The Centers for Medicare & Medicaid Services (CMS) repeals the 2024 nurse staffing rule, specifically, the numerical staffing requirements (3.48 hours per resident day, divided among various categories of nurses) and the requirement for registered nurses 24 hours per day, seven days per week. The numerical requirement reflected a modest change and would have required additional staffing, primarily in nursing homes that have the lowest nurse staffing levels. The registered nurse requirement reflected a recommendation made by experts for many decades.
The staffing rule was a key component of a comprehensive nursing home reform agenda in 2022. The rule and reform agenda responded to the hundreds of thousands of residents and staff who died during the COVID-19 pandemic, revealing problems in nursing homes that could not be ignored. Researchers at the University of Pennsylvania calculated that implementation of the final staffing rule would save 13,000 residents’ lives each year and reduce residents’ adverse health outcomes.
The repeal, issued as an interim final rule with comment period, takes effect February 2, 2026. Comments are due the same day.
Not surprisingly, the nursing home industry praised the repeal, as described by McKnight’s Long -Term Care News article “Skilled nursing providers mark ‘victory,’ forge ahead after final staffing mandate repeal” (Dec. 2, 2025). Residents’ advocates condemned the repeal. As The National Consumer Voice for Quality Long-Term Care observed, CMS justifies the repeal by citing the nursing home industry’s talking points – the rule is one-size-fits-all, there are no workers to hire, and the rule would harm rural facilities and Native American communities – all factually untrue. Senator Ron Wyden, Ranking Member of the Senate Finance Committee, also criticized the repeal, which will make residents “less safe in nursing homes,” and vowed to continue fighting “to make sure there is always a nurse in a nursing home and make sure dignity is a reality for Americans who deserve safe and affordable long-term care.”
Left untouched by the repeal rule is the enhanced facility assessment process, a distinct and independent staffing requirement set out in the final rule that addresses resident acuity and requires facilities to staff to meet the actual needs of their residents. As CMS stated repeatedly in the final rule in May 2024, many facilities will need to staff at higher levels than the minimum numbers mandated by the rule.
Advocacy will continue to improve staffing to ensure that all residents receive all the care they need.
For additional background, see
- “The Assault on the Nursing Home Nurse Staffing Rule Continues” (CMA Alert, Oct 16, 2025)
- “Reviewing the Rule: Unpacking CMS’s Minimum Staffing Standard” (May 15, 2024 PowerPoint), discussing the enhanced facility assessment process, slides 26-49.
December 4, 2025 – T. Edelman