Repeal of Nursing Home Staffing Standards Threatens Workers and Residents: PHI Comments
The Centers for Medicare & Medicaid Services (CMS) has struck down the only federal policy to establish a baseline for nursing home staffing levels, effectively removing a critical lever for workforce improvements, compounding the challenges already facing the direct care workforce, and putting nursing home residents at greater risk.
This ill-conceived change comes via an interim final rule issued to repeal the minimum staffing standards for long-term care facilities established in 2024.
This week, PHI submitted formal comments to CMS strongly opposing this change and urging the agency to withdraw the rule. The repeal abandons standards that were decades in the making—and long-advocated for by PHI. It ignores overwhelming evidence that links adequate staffing directly to the quality of care residents receive. Furthermore, it fails to offer any viable alternative to ensure the safety and well-being of the nursing home workforce and the residents they support.
A Misdiagnosis of the Workforce Crisis
CMS justifies this rollback by citing workforce shortages, arguing that facilities are unable to meet staffing mandates due to a lack of available labor. However, this rationale fundamentally misinterprets the nature of the crisis.
The challenge facing long-term care is not a shortage of workers, but a crisis of recruitment and retention driven by inadequate wages, unsustainable workloads, and poor job quality. When nursing assistants face unsafe workloads and insufficient compensation, the result is extraordinarily high annual turnover–estimates range from 40 to nearly 100 percent. This means that a typical facility must replace half to nearly its entire nursing assistant workforce every year.
Eliminating minimum standards will not solve this problem. Instead, it effectively guarantees that—until more responsive policies are enacted—the cycle of understaffing, burnout, and attrition will continue unabated, harming both staff and residents.
A Flawed Process
The 2024 Final Rule was grounded in robust research and advocacy from experts across the field. Reversing course through an interim final rule repeals a set of standards developed with robust public input and overwhelming support without engaging in that same discourse and process. Of graver concern: The standards CMS just repealed would have saved approximately 13,000 lives annually. Moving to repeal these protections without a replacement will result in the preventable deaths of thousands of nursing home residents every year.
Job Quality, Not Repeal
The 2024 Final Rule was a historic step toward ensuring safe, high-quality care. The solution to high turnover is to improve job quality, not to ignore staffing standards. Removing regulatory pressure will only reduce the incentive for facilities to invest in their workforce and provide the transparency that is critically needed.
Instead of abandoning worker protections, CMS should be leading a coordinated effort across federal, state, and employer levels to improve job quality. By strengthening recruitment and retention, we can achieve the safe staffing levels required to deliver high-quality care.
To erase minimum staffing standards without a viable alternative is to accept an unacceptable status quo.
