Biden’s ‘overly demanding’ nursing home staffing reforms met with bipartisan pushback

The Biden administration’s attempt to mandate nursing home staffing standards is getting pushback from lawmakers in both chambers of Congress.

Democrats are divided over the policy but some have joined Republican colleagues in a vocal stance against the mandate unveiled in April which will reportedly cost nursing homes $43 billion over the next 10 years, according to the Department of Health and Human Services (HHS) estimates.

“The Nursing Home Minimum Staffing Rule finalized today will require all nursing homes that receive federal funding through Medicare and Medicaid to have 3.48 hours per resident per day of total staffing, including a defined number from both registered nurses (0.55 hours per resident per day) and nurse aides (2.45 per resident per day),” the White House announced in April, making good on President Joe Biden’s promise of reforms in his 2022 State of the Union address.

“This means a facility with 100 residents would need at least two or three RNs and at least ten or eleven nurse aides as well as two additional nurse staff (which could be registered nurses, licensed professional nurses, or nurse aides) per shift to meet the minimum staffing standards,” the White House explained.

(Video Credit: KENS 5)

But in Congress, lawmakers are looking to overturn the policy, introducing joint resolutions under the Congressional Review Act (CRA) which only needs a simple majority of votes to pass.

Sens. Jon Tester (D-MT), James Lankford (R-OK), and Joe Manchin (I-WV) are leading the effort in the Senate where the measure could pass if all Republicans join in. It is highly probable, however, that the president would end up vetoing the effort.

“Too many folks in Washington don’t understand the challenges that long-term care facilities in rural areas face,” Tester said in a statement.

“At a time when nursing homes across Montana are struggling with workforce shortage issues, it makes no sense for unelected bureaucrats in the Biden Administration to hand down a one-size-fits-all policy that would force these critical facilities to shutter their doors. That’s why I’m teaming up with Republicans to shut this rule down,” added the Democrat who is running for re-election.

Manchin, who has slammed Biden’s new rule as “overly demanding and unrealistic,” joined Tester in sending a letter to the Centers for Medicare & Medicaid Services (CMS) to retract the new policy.

“Our nation’s nursing home and long-term care facilities are already facing severe staffing shortages, threatening access to critical care for seniors everywhere,” Manchin said in a statement. “This overly demanding and unrealistic staffing rule from the Biden Administration directly jeopardizes our seniors’ healthcare services, especially in rural areas like West Virginia. I encourage all of my colleagues to join my effort to prevent this burdensome regulation from taking effect and I will continue working every day to protect rural healthcare services in the Mountain State and across the country.”

In the House of Representatives, Democratic Reps. Jared Golden (ME) and Chris Pappas (NH) came out against the new rule and Republicans have backed a CRA resolution in the lower chamber.

“The HHS nursing staff mandate is a half-baked, one-size-fits-none plan that will not solve the nursing staff shortage,” Rep. Michelle Fischbach (R-MN) said in a statement last month. “I am committed to holding the government accountable and I am proud to introduce this CRA to overturn a potentially disastrous policy.”

The American Health Care Association (AHCA) in Texas has filed a lawsuit to overturn the policy, arguing that Congress did not authorize the  CMS “to impose such onerous and unachievable mandates on practically every nursing home in the country.”

But nursing industry expert David Grabowski feels the pushback is “misguided.”

“The new rule is far from perfect but lots of research supports the idea that many U.S. nursing homes often operate at levels that pose risks to the health and safety of their residents. I would rather have seen members work to improve the legislation to strengthen staffing rather than work to overturn it,” Grabowski, a professor of health policy at Harvard Medical School, told The Hill in an email.

Nonrural facilities have until May 2027 to meet the requirements while rural facilities have until May 2029.

Frieda Powers


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