Senate can protect older people by supporting nursing home staffing rules, not repealing them

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In April, the Biden administration unveiled a set of regulations to establish minimum staffing requirements for nursing homes nationwide. Under the new guidelines, nursing facilities must maintain staffing levels of 3.48 nursing hours per patient per day, including 0.55 registered nurse hours per patient per day and 2.45 nursing assistant hours per patient per day.

The introduction of these regulations is a significant step in the right direction. In fact, these minimum requirements should serve as a benchmark, not a ceiling, for staffing levels in nursing homes. The needs of each resident are unique, and staffing must be tailored to those individual requirements to ensure the highest quality of care.

However, senators appear to be swayed by a strong lobbying effort to reverse these new regulations. Such efforts could significantly jeopardize access to health care for our most vulnerable citizens.

Senators from both parties recently sponsored a resolution called the Congressional Review Act — a tool that can be used to repeal federal agency regulations — that requires only a simple majority to pass. Some senators wrongly claim that the legislation will worsen staffing problems. In fact, those arguments emphasize the need to strengthen the elder care workforce, a sentiment echoed by organizations including AARP, whose spokesperson told Axios, “It would be deplorable if lawmakers continued to attempt to derail this critical rule.”

Nursing homes must be prepared to meet the growing needs of their patient population. According to the Census Bureau, by 2030 all baby boomers will be over the age of 65, increasing the elderly population to one in five residents will be of retirement age.

About 1.3 million Americans resided in nursing homes in 2020. Ensuring adequate staffing levels in these facilities is critical to meeting the complex needs of this growing population. In fact, a significant body of evidence indicates that adequate staffing levels, particularly for registered nurses and certified nursing assistants, correlate with improved scores on a variety of quality measures and resident outcomes.

The continued decline in quality of care has not gone unnoticed by the public. In 2023, a Gallup poll found that Americans were extremely dissatisfied with the quality of care in nursing homes, giving them a “D+” rating. Seven in ten American adults said they would “be very or somewhat uncomfortable being admitted to a nursing home if they could no longer care for themselves.”

Of particular importance is the provision in revised section 483.35, which emphasizes that meeting numerical standards should not serve as a justification for facilities to meet only the minimum requirements. Instead, facilities must ensure that there are sufficient staff with the requisite competencies and skills to protect the safety of residents and promote their overall physical, mental, and psychosocial well-being. This holistic approach to staffing reflects a commitment to person-centered care and recognizes the diverse needs of nursing home residents.

It is imperative that senior care advocates—including senators—support the implementation of this legislation, particularly with respect to the issuance of hardship waivers under Section 483.35(h), which allow for exemptions from the requirements for minimum hours of care per resident per day and the presence of a registered nurse on site 24/7. If the new regulations remain in place, there is a legitimate concern that some owners of skilled nursing facilities may seek to circumvent these minimum staffing requirements, which could impact the quality of care provided to our vulnerable senior population.

While setting minimum employment regulations in care homes is crucial, it is equally important to enforce them rigorously.

Without it, regulations risk becoming guidelines, leaving room for noncompliance and reducing the quality of care. Enforcement ensures accountability, requires operators to meet staffing standards and prioritizes resident well-being. It fosters a culture of compliance and signals the importance of resident safety over financial concerns. Ultimately, effective enforcement complements regulations by translating policy into tangible outcomes, protecting the health, safety and dignity of nursing home residents.