Judge Matthew Kakusmalik of the U.S. District Court for the Northern District of Texas has announced a ruling to destroy the Biden administration's federal staffing mandate for nursing homes, which should be gradually progressive starting in 2026.
“Today's ruling from the Northern District of Texas is a victory for our country's seniors and their families,” said Cliff Porter, president and CEO of the American Medical Association and CEO of the National Auxiliary Center (AHCA/NCAL). “This unrealistic staffing mission has threatened to close nursing homes and drive away vulnerable elderly people. The court's decision not only maintains a balance between the rule of law and authority, but also protects access to care for an aging population. We appreciate Justice Kaxmalick's careful and thoughtful review of this case.”
“The court has confirmed that CMS does not have the authority to issue such staffing requirements, and therefore calls on Congress to act as they do,” Porter continued. “In light of evolving care practices and changing demographics in our country, federal policymakers should encourage innovation and high-quality outcomes rather than determining staffing times. The staffing mission is a 20th century solution that should never be blocked by Congress.”
Reserved requirements include nurse staffing criteria of 3.48 hours per day (HPRD) per resident. This should include at least 0.55 HPRD for direct registered nurse (RN) care and 2.45 HPRD for direct nurse aides. The facility may use any combination of nurse staff (RN, licensed practical nurses (LPN) and licensed occupational nurses (LVN), or nurse aides) to describe the additional 0.48 HPRD required to comply with the total nurse staff standards. This means that a facility with 100 residents will need two additional nurse staff (registered nurses, licensed specialist nurses, or nurse aides) per shift to meet at least two or three RNS and at least 10 or 11 nurse aides (minimum staffing standards).
National Consumers' Voices for Quality Long-Term Care said the rules save the lives of more than 13,000 nursing home residents each year and improve the quality of care for the residents of hundreds of thousands of nursing home residents in the county.
The CMS said the standards take into account the realities of rural and underserved communities through a phenomenal implementation and exemption process. CMS executives said the initiative focuses on improving the lives of more than 1.2 million residents living in Medicare and Medicaid-certified long-term care facilities.
However, nursing home operators and associations saw the new rules as unenforceable.
The AHCA joined the Texas Health Care Association (THCA), Reading, and several Texas long-term care facilities, and filed lawsuits last May against the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS).
“Our nonprofit organization, mission-led members — we've been serving our community for decades,” said Katie Smith Sloan, president and CEO of Leadingage, an association of nonprofit providers of aging services, including nursing homes.
The Trump administration is unlikely to resort to a ruling.
