This month, the Centers for Medicare & Medicaid Services (CMS) issued an interim final rule rescinding key portions of the federal minimum staffing rule for nursing homes, a regulation that had been widely viewed as a long-overdue effort to improve resident safety and quality of care.

The rescinded provisions eliminate the minimum hours-per-resident-day requirements that were set to establish, for the first time, a national staffing floor for nursing homes participating in Medicare and Medicaid. Specifically, CMS has withdrawn requirements that facilities provide:

• 0.55 hours of Registered Nurse (RN) care per resident per day

• 2.45 hours of nurse aide care per resident per day

• 3.48 total nursing hours per resident per day

• A registered nurse on-site 24 hours a day, seven days a week

These standards were adopted during the Biden Administration and represented the first federal attempt to impose concrete, enforceable staffing minimums—an issue long identified as central to nursing home neglect and abuse.

The Rationale for the Rescission

CMS cites two primary reasons for rolling back the staffing requirements:

1. Congressional Action:

   Congress recently postponed implementation of the staffing rule until 2035 under H.R. 1 (the One Big Beautiful Bill Act, or OBBA), effectively placing the rule on hold for more than a decade.

2. Federal Court Decisions:

   Two federal court rulings concluded that certain aspects of the staffing rule exceeded CMS’s statutory authority, rendering portions of the regulation legally invalid.

On those grounds, CMS concluded that rescinding the staffing requirements was necessary.

A Contradictory Position by CMS

Notably, CMS went further than merely acknowledging congressional delay and adverse court rulings. In the interim final rule, the agency asserted that the staffing standards were “no longer appropriate”—a striking reversal given that CMS had promulgated the rule just last year and vigorously defended it in litigation.

This shift raises serious questions. The agency’s own data and findings have consistently shown that chronic understaffing is one of the most significant drivers of poor outcomes in nursing homes, including preventable falls, pressure injuries, dehydration, malnutrition, medication errors, and resident abuse.

Staffing Shortages Remain a National Crisis

CMS’s own statistics undermine the notion that minimum staffing standards are unnecessary. According to agency data:

• The average annual turnover rate for direct-care nursing home staff is approximately 50% nationwide.

• High turnover and understaffing are closely correlated with lower quality of care and increased harm to residents.

In practice, many facilities operate with staffing levels that barely meet—or fall below—state minimum requirements, which themselves are often outdated and inadequate. Without a federal staffing floor, residents remain vulnerable to systemic neglect driven by cost-cutting and profit maximization.

What This Means for Nursing Home Residents

The rescission of the minimum staffing rule does not mean that understaffing is acceptable, nor does it eliminate nursing homes’ existing legal obligations. Facilities are still required to:

• Provide sufficient staff to meet residents’ needs;

• Comply with federal and state regulations governing quality of care;

• Prevent avoidable harm caused by inadequate supervision or care.

When nursing homes fail to staff appropriately and residents are injured as a result, those failures can still form the basis for claims of negligence, abuse, or neglect, including claims under state elder-abuse statutes where applicable.

The Bottom Line

The rollback of the CMS minimum staffing rule represents a significant setback for nursing home reform and resident safety. While political and legal forces have delayed federal enforcement, the underlying problem—dangerous understaffing—remains unchanged.

For residents and families, this development underscores the importance of vigilance, documentation, and accountability. For nursing homes, it does not provide a license to cut corners. And for regulators and courts, it highlights the continuing gap between what is known to be necessary for safe care and what is currently required by law.

One bill, AB 2236 (Brian Maienschein; R-San Diego, Mark Stone; D-Monterey): Increases fines for health and safety violations at assisted living facilities, now set at a maximum of $150. The bill calls for fines for violations that can cause death to increase to $15,000.  Fines of $150 are absolutely NO deterrent to large, for-profit nursing homes.

The other bill, SB 911 (Marty Block; D-San Diego): Requires higher levels of training for facility managers and staff at assisted living facilities.  Assisted living facilities include facilities like those owned and operated by Emeritus Corporation, which has been the subject of many lawsuits and extensive medial coverage.

“Both of these bills would help make strides in providing better care to Californians who are in assisted living facilities,” said Stop EA attorney, Sean Laird. “Take action and contact your representatives in the Senate and Assembly to make sure these bills continue and eventually make it to the Governor’s desk.”

The two bills face a critical fight this week.  AB 2236 will next be heard on the Senate floor, and the full Assembly will hear SB 911.  To find your state senator and contact information, visithttp://senate.ca.gov/senators. To find your state assembly member and contact information, visithttp://assembly.ca.gov/assemblymembers.

“Reach out to them and ask them to vote yes on these bills that protect the elderly people that mean so much in our lives. These bills have Stop EA’s full support,” Laird said.

Although California has a set of rules that seek to regulate the behavior of assisted living facilities, these regulations are virtually meaningless when not enforced or enforced with fines that have absolutely no financial impact on large, for-profit assisted living facility corporations that have policies which have the potential to lead to widespread neglect of residents.

Sean Laird is a California lawyer who seeks justice for families whose loved one’s have been harmed in these facilities and attempts to ensure that the same thing does not happen to the next vulnerable, unsuspecting family.

Those who are concerned about the quality of care their loved ones may be receiving in one of these facilities can obtain a free, private case evaluation from Mr. Laird by calling 916-441-1636 .

For more information on the campaign, identifying symptoms of abuse and neglect and informational videos, visit our webpage at seanlairdlaw.com