The North Dakota Monitor reported the critical need for safe staffing levels. The Biden administration’s newly implemented staffing standards for nursing homes mark a long-overdue effort to address systemic neglect in the industry. These standards require at least 0.55 hours (33 minutes) of RN care per resident per day and 2.45 hours (2 hours and 27 minutes) of CNA care per resident per day, as well as mandate 24/7 on-site RN coverage. Previous peer-reviewed articles and studies state you need at least 4.1. hours of direct nursing care per patient day to prevent neglect and abuse. The new staffing rule allows flexibility for LPN hours based on the needs and acuity of the residents.
Rural or underserved facilities may apply for waivers if they cannot meet these requirements. These waivers would allow them to temporarily avoid compliance with the staffing mandates. However, facilities must provide clear evidence demonstrating that compliance is unfeasible due to specific challenges beyond their control. These mandates are not ambitious demands, and the inclusion of waivers for rural and underserved facilities already addresses genuine challenges, ensuring these areas are not unfairly penalized.
As this article highlights, despite the clear need for these changes, the nursing home industry and 20 industry backed Republican state attorneys general filed a lawsuit to block safe staffing requirements. However, their arguments hold little weight when scaled against the landscape of a multibillion-dollar industry with a long history of prioritizing profits over care. Many of these same facilities are owned by companies that have funneled taxpayer dollars into administrative overhead or affiliated entities instead of reinvesting in staff or care quality. The notion that facilities cannot afford to meet these standards often reflects their own mismanagement rather than actual financial or situational impossibility.
Advocates like the National Association of Long Term Care Ombudsmen (NALTCO) arguing that these standards are essential to protect residents who have borne the brunt of this systemic neglect is extremely important. The federal court’s recent decision to deny the injunction requested by the nursing home industry highlights the nationwide mistrust and skepticism of nursing home ownership, as well as a lack of evidence supporting claims that the standards would lead to “widespread closures”. The court sided with advocates, recognizing the new standards as critical for ensuring proper care to all.
The nursing home industry’s resistance to these changes reflects an unwillingness to invest in the very populations they are entrusted to care for. This fight is not just about staffing, but rather about holding an industry accountable for decades of neglect and systemic failure. These requirements don’t demand luxury care or extensive upgrades but rather ask for the bare minimum necessary to prevent harm and provide residents with basic human decency. These reforms are a necessary step toward providing the level of care every nursing home resident needs and deserves.
As I read this McKnights’
article, I realized I had overlooked a crucial element in the request for an injunction to block Biden’s new staffing mandate: the potential influence of the incoming Trump administration. This adds a whole new layer of deceptiveness that the request for an injunction was partly motivated by a desire to delay the rules until Trump takes office.
The Trump administration’s first term was characterized by widespread deregulation, particularly in healthcare and other industries where profit-driven interests have long pushed back against oversight. Nursing home operators have a history of resisting reforms, and many likely saw the return of Trump as an opportunity to roll back Biden-era mandates. They can reasonably anticipate that the new administration will either weaken or entirely eliminate the Biden-era staffing requirements, aligning with their interests in reducing costs and avoiding strict oversight.
The timing of the injunction suggests that the nursing home industry and the supporting state attorneys general were aware of the potential for the new administration to halt or likely even reverse the regulations if they could delay them long enough. The issue is that this mandate falls within the Congressional Review Act (CRA), which allows Congress to review and potentially overturn regulations finalized within 60 legislative days of adjournment. Therefore, the future of the staffing mandate will depend on the legislative priorities and decisions of the new Congress and Trump administration. Facilities might begin adjusting their staffing plans in response to the mandate, but this could be halted abruptly if the CRA is invoked to repeal the rule.
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