New U.S. Nursing Home Staffing Requirements


Ruby Care Senior Living Advisors

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Mar 03, 2024


Texas - Dallas, Collin, SE Denton & Rockwall Counties

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Originally Posted September 15, 2023

Long-term care facilities, also referred to as Nursing Homes


Working to improve the quality of care for elderly residents, the Biden Administration has given CMS the authority to implement new regulations that mandate nursing homes participating in Medicare and Medicaid to maintain minimum staffing levels and promote transparency.  Outlined in a report from The White House, the new regulations target the long-standing concerns of understaffing and the impact it has on the quality of life and care of vulnerable residents in nursing homes. In this blog, we will discuss implications of the new rules and their potential to make an impact on long term care in the United States.


Understaffing Problem

For years understaffing has been an ongoing issue in U.S. nursing homes, with consequences being inadequate care to elderly neglect and abuse.  The COVID-19 pandemic called attention to the vulnerabilities our loved one’s face in these facilities, over 200.000 lives were lost in long-term care facilities (, which prompted a call for systemic change.  As nursing homes struggled to cope with the demands of the pandemic, the need for more personnel and better staffing ratios became glaringly evident.  


New Regulation Focus

The Centers for Medicare & Medicaid Services (CMS) has introduced new regulations requiring nursing homes to meet minimum staffing requirements, in an ongoing effort to improve the quality of care for Medicaid and Medicaid recipients and are expected to have a profound impact on the industry.


New Regulations Key Provisions


·  Minimum Staffing Levels: Nursing homes are now required to maintain a minimum staffing level, ensuring there are enough nurses and other staff members to meet residents’ needs adequately. These levels will vary depending on the size and needs of the facility.

·  Staffing Ratios: Facilities must now have an appropriate number of registered nurses (RNs) on staff 24/7 to provide skilled nursing care to residents.

·  Transparency: Nursing homes must be transparent about their staffing levels and retention, making this information readily available to residents and their families.  As staffing levels and turnover have shown to be directly correlated with quality of care

1.  CMS database of nursing home owners and operators.

2.  Improve transparency of facility ownership and finances.

3.  Enhance nursing home Care Compare rating website.

4.  Examine the role of private equity investors in the nursing home sector

· Accountability: CMS will enforce these regulations through regular inspections and assessments. Nursing homes failing to meet the requirements may face serious penalties of lose their eligibility to Medicare and Medicaid funding

Potential Impact


There are several positive changes these new regulations are expected to make in the long-term care industry


· Improved Quality of Care: Appropriate staffing levels mean better care for residents, as their needs will be addressed more promptly.  When a resident’s need is met in a timely manner it can lead to preventable medical complications and overall improvement in the resident’s quality of life. (PubMed)


· Improved Resident Safety: Incidents of neglect and abuse may decline with more staff members available, ensuring a safer environment.


· Better Staff Retention: CMS is investing $75 million in financial incentives, in things like tuition reimbursement to help improve retention at nursing homes. ( When a facility is staffed adequately it can reduce burnout and stress, leading to less staff turnover and hopefully as a result will attract more skilled professionals to the industry.


· Informed Choices and Transparency: Nursing Home Five-Star Rating System will aid families in making informed decisions when choosing a facility for their loved ones.


· Government Accountability: Oversight and government enforcement are critical in ensuring nursing homes are held accountable and lead to systemic positive changes.

Challenges and Concerns

Implementation: Due to nationwide shortages in nursing and healthcare supportive staff, nursing homes participating in Medicare and Medicaid may struggle to meet the new regulations standards.

Costs: Hiring additional staff equates to increased costs which are often passed on to the residents. The American Health Care Association believes that the proposal will worsen current conditions and cost nursing homes billions. (Associated Press)

Monitoring and Enforcement: Effectiveness of the new regulations will rely on regular monitoring and enforcement by CMS. With 75% of nursing homes nationwide being impacted, this could potentially lead to closures and additional struggles, especially in remote areas. (Associated Press)

Not Enough: Leader of Long-Term Care Community Coalition, Richard Mollot, called the measures “completely inadequate”. While admitting that the 24/7 nursing requirement may make small improvements in some of the worst facilities. (Associated Press)

There is no question that we all want quality care in a safe environment for our elderly and loved ones.  While there will be many challenges to overcome implementation, the benefits in enhanced quality care, resident safety, and transparency outweigh the concerns. Only time will tell if these new regulations will truly be able to aid nursing homes in making changes that yield positive long-term outcomes for residents. Families being able to make better and more informed choices as to where their loved ones receive care is a step in the right direction. After decades of caring for loved ones, there is nothing that can compare to having a family member or friend that checks in on their person regularly. Being present and knowing you’re coming has a positive impact not only on the residents but the staff too. Long-term care is a team effort and taking an active role to be a positive part of that team can make a significant difference. 


'Britt Hemsell | Senior Living Advisor & Blog Contributor


The Associated Press by Matt Sedensky:

The White House: FACT SHEET: Biden-Harris Administration Announces New Steps to Improve Quality of Nursing Homes | The White House

NPR: Biden New Federal Standards for Nursing Home Care : NPR

PubMed: The association between nurses' burnout and objective care quality indicators: a cross-sectional survey in long-term care wards - PubMed (

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