Biden’s Nursing Home Staffing Standards: What Led to the Trump Administration’s Withdrawal?
The quality of care in nursing homes is a critical concern for the elderly and their families. In 2024, the Biden administration finalized a rule mandating minimum staffing levels in nursing homes, aiming to improve resident safety and quality of care. However, this regulation faced strong opposition, culminating in its repeal by the Trump administration in December 2025. This blog post will delve into the specifics of Biden’s nursing home staffing standards and explore the reasons behind the Trump administration’s decision to withdraw them.
The Push for Minimum Staffing Standards
For decades, concerns about inadequate staffing in nursing homes have persisted. Studies have consistently shown a strong correlation between staffing levels and resident outcomes. Insufficient staffing can lead to various issues, including:
- Increased risk of falls and injuries
- Development of bedsores due to infrequent turning
- Poor hygiene and sanitation
- Medication errors
- Neglect of basic needs such as feeding and hydration
- Higher rates of infection
The COVID-19 pandemic further highlighted the importance of adequate staffing, as nursing homes with insufficient staff experienced higher infection and mortality rates. In February 2022, President Biden announced his Action Plan for Nursing Home Reform, which included establishing minimum staffing requirements. This plan was motivated by data showing that over 200,000 nursing home residents and staff died from COVID-19.
Key Provisions of Biden’s Nursing Home Staffing Standards
The final rule, published by the Centers for Medicare & Medicaid Services (CMS) in May 2024, mandated the following:
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Minimum Nursing Hours Per Resident Day (HPRD): A total of 3.48 HPRD, including:
- 0.55 HPRD of direct registered nurse (RN) care
- 2.45 HPRD of direct nurse aide care
- The remaining 0.48 HPRD could be fulfilled by any combination of RNs, licensed practical nurses (LPNs), or nurse aides.
- 24/7 Registered Nurse (RN) Presence: Nursing homes were required to have a registered nurse on-site 24 hours a day, seven days a week, to provide skilled nursing care.
CMS provided a phased implementation timeline, with urban facilities given two years and rural facilities three years to comply with certain parts of the rule. The agency also announced an investment of over $75 million in financial incentives, such as scholarships and tuition reimbursement, to build the future nursing workforce.
Industry and Political Opposition
Despite the Biden administration’s efforts, the staffing mandate faced significant opposition from nursing home industry groups and Republican lawmakers. The primary arguments against the rule were:
- Financial Burden: Industry groups argued that the mandate would be too costly to implement, particularly for smaller and rural facilities. CMS estimated the rule could cost the industry between $1.5 billion and $6.8 billion, while other analyses placed the figure even higher.
- Workforce Shortages: Opponents claimed that a nationwide shortage of nurses and nurse aides would make it impossible for many facilities to meet the staffing requirements, potentially leading to facility closures and reduced access to care, especially in rural and underserved communities.
- Lack of Flexibility: Critics argued that the “one-size-fits-all” mandate failed to account for the unique needs and circumstances of individual facilities and residents.
- Overreach of Authority: Some argued that CMS lacked the statutory authority to impose such rigid staffing requirements, claiming that Congress, not federal agencies, should set these standards.
Several lawsuits were filed against the mandate, with plaintiffs arguing that CMS had overstepped its authority and skirted administrative law principles. In April 2025, a federal judge in Texas struck down key provisions of the rule, including the 24/7 RN requirement and the per-resident minimum hours, ruling that HHS had exceeded its statutory authority.
The Trump Administration’s Withdrawal
In December 2025, the Trump administration officially repealed the Biden-era staffing standards. The Department of Health and Human Services (HHS) cited several reasons for the withdrawal, including:
- The disproportionate burden on rural and tribal communities
- The potential for jeopardizing patients’ access to care
- The legal challenges and court rulings against the mandate
- The passage of the One Big Beautiful Bill Act, which included a 10-year pause on enforcing the mandate
HHS Secretary Robert F. Kennedy Jr. stated that “rigid, one-size-fits-all mandates fail patients” and that the administration would “safeguard access to care by removing federal barriers – not by imposing requirements that limit patient choice.” CMS Administrator Mehmet Oz echoed these sentiments, emphasizing the need for “smarter, more practical solutions that truly work for the American people” and acknowledging the “daily realities facing rural and underserved populations.”
Reactions to the Repeal
The repeal of the staffing mandate was met with mixed reactions. Nursing home industry groups praised the move, arguing that it recognized the “very real barriers” they face in recruiting and retaining staff. The American Hospital Association (AHA) also applauded the repeal, expressing concerns that the requirements could “exacerbate workforce shortages, lead to facility closures, and jeopardize access to care.”
However, nursing home consumer groups and patient advocates expressed disappointment. Sam Brooks, director of public policy for the National Consumer Voice for Quality Long-Term Care, stated that the rescission repeated “often-debunked lines from the nursing home industry that there are not enough staff and that rural facilities will be harmed,” arguing that the rule had sufficient exceptions for facilities with legitimate hiring challenges.
The Ongoing Debate
The withdrawal of Biden’s nursing home staffing standards highlights the ongoing debate surrounding the best way to ensure quality care for the nation’s elderly. While advocates argue that minimum staffing requirements are essential to protect residents from neglect and abuse, industry groups contend that such mandates are unrealistic and unsustainable.
Several factors contribute to the complexity of this issue:
- Funding: Nursing home care is primarily funded through Medicaid, which often reimburses at rates that are insufficient to cover the costs of adequate staffing.
- Workforce: A shortage of qualified nurses and nurse aides makes it difficult for facilities to attract and retain staff, particularly in rural areas.
- Oversight: Lax enforcement of existing regulations has allowed some facilities to operate with inadequate staffing levels, compromising resident care.
Moving forward, policymakers must consider these factors and work collaboratively to develop solutions that address the challenges facing the nursing home industry while prioritizing the safety and well-being of residents. This may involve exploring alternative approaches, such as:
- Incentivizing facilities to increase staffing levels through higher reimbursement rates
- Investing in training and recruitment programs to expand the pool of qualified caregivers
- Strengthening oversight and enforcement of existing regulations
- Adopting innovative models of care that improve efficiency and quality
Ultimately, ensuring quality care in nursing homes requires a multifaceted approach that addresses the complex interplay of funding, workforce, and regulatory factors.