualified under, and that the evidence is actually in the file.
2. Find the date of each worker's most recent documented competency review. Anything older than twelve months is a gap today.
3. Check that your exam or training program covers all ten subject areas — and sixteen for personal care workers.
4. Connect your disciplinary process to your review schedule, so a quality of care warning triggers an off-cycle review.
5. Decide how you'll accept incoming documentation from workers whose employment gap is under twelve months, instead of retraining them.

Work through this as a 10-question self-audit →

This guide summarizes 28 Pa. Code § 611.55 for general information. It isn't legal advice — consult the regulation text or a Pennsylvania attorney for your agency's specific situation. Where this page and the official text published by the Commonwealth differ, the official text controls.