House Lawmakers Propose Bill to Block New Nursing Home Staffing Requirements

A group of House Republican lawmakers are trying to stop recently proposed nursing home staffing standards from being adopted, which would require long-term care facilities to have sufficient numbers of nurses to reduce the risk of nursing home neglect injuries.

The U.S. House of Representatives Ways and Means Committee voted 26-17, mostly along party lines, to approve House Bill H.R. 7513 (PDF) to move on to the House floor for a vote. The bill directly targets minimum staffing requirements that were first proposed by the Biden Administration in 2022, and outlined in further detail in a proposal issued in late last year.

The language of the bill states that its purpose is to “prohibit the Secretary of Health and Human Services from finalizing a proposed rule regarding minimum staffing for nursing facilities”. The legislation also calls for the establishment of an advisory panel on the “skilled nursing facility workforce.”

Understaffed Nursing Home Risks

Prior research has shown that insufficient staffing and frequent turnover reduces nursing home care quality, and increases the risk of nursing home negligence. Researchers indicate even a 10% increase in staff turnover can decrease the quality of care patients receive.

A 2022 investigation led by a panel of U.S. lawmakers indicated that shortages of nurses and certified nursing aides (CNAs) in nursing homes was a major contributing factor of COVID-19 deaths and poor health outcomes for residents during the pandemic. The Government Accountability Office found that more than 200,000 nursing home deaths were reported throughout the course of the pandemic, due to poor quality of care and neglect from insufficient staffing.

A study conducted by the American Health Care Association (AHCA) revealed that more than 73% of U.S. nursing homes reported they were at risk of closing due to insufficient staffing stemming from the COVID-19 pandemic. The study also found that approximately 60% of the participating nursing homes reported moderate or high staff shortages, and at least 98% reported difficulty hiring staff.

Proposed Nursing Home Staffing Standards

A series of nursing home staffing reform policies were introduced in February 2022, in an effort to ensure residents receive quality care by establishing a minimum staffing requirement, reducing the amount of residents placed in shared rooms, and providing incentives to facilities that maintained adequate staffing and provided quality care.

The proposed nursing home staffing rules were outlined in further detail in a fact sheet released in September 2023, indicating that facilities should be required to have a registered nurse on site 24/7, and provide each resident with at least 0.55 hours of care from a registered nurse, as well as at least 2.45 hours of care from a nurse aide each day.

Other improvements would include better enforcement of existing staffing standards, review of nursing home spending of taxpayer funds, inappropriate medication prescriptions, and enhance emergency planning. The government would also help recruit, train, and retain nursing home staff by investing more than $75 million in scholarships and tuition reimbursement.

If implemented, non-rural nursing homes would have three years to meet the new minimum standards, and rural facilities would have 5 years.

Critics Say New Rules Won’t Help

Despite the recognized need for increased nursing home staffing, critics of the proposed minimum standards argue that the result will be less care for seniors, not more.

They indicate that proposing standards will not increase the available pool of skilled workers that nursing homes would need to hire to meet the new federal requirements. Proponents of the new bill claim forcing nursing homes to hire new staffers, when there are none available is unreasonable.

The critics argue that the end result of the new standards will be nursing homes having to downsize the number of residents to meet the minimum staffing requirements, or will have to shut down entirely. This would lead to less room in U.S. nursing homes for elderly residents nationwide, they claim.

However, a number of groups support the new minimum staffing standards, including the United Food and Commercial Workers International Union (UFCW), which has come out against the proposed legislation to invalidate the nursing home staffing requirements, saying the measure would only allow facility owners to continue to place profits ahead of resident safety and care.