President Joe Biden wanted nursing homes to boost staffing to provide better care. But in April, a federal judge blocked those staffing requirements, ruling (ironically, in the Trump era) that regulations “must be consistent with Congress’s legislation governing nursing homes.” This summer’s big ugly budget reconciliation bill delayed implementation of the staffing rule for nine years.
This week King Don’s Department of Health and Human Services repealed the Biden rule:
The Department of Health and Human Services today repealed key provisions of the minimum staffing standards for long-term care facilities finalized in 2024.
The move follows months of legal and legislative challenges, which had already rendered hourly staffing and registered nurse requirements moot.
…Notice of the [repeal] was posted in the Federal Register Tuesday morning.
The 2024 staffing rule established a requirement for all nursing homes participating in Medicare and Medicaid to provide residents with a minimum total of 3.48 hours of nursing care per day, including at least 0.55 hours from a registered nurse per resident per day, and 2.45 hours from a nurse aide per resident per day. Providers roundly objected to those rules, saying they did not account for labor challenges or give the flexibility needed to address different resident needs.
The rule had also imposed a requirement that each facility have a registered nurse onsite all day, every day — an element that appeared impossible with the nation facing a chronic RN shortage through at least 2030 [Kimberly Marselas, “Bulletin: HHS Repeals Nursing Home Staffing Rule Provisions,” McKnight’s Long-Term Care News, 2025.12.02].
The folks making money on health care are generally pleased that Uncle Sam won’t make them provide better care:
“The [American Hospital Association] applauds CMS’ repeal of the misguided minimum staffing requirements for long-term care facilities,” said Stacey Hughes, AHA executive vice president for government relations and public policy, in a statement shared with media. “The AHA has repeatedly raised concerns that the requirements could exacerbate workforce shortages, lead to facility closures and jeopardize access to care, especially in rural and underserved communities that often do not have the workforce levels to support these requirements. The AHA appreciates the administration’s recognition that safe staffing of any health care facility has always been about clinical judgment and flexibility to meet continually evolving patient needs rather than meeting arbitrary, one-size-fits-all numbers set by regulation” [American Hospital Association, press release, 2025.12.02].
Counties also fretted that the Biden rule would have exacerbated the nursing shortage and left their aging constituents with fewer services. However, the Trump Administration isn’t doing much to expand that needed workforce. Just a couple weeks ago, the feds removed nursing from the category of “professional degrees” that can access bigger student loans. Kicking immigrants out of the country will deplete the direct care and long-term care workforce, 28% of which is immigrants. Combine that immigration crackdown with cuts to Medicaid, and the harm that the Trump Administration is doing to nursing homes overwhelms the minor relief of suspending the Biden Administration’s well-intended staffing requirements.