Breaking: Texas Judge Blocks Biden’s Nursing Home Staffing Mandate – What It Means for Residents & Lawsuits
A federal judge in Texas has blocked the Biden administration’s nursing home staffing mandate, a ruling that has sent shockwaves through the healthcare industry and sparked a flurry of debate about the future of long-term care. This decision, handed down on April 7, 2025, has far-reaching implications for nursing home residents, facilities, and the legal landscape surrounding nursing home care. The ruling has brought uncertainty to the sector, with industry groups celebrating the decision and patient advocates expressing deep concern.
What Was the Biden Administration’s Nursing Home Staffing Mandate?
In April 2024, the Centers for Medicare & Medicaid Services (CMS) finalized a rule mandating minimum nurse staffing levels in nursing homes that receive federal funding through Medicare and Medicaid. This mandate, set to be phased in starting in 2026, aimed to address long-standing concerns about understaffing and quality of care in long-term care facilities.
The key components of the mandate included:
- 24/7 Registered Nurse (RN) Presence: Requiring nursing homes to have a registered nurse on-site 24 hours a day, seven days a week. Previously, federal law required a nursing home to employ an RN for at least eight consecutive hours per day.
- Minimum Staffing Hours Per Resident Day (HPRD): Mandating a total nurse staffing standard of 3.48 hours per resident per day (HPRD). This included a minimum of 0.55 HPRD of direct RN care and 2.45 HPRD of direct nurse aide care.
The CMS predicted that the proposed rule would require approximately 75% of all nursing homes to increase their hiring, incurring a collective expense of roughly $4 billion. However, an industry-backed analysis estimated that 94% of nursing homes would need to increase staffing, with costs potentially reaching $6.8 billion. This analysis warned that nursing homes might choose to reduce their resident numbers rather than increase hiring, potentially displacing hundreds of thousands of individuals.
Why Did the Texas Judge Block the Mandate?
Judge Matthew Kacsmaryk of the U.S. District Court for the Northern District of Texas ruled that the Department of Health and Human Services (HHS) exceeded its statutory authority in issuing the mandate. The judge agreed with the plaintiffs’ arguments that the mandate overstepped the authority granted by Congress and that the blanket minimum requirements did not account for the individual needs of residents and facilities.
Kacsmaryk focused on the parties’ arguments surrounding existing law on nursing home staffing requirements. For the 24/7 on-site requirement, that involved statute requiring facilities have “at least” eight hours of an on-site nurse. The defense argued by the HHS (under the Biden administration) had said the language was permissive of higher standards, while plaintiffs argued that it reinterpreted Congress’ intent. Similarly, on the second statute challenged by plaintiffs regarding various hour per resident day requirements, plaintiffs argued that Congress had “opted for a flexible qualitative standard” with its requirement that nursing home provide services “sufficient to meet the nursing needs of [their] residents.” The judge ruled that the blanket minimum requirements of nursing hours do not take individual residents and facilities’ needs into account, and so were not consistent with the flexibility outlined in statute.
The judge did not strike down the entire final rule but vacated the two provisions related to a 24/7 on-site nurse and minimum nursing hours per resident per day that were challenged by the plaintiffs.
What Does This Mean for Nursing Home Residents?
The ruling has created uncertainty about the level of care residents can expect in the future.
Potential Negative Impacts:
- Continued Understaffing: Without the mandate, some fear that nursing homes may continue to operate with inadequate staffing levels, leading to neglect, increased risk of injuries like falls and bedsores, and a decline in the overall quality of care. Studies have shown that inadequate staffing can lead to residents lying in feces because no one comes to attend to them and being subjected to chemical and physical restraints to sedate and pacify them.
- Facility Closures: Some argue that the mandate was unrealistic and would have forced many facilities to close, particularly in rural areas, limiting access to care for vulnerable seniors.
- Displacement of Residents: Concerns were raised that facilities might reduce their census to comply with the mandate, potentially displacing a significant number of residents.
Potential Positive Impacts:
- Flexibility for Facilities: The ruling allows nursing homes to maintain flexibility in staffing decisions, tailoring their approach to the specific needs of their residents and the resources available to them.
- Focus on Individualized Care: Some believe that rigid staffing mandates are not the best way to improve care and that a more individualized approach, taking into account the unique needs of each resident, is preferable.
What Are the Lawsuits Involved?
The Texas ruling stems from consolidated lawsuits filed by the American Health Care Association (AHCA), the Texas Health Care Association (THCA), and Texas Attorney General Ken Paxton. These lawsuits argued that the mandate exceeded the CMS’s statutory authority and was unrealistic given the current costs of nursing labor. Twenty-one other states had also joined the challenge against the federal minimum staffing mandate.
The lawsuits also claimed that the Department of Health and Human Services violated the “major questions doctrine” by imposing an estimated $4.3 billion of costs per year on nursing homes across the U.S. without statutory authorization.
What Happens Next?
The future of nursing home staffing requirements remains uncertain. The Biden administration could appeal the Texas ruling, potentially setting the stage for a legal battle that could reach the Supreme Court. Alternatively, the administration could work with Congress to develop new legislation that addresses the issue of nursing home staffing levels.
Potential Outcomes:
- Appeals Process: The Biden administration may appeal the ruling to a higher court.
- Congressional Action: Congress could step in to legislate on the matter, potentially creating new federal standards for nursing home staffing.
- State-Level Regulations: States may choose to implement their own staffing requirements, leading to a patchwork of regulations across the country.
The Role of Nursing Home Abuse Lawyers
In the wake of this ruling, nursing home abuse lawyers play an increasingly important role in protecting the rights of residents and their families. These attorneys can:
- Investigate Claims of Neglect and Abuse: Attorneys can investigate cases of suspected neglect or abuse in nursing homes, gathering evidence to support claims of inadequate care due to understaffing or other factors.
- Advocate for Residents’ Rights: They can advocate for residents’ rights, ensuring that facilities are held accountable for providing a safe and healthy environment.
- Pursue Legal Action: If neglect or abuse is found, attorneys can pursue legal action against the facility to recover damages for the resident’s injuries and suffering.
- Provide Guidance and Support: Nursing home abuse lawyers can provide guidance and support to families navigating the complex legal and regulatory landscape of long-term care.
Do you suspect a loved one has suffered from neglect or abuse in a nursing home? Contact a qualified attorney to discuss your legal options and protect your loved one’s rights.