PHI Statement on the Reversal of Federal Nursing Home Staffing Standards

Last week, the Centers for Medicare and Medicaid Services (CMS) took the final step in formally rescinding the federal Minimum Staffing Standards for nursing homes, marking the culmination of a months-long campaign by opponents to dismantle this landmark rule. In taking this step, the current Administration has abandoned critical, hard-won protections for older adults and people with disabilities —and the direct care workers who support them. While it has potential to go unnoticed in an ongoing cycle of significant challenges for our country’s care infrastructure, this step represents the most significant setback for nursing home reform in decades.

Finalized in April 2024, the Minimum Staffing Standards rule was a direct response to the nation’s long-standing nursing home challenges. With an aging population living with increasingly complex conditions, the rule established a clear, evidence-based floor for resident safety: 3.48 nursing hours per resident day, including dedicated time from a registered nurse (RN) and a nurse aide, along with a 24/7 on-site RN presence.

Yet, this reform was not just about resident safety; it was a long-overdue acknowledgment that quality care is impossible without quality direct care jobs. The staffing minimums were designed to address the unsafe and unreasonable workloads that impact direct care work, while enhanced transparency measures offered a path toward improved wages. These were essential first steps in tackling the high rates of nursing assistant turnover that destabilize care for millions.

During the rulemaking process, PHI submitted detailed comments to strengthen the rule and aid its implementation. While not perfect, the final rule was a crucial and foundational step forward in addressing the quality challenges in our nation’s nursing homes.

Now, this progress is being undone. Through a series of legal and legislative actions in 2025, the standard has been effectively nullified:

• A federal district court in Texas vacated the rule, arguing that CMS had overstepped its authority.
• Additional litigation in Iowa followed, further challenging the rule’s core requirements.
• Most decisively, Congress passed, and President Trump signed, H.R. 1, a budget reconciliation law that imposes a 10-year moratorium on implementing or enforcing the staffing rule.
• Now, CMS has moved to formally rescind the standard via an interim final rule now under review at the Office of Management and Budget.

“Quality jobs are essential for quality care, and this rule represented a critical step in ensuring both. Its reversal ignores decades of evidence linking nursing home staffing to quality care, workforce retention, and safety for direct care workers and residents alike,” said Jodi M. Sturgeon, President and CEO of PHI. “To eliminate Minimum Staffing Standards without a viable alternative is to accept an unacceptable status quo.”

Reforms such as the Minimum Staffing Standards rule typically raise implementation challenges. Such challenges in themselves do not present a valid rationale for entirely eliminating this rule, a step that leaves residents and workers without a critical safeguard. The standard was a floor, not a ceiling—an essential starting point that required additional, meaningful investments in the direct care workforce.

Growing demand for care is a crisis that is only exacerbated by the current Administration’s ongoing targeting of this sector. PHI calls on local, state, and federal policymakers to make best efforts to stabilize the direct care workforce for the benefit of the entire long-term care system. The health and well-being of millions of Americans depend on it.