Last month, a federal judge in Texas overturned the first-ever minimum staffing requirements for most nursing homes in the country, including Colorado.
On April 7, U.S. District Judge Matthew Caxmalick ruled in a summary ruling that “although rooted in admirable goals,” the rules set by the Centers for Medicare and Medicaid Services were overreachable and that changes to federal nursing home statues must be made by Congress.
“The separation of power demands more than admirable intentions,” Kakumalik wrote in his ruling.
The decision was seen as a victory for the country's nursing home industry that sued the Biden administration in Texas court, calling the requirement too expensive and infeasible for facilities struggling to seduce workers.
In a broader sense, it was a victory for the Trump administration, targeting the minimum staffing value for potential elimination as part of the ongoing push for deregulation.
The measure, which was finalised in April 2024 and will be phased in stages over the next few years, included a requirement for at least 3.48 hours of total nursing care for each resident per day.
This includes 0.55 hours from registered nurses and at least 2.45 hours from nurse assistance. The rest could come from either a registered nurse, a licensed practical nurse, or other nursing staff.
Additionally, the facility has tripled its prior requirements and has registered nurses on its website 24 hours a day.
The Sierra Vista Health Care Center was a 117 Colorado Nursing Home to receive both fines and bonuses from the federal government for handling outbreaks.
In Colorado, the state is currently only requesting facilities from staff “as per the needs of residents,” the Colorado Department of Public Health and Environment said in an email. However, facilities must provide nursing or care for at least two hours per day for a total of two hours per resident, the agency said.
Just 19% of the nation's 14,500 nursing homes met all staffing ratios last year, according to an analysis by KFF, the National Health Care Research and Information organization known as the Kaiser Family Foundation.
In Colorado, only 22% of state nursing homes meet all requirements, according to the KFF analysis.
The Denver Gazette breakdown in CMS data found that as of last month, only half or about 51%, had met the required 3.48 hours of overall nursing care in 211 nursing homes in Colorado. Five facilities did not report.
Furthermore, the official gazette analysis found that about three-quarters of state nursing homes meet the 0.55 hours of daily registered nurse care required per residents, while less than one in four comply with a minimum of 2.45 hours of care from nurse assistance. That's important because nurse AIDS performs many of its practical duties in nursing homes and monitors residents for safety.
The nursing home industry says facilities across the country need to add more than 100,000 new nurses and caretakers to comply with more stringent requirements. According to the industry, some homes may have been closed under new rules.
And while the measures included difficult exemptions, the industry said the lawsuit was insufficient.
File Photo: Holly Lawson, clinical coordinator at St. Francis Hospital, will be located next to a new camera monitor system in the room at St. Francis Hospital in Colorado Springs on Friday, March 25, 2022. Hospitals, nursing homes and the broader healthcare system face a long road to recover from staffing shortages. (Cursed Bush/General Gazette)
Advocates of elder care have long said that staffing ratios are a key indicator of overall quality of care. In fact, some criticized the Biden era rules for not being fully advanced.
In July 2024, the University of Pennsylvania Study, commissioned by US Senator Elizabeth Warren (D-Mass.), concluded that federal minimum staffing rules when fully implemented could save 13,000 lives per year.
“When residents are thriving and going well, staffing levels are sufficient. When residents are not doing well, or suffering, we hear concerns that there are not enough staff on the floor of our residents.”
A fully and well-trained staff will provide careful eyes to prevent falls and ensure that the medication is administered properly, she said. Bed pain and other wounds are monitored, so they should not accelerate into sepsis.
The Trump administration's U.S. Department of Health and Human Services, which oversees nursing homes, will need to appeal Texas' decision until next month, but it's not happening yet, so it's unlikely.
Both the HHS and the CMS declined to comment if the ruling or the administration appealed.
At a confirmation hearing in January, Robert F. Kennedy Jr., now head of the HHS, was critical of the requirements, saying it created difficulties for facilities, particularly in rural areas where employment is often a problem.
He told lawmakers that he is “noble” to provide comprehensive care for older people and vulnerable residents, but the measure was “disaster.”
And in a March email from the Trump administration's Economic Advisory Council to White House staff, nursing home staff requirements were cited as an overly expensive Biden administration initiative.
Two lobbying groups in the nursing home industry, the American Medical Association/National Living Assistance Center and Leading Sage, filed a lawsuit against the Biden administration in Texas in June 2024. The Texas Healthcare Association and three Texas Nursing Facilities were also part of the legal challenges.
The incident landed before Kakusmalik, the US district judge for Amarillo's Northern District of Texas, and was nominated to the bench by President Donald Trump in 2017, confirmed two years later.
Kakumarik, known for his conservative views, rose to the national spotlight in 2023 when he ruled that approval for U.S. Food and Drug Administration's abortion drug Mifepristone was on hold. The U.S. Supreme Court later overturned the decision.
In its nursing home decision, Kacsmaryk left some of the Biden-era rules, including several Medicaid reporting requirements, but rescinded staffing requirements that were considered the centre of the scale.
It led to both cheers from the nursing home industry, and both fears from people who say it could potentially put their lives at risk.
“Today's ruling from the Northern District of Texas is a victory for our country's seniors and their families,” said Clif Porter, president and CEO of Washington, D.C.-based American Health Care Association and National Assisted Living Center, in a statement last month.
“As we've been saying, nursing homes want to hire more nurses and caregivers. Despite our limited resources, we do everything in our power to boost our workforce,” his statement added.
The group, which represents more than 15,000 facilities, said in an email they are confident the Trump administration will not appeal, that the judge will be sentenced. The Congress will also promote the abolition of mandate by saying, “it is not a matter of future administration, it is not a law.”
In Colorado, the state branch of Leading Age, representing nonprofit aging service providers, said in a statement to the Denver Gazette that it was “thank you for this common sense ruling.”
“Without proper funding for Medicare and Medicaid, we are working to care for the rapidly growing population of 65 and older, particularly in Colorado and across the nation, orders like falling without adequate funding for the workforce are ineffective,” the statement said.
Colorado has the third fastest population growth rate in the nation with people ages 65 to 84, with over 300,000 people over the past decade, with a forecast of 265,000 people expected to increase in the next 2020 US Census.
That's exactly why some people say that personnel was so important.
“I'm absolutely worried,” said McMahon, the Ombudsman of the state. “[This ruling]says we don't care, residents say we don't think we don't care, and I don't think their quality of life and care is important.”
“There is no incentive to improve,” agreed Robert Blancato, national coordinator of the 3,000-member Elders Justice Coalition and board member of the Denver-based Next50 Foundation, a national advocacy group for seniors.
Ernest Tosh, a Texas lawyer specializing in cases of elder abuse across the country, said as the country's population ages, staffing requirements were needed to ensure better care.
“We thought there was a first step,” Tosh said. “And now we have taken a monumental step.”
