When the Biden administration issued its final rule related to federally imposed minimum staffing requirements for long-term care facilities (“Final Rule”) on April 22, 2024,[i] it sought to mandate minimum levels of nursing staff, requiring a 24/7 RN on-site requirement, and implementing new requirements related to facility staffing assessments.
Even before the Final Rule was issued, the proposed federal nursing home staffing mandate was already a controversial topic as the implementing agency, the Centers for Medicare and Medicaid Services (“CMS”) aimed to impose the new staffing standards without providing for any related funding to support the new requirements. At the time, the nursing home industry’s leading association, the American Health Care Association’s (AHCA) CEO, Mark Parkinson, responded to the passage of the Final Rule by saying while the Final Rule “may be well intentioned, the federal staffing mandate is an unreasonable standard that only threatens to shut down more nursing homes, displace hundreds of thousands of residents, and restrict seniors' access to care.”[ii]
The AHCA along with several other Plaintiffs including LeadingAge[iii] subsequently filed suit in the United States District Court in the Northern District of Texas[iv] seeking to overturn the Final Rule, arguing it “exceeds CMS’s statutory authority, effects a baffling and unexplained departure from the agency’s longstanding position, and creates impossible-to-meet standards that will harm thousands of nursing homes and the vulnerable Americans they serve.” On April 7, 2025, the District Court agreed with the Plaintiffs, ruling in their favor and vacating the Final Rule.[v]
The general consensus is that the Trump administration is unlikely to appeal the District Court’s decision, granting a win for nursing home operators.[vi] Even so, the nursing home industry still wants to seek workforce solutions to allow caregivers to staff the nation’s nursing homes. Cliff Porter, the current President and CEO of AHCA/NCAL called the Final Rule an “unrealistic staffing mandate,” while also continuing to call on Congress for assistance in creating “a variety of workforce solutions that would help build a pipeline of new caregivers, attract them to long term care, and develop their skills and career.”[vii]
In summary, while nursing home operators are now free from federally imposed minimum staffing requirements, the hard work continues to identify long-term solutions to caregiver staffing shortages.
[i] https://www.cms.gov/newsroom/fact-sheets/medicare-and-medicaid-programs-minimum-staffing-standards-long-term-care-facilities-and-medicaid-0
[ii] Nursing Homes React to Staffing Mandate Final Rule (ahcancal.org)
[iii] LeadingAge is an advocacy group with a membership of nonprofit aging services providers and other mission-driven organizations serving older adults. https://leadingage.org/about-us/
[iv] 2024-05-23 AHCA Complaint.pdf
[v] nursing home verdict | DocumentCloud
[vi] Court tosses Biden nursing home staffing standard
[vii] AHCA Applauds Court Vacating the Federal Staffing Mandate
