In an important development impacting nursing home care across the country, a federal court has recently blocked the Biden administration's proposed changes to minimum staffing requirements in nursing homes. The proposed reforms sought to establish national baseline standards for staffing levels in facilities that receive Medicare and Medicaid funding.  Research into quality of care at long-term care facilities long ago established that adequate staffing is essential to the safety and well-being of residents. These changes would have helped prevent the corporate owners of these facilities from profiting from the neglect of residents.  

Why Staffing Levels Matter in Nursing Homes

Staffing levels in nursing homes directly affect quality of resident care and, ultimately, the safety of those residents. Nursing home residents are among the most vulnerable individuals in our society, often requiring assistance with basic needs such as eating, bathing, mobility, and medication management. Understaffed facilities are more likely to see delays in care, increased rates of neglect, medication errors, and preventable injuries such as falls, bedsores, and infections.

Numerous studies have shown that higher staffing levels—particularly of registered nurses (RNs) and certified nursing assistants (CNAs)—lead to better health outcomes, fewer hospitalizations, and improved quality of life for residents. Simply put, when nursing homes do not have enough qualified staff, residents suffer.

What the Biden Administration Proposed

While some states already had minimum staffing requirements in place, there have never been federal minimums in place.  This is even though the Centers for Medicare and Medicaid Services (CMS) reported to Congress as early as 2001 that resident care would be improved by setting minimum staffing requirements.  Finally, in 2023, the Biden administration, through CMS, proposed the first-ever national minimum staffing requirements for nursing homes. These proposed rules included:

• A requirement for each facility to have an RN on-site 24 hours a day, 7 days a week.
• Minimum staffing standards of 0.55 hours per resident per day for RNs and 2.45 hours per resident per day for nurse aides.
• Mandates for facilities to conduct thorough assessments of their staffing needs and maintain sufficient staff to meet those needs.

These proposals were developed in response to widespread concerns about inadequate staffing, particularly in the wake of the COVID-19 pandemic, which revealed deep systemic problems in long-term care facilities.

The Court Ruling: A Step Backward?

Despite the goals of the proposed rules, the nursing home industry and some state officials pushed back, arguing that the staffing mandates would be too costly and difficult to implement—particularly in rural areas facing workforce shortages.
In early April 2025, a federal court sided with those concerns and struck down the Biden administration's proposed staffing minimums. The court found that the rules exceeded the authority of CMS, effectively halting their implementation.

What This Means for Nursing Home Residents

The court's decision is a significant setback for efforts to ensure safer and more accountable nursing home care. Without enforceable national staffing minimums, facilities can continue to operate under state-level requirements—many of which are minimal or poorly enforced.

For residents and their families, this means ongoing uncertainty and risk. The lack of sufficient staff can continue to contribute to the kinds of injuries and tragedies we see too often in our work: dehydration, untreated infections, avoidable falls, and residents left unattended for hours.

Moving Forward

While the legal battle over staffing requirements may continue, it remains clear that more needs to be done to protect nursing home residents. Families should be aware of the staffing levels and care quality at their loved one's facility. Transparency, accountability, and advocacy remain crucial.  

Our firm is committed to supporting families whose loved ones have suffered harm due to inadequate nursing home care. We will continue to monitor developments in staffing regulations and fight for better protections for residents.

If you have concerns about the care your loved one is receiving in a nursing home, or if you believe a lack of proper staffing contributed to an injury or death, we are here to help answer your questions and discuss your legal options. Contact us today at 833-381-6589 or send us an email on our Contact Page. Serving the surrounding areas of St. Louis, Benton County, Southern Illinois as well as Kansas City, MO and KS.