CMS Rescinds Nursing Home Staffing Mandate: Access to Care vs. Quality Standards

The Centers for Medicare & Medicaid Services (CMS) has recently rescinded key parts of the 2024 minimum staffing rule for nursing homes, igniting a debate about balancing access to care and maintaining quality standards. This decision, finalized in December 2025, rolls back requirements for minimum hours of nursing care per resident day and 24/7 on-site registered nurse (RN) services. This move has been met with both praise from industry groups and strong opposition from resident advocates, raising critical questions about the future of long-term care in the United States.

The Staffing Mandate: A Brief Overview

The 2024 staffing mandate aimed to address long-standing concerns about inadequate staffing levels in nursing homes, which have been linked to poorer resident outcomes. The rule stipulated that nursing homes participating in Medicare and Medicaid must provide a minimum of 3.48 hours of nursing care per resident per day (HPRD), including 0.55 hours from a registered nurse and 2.45 hours from a nurse aide. It also required a registered nurse to be present in the facility 24 hours a day, seven days a week.

These requirements were intended to ensure that residents receive adequate care, reduce the risk of adverse health outcomes, and improve the overall quality of life in nursing homes. Researchers at the University of Pennsylvania had estimated that implementing the staffing rule could save 13,000 residents’ lives each year and reduce adverse health outcomes.

The Rescission: Rationale and Key Changes

On December 2, 2025, CMS issued an interim final rule (IFR) repealing key components of the staffing mandate. The IFR specifically rescinds the implementation of the 24/7 on-site registered nurse requirement and the specific minimum number of nursing hours per resident per day requirements. However, the requirement for facilities to conduct enhanced assessments of resident needs remains in place.

CMS justified the rescission by citing concerns about the mandate’s impact on access to care, particularly in rural and underserved communities. The agency argued that the “one-size-fits-all” approach of the mandate would disproportionately burden facilities already facing workforce shortages and financial constraints, potentially leading to facility closures and reduced admissions. 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.”

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL), which represents nursing homes and long-term care facilities, had long fought the federal rule. They argued that the mandate was unrealistic and potentially damaging to an already strained industry.

Access to Care vs. Quality Standards: The Central Debate

The rescission of the staffing mandate has reignited the debate about the balance between access to care and quality standards in nursing homes.

Arguments for Rescission (Prioritizing Access):

Workforce Shortages: Nursing homes, particularly in rural areas, are facing severe workforce shortages, making it difficult to meet the staffing requirements of the mandate.
Financial Burden: The mandate would impose significant financial costs on facilities, potentially leading to closures, especially for those operating on thin margins.
Reduced Admissions: To comply with the mandate, some facilities might have to reduce admissions, limiting access to care for seniors in need.
Flexibility: A rigid mandate removes the flexibility needed for facilities to tailor staffing levels to the specific needs of their residents.

Arguments Against Rescission (Prioritizing Quality):

Resident Safety: Minimum staffing levels are essential for ensuring resident safety and preventing neglect or abuse.
Quality of Care: Adequate staffing is directly linked to improved quality of care, including reduced rates of infections, pressure ulcers, and other adverse outcomes.
Staff Burnout: Insufficient staffing levels can lead to staff burnout and turnover, further compromising the quality of care.
Accountability: Minimum standards provide a benchmark for accountability and help ensure that facilities are providing adequate care.

Potential Implications and Future Directions

The rescission of the staffing mandate could have several potential implications for the long-term care industry and the residents it serves:

Increased Risk of Neglect and Abuse: Without minimum staffing standards, there is a risk that some facilities may prioritize cost savings over resident care, leading to neglect or abuse.
Worsening of Existing Disparities: The rescission could exacerbate existing disparities in access to quality care, particularly for residents in rural and underserved areas.
State-Level Action: In the absence of a federal mandate, some states may choose to implement their own minimum staffing requirements.
Focus on Alternative Solutions: The debate over the staffing mandate may spur greater focus on alternative solutions to improve quality of care, such as investing in workforce development, improving staff training, and promoting innovative models of care.

The Role of Facility Assessments

It’s important to note that while the specific minimum staffing requirements have been rescinded, the enhanced facility assessment process remains in place. This process requires facilities to assess the needs of their residents and staff accordingly. CMS has stated that many facilities will still need to staff at higher levels than the previously mandated minimums to meet the actual needs of their residents.

Legal and Political Challenges

The rescission of the staffing mandate is likely to face legal and political challenges. Consumer advocacy groups may file lawsuits challenging the legality of the rescission, arguing that it violates the rights of nursing home residents. Congress could also take legislative action to reinstate the mandate or to establish alternative minimum staffing standards.

What This Means For You

The changes to nursing home staffing requirements could impact you or your loved ones. Here’s what you should consider:

Research Facilities Thoroughly: When choosing a nursing home, carefully research staffing levels, quality ratings, and inspection reports.
Advocate for Quality Care: If you have a loved one in a nursing home, be an active advocate for their care. Visit regularly, communicate with staff, and report any concerns to facility administrators or regulatory agencies.
Stay Informed: Keep up-to-date on the latest developments in nursing home regulations and quality standards.

The rescission of the CMS nursing home staffing mandate marks a significant shift in the regulatory landscape for long-term care. As the debate over access to care and quality standards continues, it is crucial for policymakers, industry stakeholders, and consumer advocates to work together to find solutions that ensure the safety, well-being, and dignity of all nursing home residents.

Do you have concerns about the quality of care in a nursing home? Contact our firm today for a free consultation to discuss your legal options.