Elder advocates say the Massachusetts Department of Public Health appears to be dragging its feet in finalizing long-awaited rules for Alzheimer’s and dementia care units in nursing homes.

In a letter sent Tuesday to the health department, the Alzheimer’s Association of Massachusetts and New Hampshire urged regulators to schedule a final vote on the rules, which would set minimum standards for dementia care in licensed nursing homes.

“There are tens of thousands of families who are impacted by the failure to have these regulations in place,” association president James Wessler said in an interview. “It’s not acceptable to delay any more.”

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State lawmakers last year approved legislation to establish the care standards, after years of lobbying by patient advocates who said a loophole in Massachusetts law allowed nursing homes to advertise special care units without any special training for workers. That law required the state health department to craft regulations and to issue those “initial” rules no later than April 2013.

The department did not unveil its proposed new rules until August. The rules require facilities to provide workers with at least eight hours of initial training to care for dementia residents, and four additional hours annually.

The rules would also require all licensed nursing homes, and not just those with special dementia units, to provide dementia-specific training for all direct-care workers, which include medical directors, nurses, social workers, dietary aides, therapists, and activities staff.

The department held a public hearing on the proposal in September, and said it expected a final vote on the rules by the end of this year.

But Dr. Madeleine Biondolillo, director of the state public health department bureau that regulates nursing homes, said in an interview Wednesday that her agency received so many suggestions and comments at the hearing, it needs more time to review the issue.

“We want to make sure that when we tackle a complicated issue like this, we take time to get it right, so that’s what we are doing,” Biondolillo said.

She said she expected regulators to vote on the final rules sometime in “early 2014,” but declined to elaborate.

The issue has been contentious, and the department held several meetings with elder advocates, patient groups, and nursing home industry leaders to try and reach a consensus before issuing the proposed rules.

Nursing home industry leaders say they agree on the need for minimum training standards but worry about how facilities will pay for it.

When the rules were unveiled in August, Scott Plumb, senior vice president of Massachusetts Senior Care, a trade association, estimated that more than 40,000 nursing facility employees would require additional training under the proposed regulations at an annual cost of “millions of dollars.”

He said the regulations come at a time when nursing homes are “being underfunded by the state Medicaid program by more than $370 million a year and have not had a rate increase in six years.”

Asked on Wednesday about the industry’s concerns, Biondolillo said that when “financially pressed organizations express concerns about potential new costs,” her department felt it important to take a closer look to ensure it has “covered all the bases.

“We are looking at everybody’s point of view, and are trying to come up with something that makes sense for patients,” she said.