Residents Will Continue to Suffer Under Chronic Understaffing
Safe, quality care in nursing homes is a right—not a privilege. Unfortunately, despite overwhelming evidence that understaffing causes harm, powerful lobbying interests have once again succeeded in delaying long-overdue reforms. Buried deep in what politicians hailed as a “big, beautiful bill,” Congress quietly imposed a 10-year delay on the implementation of the federal nursing home staffing mandate. For the most vulnerable among us, this delay is not just disappointing—it’s dangerous.
A Brief History of Federal Staffing Rules
For decades, the federal government has acknowledged that sufficient staffing is essential to resident safety in nursing homes. The 1987 Nursing Home Reform Act (part of the Omnibus Budget Reconciliation Act of 1987, or OBRA ’87) required facilities receiving Medicare and Medicaid funds to provide “sufficient nursing staff to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.”
However, OBRA did not set specific numerical staffing ratios. In 2001, a landmark report commissioned by the Centers for Medicare & Medicaid Services (CMS) concluded that nursing home residents need a minimum of 4.1 hours of direct care per resident per day (HPRD) to avoid harm. Yet this recommendation was never codified into enforceable regulations.
For over 20 years, advocates, researchers, and families have pushed for clear, enforceable staffing standards. Meanwhile, evidence of chronic understaffing and resident harm has continued to mount.
The Biden Administration’s 2023 Staffing Mandate
In 2023, CMS finally proposed a federal staffing mandate. The rule would have required:
- A minimum of 0.55 RN hours per resident per day
- A minimum of 2.45 CNA hours per resident per day
- 24/7 RN coverage in all Medicare- and Medicaid-certified facilities
The proposal was backed by extensive data, public comments, and heartbreaking accounts from residents and families. It was a critical step toward holding nursing homes accountable and ensuring residents receive safe, quality care.
The Industry Pushback and “Big, Beautiful” Delay
The nursing home industry—led by powerful lobbying groups like the American Health Care Association—fiercely opposed the staffing mandate. Despite billions in taxpayer funding, the industry claimed it lacked the resources and workforce to meet the requirements.
In 2025, Congress passed what some leaders dubbed the “big, beautiful bill”—a sprawling legislative package meant to fund the government and avoid a shutdown. Hidden in the fine print was a provision delaying implementation of the federal staffing mandate by ten years.
That means no minimum staffing ratios will be enforced until at least 2035.
What This Means for Residents and Families
The consequences of this delay are real and devastating:
- Residents will continue to suffer preventable harm—including falls, bedsores, infections, dehydration, and even death—due to lack of staff.
- Overworked, underpaid staff will continue to burn out, quit, or be unable to provide basic care to every resident.
- Nursing homes will face no meaningful accountability for operating with dangerously low staffing levels.
- Taxpayer dollars will continue to flow to facilities that fail to meet even the most basic standards of care.
This delay doesn’t just stall progress. It puts lives at risk.
At Olsman MacKenzie Peacock, We’re Not Waiting Until 2035
While Congress caves to industry pressure, we are fighting back. At Olsman MacKenzie Peacock, we represent families whose loved ones have suffered or died because of inadequate care. We hold nursing homes accountable through civil litigation and help expose systemic failures that harm residents.
If your loved one has suffered abuse or neglect in a nursing home, don’t wait. Call us. We are committed to seeking justice, pushing for reform, and standing up for the dignity and safety of every nursing home resident.
Because residents can’t wait ten more years. And neither can we.