Health officials are rolling out regulations to implement a 2024 law legalizing the use of certified medication aides in long-term care facilities, rules that supporters say will help address severe staffing shortages but that nurses are still wary could put patients at risk.

“As Massachusetts continues to face a historic health care workforce crisis, particularly in the nursing facility sector that has nearly 5,000 vacant caregiving positions, this regulation offers timely, responsible and safe standards for implementing the certified medication aide role,” Susan Misiorski, testifying for the Massachusetts Senior Care Association, said at a public hearing on the regulations on Monday.

A 2024 long-term care law authorized the Department of Public Health to create a regulatory framework for the training, certification and oversight of a new category of health care worker: a certified medication aide (CMA).

These workers will be certified to work in long-term care facilities and administer non-narcotic medications to residents under the supervision of a licensed nurse or physician.

The regulations released in July include safeguards such as evaluations every six months by a licensed nurse or physician, continuous training requirements, requirements for recertification every two years, and conduct and disciplinary provisions. In order to be certified, a CMA would have to apply, complete a training program and pass an exam.

Additionally, the rules create a new intermediary position to enable certified nurse aides to gain additional training and take on more responsibilities, meant as an opportunity to facilitate career growth, according to the department’s regulations.

“Certified medication aides will be viewed as welcome relief to overburdened registered nurses (RNs) and licensed practical nurses (LPNs), who are currently the only personnel allowed to administer medications in Massachusetts long-term care facilities,” says the department’s regulation document.

It continues, “Certified medication aides in long-term care facilities will be viewed as allowing for a more efficient use of licensed nursing staff, with an ultimate outcome of improving the overall quality and safety of resident care, as well as significantly increasing staff satisfaction. Certified medication aides will also allow nurses to spend more time on resident clinical assessments, treatments, and other necessary skilled nursing services.”

Medication aides are used in 35 states, including every other New England state, according to the DPH. They say the aides may “help address the growing workforce crisis impacting long-term care providers.”

Massachusetts Senior Care Association, LeadingAge Massachusetts and Dignity Alliance Massachusetts have advocated for these reforms for years, the department said, and representatives from the senior care group and LeadingAge testified in support of the reform at Monday’s hearing.

Nurses have resisted the change.

Massachusetts Nurses Association Director of Nursing Betty Sanisidro said the union “strongly opposed... allowing medication administration by unlicensed personnel.”

“Many long-term care patients have complex medical needs that require clinical assessment before, during and after medication administration, something CMAs are not trained or qualified to perform,” she said.

However, in the wake of the law’s passage last year, Sanisidro said the union is now offering recommendations to tighten the regulations.

The MNA recommends all CMA training include theoretical instruction, practical training and a formal competency evaluation, she said. Training should be reviewed every two years and integrated into a nationally accredited certification program.

“We’re also concerned about the liability supervisors may face,” Sanisidro said. “RN supervisors should not bear the burden of liability for the actions of unlicensed personnel. Safeguards must be in place to protect their professional licensure from undue disciplinary action.”

Regarding CMAs who move from another state and would like to continue work in Massachusetts, Sanisidro said reciprocity should be limited to individuals who have completed a nationally accredited program to ensure “consistency in training and competency across states.” Additionally, she added that any reciprocity granted should be temporary for only a year, allowing people to meet Massachusetts’s standards.

“Long-term care patients are among the most medically vulnerable. As their needs grow more complex, we must ensure their care is delivered with the highest clinical oversight and responsibility; the safeguards we propose, rigorous training, restricted reciprocity, qualified supervision and clear liability protections are not optional. They are essential to preserving the safety, dignity and well being of our elders and to protecting the integrity and licenses of the professionals entrusted with their care,” Sanisidro said.

Elissa Sherman of LeadingAge Massachusetts testified Tuesday asking for small adjustments to the rules.

“We are in strong support of the requirement that prohibits certified medication aides from administering any narcotics, and also believe that medication aides should not be involved in administering any injectable medications like insulin. So we ask the department to clarify that restriction of medication aides from giving medications like Coumadin, which require specific lab work, review of the lab work and use of nursing assessment skills,” Sherman told officials with the Executive Office for Administration and Finance and the Department of Public Health’s Drug Control Program.

Additionally, Sherman raised concerns about Level IV rest homes, which provide provide 24-hour supervision and supportive services for individuals who don’t routinely need nursing or medical care.

“LeadingAge Massachusetts had been previously assured by department staff that the certified medication aide program was not intended for rest homes. However, the regulations are silent regarding Level IV facilities. Rest homes rely on a model of responsible persons to administer medications, which has been in operation successfully for many decades. We want to ensure that rest homes will continue to be able to operate under the current requirements,” she said.

Sherman said she looks forward to working with the department to refine the rules, believing that clear safeguards will help make long-term care facilities more efficient and ease the workforce crisis.