Sen. Kevin Cramer, R-N.D., in a speech on the Senate floor Tuesday, criticized new federal minimum staffing rules for nursing homes, saying the mandates could worsen staffing shortages, reduce access to care and lead to more nursing home closures in rural communities.
The Centers for Medicare and Medicaid Services issued final rules in April that require Medicare and Medicare-funded nursing homes to provide at least 3.48 hours of direct nursing care per resident per day and to have a nurse on-site 24 hours a day, 7 days a week to provide skilled nursing care.
Cramer said on the Senate floor that those requirements are nearly impossible to meet, especially for rural facilities.
“These facilities are already severely understaffed,” he said, “and the most burdensome aspect is the new requirement to have nurses on-site 24 hours a day, seven days a week, instead of the traditional eight hours a day, seven days a week. Fewer than a quarter of North Dakota facilities meet this requirement, and only 14 percent of rural facilities meet this requirement.”
Kramer said existing staffing shortages will force nursing homes in North Dakota and other states to reduce the average number of residents they serve in order to meet the new requirements. He noted that facilities that fail to meet the requirements could face civil penalties, which could further hurt a facility’s revenue and ability to operate.
“In my state, six facilities have closed since 2021, illustrating an already challenging operating environment,” Kramer said. “I am concerned that this misguided rule will exacerbate this trend and deny people in rural areas the opportunity to receive care in their own communities, close to the people they know best – their family, friends and loved ones.”
The American Healthcare Association/National Center for Assisted Living highlighted Gov. Cramer’s state of the state address on Wednesday, noting similar strong concerns in other states, including Idaho and Maine.
“Outside of North Dakota, nursing homes across the country are facing unprecedented workforce shortages, leading to widespread closures and concerns about access to care for older Americans,” AHCA said in a press release. “When it comes to long-term care, thousands of seniors and their families have fewer options, and federal staffing mandates only exacerbate this crisis.”
A recent AHCA report found that between February 2020 and July 2024, roughly 800 nursing homes closed across the U.S.
In October 2023, Cramer sent a bipartisan letter to the CMS administrator urging the agency to hold off on finalizing the rule and work with Congress to explore more flexible solutions.
The staffing rules have drawn criticism from lawmakers of both parties, including Sen. Jon Tester (D-Mont.), a vocal opponent of staffing mandates.
Senate Republicans said last week they would not force a vote on a congressional review bill to overturn the personnel rules, citing the possibility of a presidential veto, and signaled they were considering other options to block the rules from going into effect.
