20 States Could Block Federal Nursing Home Staffing Rule, Joint Lawsuit Filed

In a significant development for the nursing home industry, 20 states have joined forces to sue the U.S. federal government over new minimum staffing requirements for nursing homes. This legal challenge represents a major pushback against the Biden administration’s efforts to improve care quality in long-term care facilities.

The Controversy Surrounding New Staffing Mandates

The lawsuit centers on recently imposed federal rules that mandate higher staffing levels in nursing homes across the country. These new requirements, put forth by the Biden administration, aim to address longstanding concerns about understaffing and quality of care in long-term care facilities. However, the states involved in the lawsuit argue that these mandates are not only unwarranted but also excessively burdensome for nursing homes to implement.

At the heart of the controversy is the question of whether federal intervention in this manner is necessary or appropriate. The states contend that the new staffing requirements could lead to significant financial and operational challenges for nursing homes, potentially compromising their ability to provide care rather than improving it.

The coalition of states challenging the federal government’s nursing home staffing mandate is diverse and widespread. Initially, 19 states joined the lawsuit, including,

• Iowa
• Nebraska
• Kansas
• South Carolina
• Alabama
• Alaska
• Arkansas
• Florida
• Georgia
• Idaho
• Indiana
• Kentucky
• Virginia’s 

The staffing rule, announced by the Center for Medicare and Medicaid Services in April 2024, requires nursing homes to have a registered nurse on-site for at least eight hours per day, seven days a week. Additionally, it mandates specific staffing levels for other nursing staff, such as licensed practical nurses and certified nursing assistants. The rule is aimed at improving the quality of care in nursing homes by ensuring adequate staffing levels.

According to the CMS website, long-term care facilities (LTC) must adhere to the following rules:

• Minimum Direct Nursing Care Requirement: Facilities must provide at least 3.48 hours per resident day (HPRD) of direct nursing care.
• Registered Nurse (RN) Care: At least 0.55 HPRD must be provided by registered nurses (RNs).
• Nurse Aide Care: At least 2.45 HPRD must be provided by nurse aides.
• Flexible Staffing: The remaining 0.48 HPRD required to meet the total 3.48 HPRD standard can be fulfilled using any combination of nursing staff, including RNs, licensed practical nurses (LPNs), licensed vocational nurses (LVNs), or nurse aides.

Legal Arguments and State Concerns

The attorneys general from the participating states have raised several key arguments against the federal staffing mandate. Chief among these is the contention that the new requirements are not feasible given the current healthcare workforce landscape. Many states argue that meeting the new federal standards could be practically impossible in some rural regions.

Furthermore, the lawsuit challenges the federal government’s authority to impose such sweeping changes on nursing homes, which have traditionally been regulated primarily at the state level. The states argue that this mandate represents an overreach of federal power and fails to account for the diverse needs and resources of different states and communities.

Potential Impacts on Nursing Home Care and Access

One of the primary concerns raised by the states in their lawsuit is the potential negative impact on nursing home care and accessibility. While the federal government’s intention is to improve care quality through increased staffing, the states argue that the mandate could have unintended consequences.

There are fears that the financial burden of meeting these new staffing requirements could force some nursing homes to close, particularly in rural or underserved areas. This could potentially reduce access to long-term care for vulnerable populations, especially in regions already struggling to meet healthcare needs.

Additionally, the states contend that the new staffing requirements may not necessarily translate to better care outcomes. They argue that a one-size-fits-all approach fails to account for the unique needs of different facilities and patient populations, potentially diverting resources from other important aspects of care.

The Road Ahead: Legal Proceedings and Policy Implications

As this lawsuit progresses through the legal system, it could have significant implications for nursing home policy and regulation across the United States. The outcome of this case could set important precedents regarding the balance of federal and state authority in healthcare regulation, particularly in the long-term care sector.