The federal government has formally withdrawn the Biden-era minimum staffing mandates for nursing homes and long-term care operators, marking a significant repeal that reshapes workforce expectations across the sector.
The nurse staffing rule repeal removes federally defined staffing thresholds that operators argued were financially unsustainable and operationally unworkable amid prolonged labor shortages. The decision carries direct implications for facility budgets, workforce planning, compliance strategies and the continuity of care delivery, particularly in rural markets where hiring challenges remain acute.
The Department of Health & Human Services (HHS) confirmed earlier this week that it has revoked the staffing standards originally designed to set minimum coverage levels for registered nurses and nursing assistants in nursing homes and long-term care facilities. Operators had maintained that such requirements imposed disproportional cost pressures and could not be met in a constrained labor environment.
According to HHS, rural providers would have faced the greatest burden under the rule, which the agency acknowledged positioned many facilities at risk of noncompliance or reduced service availability. Health systems and facility operators had consistently pushed back on the regulation, noting that mandatory staffing ratios could force reductions in operational capacity or lead to facility closures if workforce supply remained insufficient.
The provisions set aside under the repeal would have required a registered nurse on-site 24 hours a day, along with an average of 0.55 hours of daily registered nurse care and 2.45 hours of daily nurse aide care per resident. These thresholds were intended to strengthen care protections but were criticized by operators as unattainable given national workforce constraints.
Industry groups representing nursing homes and long-term care facilities, including the American Health Care Association and the National Center for Assisted Living, had campaigned extensively against the rule. They described the standards as unrealistic and argued that facilities would be unable to maintain operations without substantial increases in staffing supply or government subsidies.
Health & Human Services Secretary Robert F. Kennedy Jr. stated, “Rigid, one-size-fits-all mandates fail patients.”
“This Administration will safeguard access to care by removing federal barriers—not by imposing requirements that limit patient choice,” he said in a statement.
Charlene MacDonald, executive vice president of public affairs for the Federation of American Hospitals, supported the decision. “This repeal rightfully reflects the reality that long-term care facilities are facing challenging workforce shortages,” MacDonald said in a statement. “Rolling back this regulatory burden recognizes flexible staffing coupled with innovation improves the quality of care, reduces staff burnout, and keeps facilities’ doors open so patients can access the care they need when they need it.”
Stacey Hughes, executive vice president of government relations and public policy for the American Hospital Association, echoed concerns about operational feasibility. “The AHA has repeatedly raised concerns that the requirements could exacerbate workforce shortages, lead to facility closures and jeopardize access to care, especially in rural and underserved communities that often do not have the workforce levels to support these requirements,” Hughes said in a statement.
The American Health Care Association earlier stated that the Biden-era regulation represented “an unreasonable standard” that “creates an impossible task for providers” during a nationwide workforce shortage.
Advocacy groups for seniors sharply criticized the nurse staffing rule repeal decision, noting that the staffing standards, considered by some the most significant care protections in decades, were estimated to save thousands of lives annually. The National Consumer Voice for Quality Long-Term Care said it “strongly condemns” the rollback, arguing the rule would have materially improved resident safety. The AARP, which had previously opposed proposals to delay implementation to 2035, reiterated that the standards were “long-overdue.”
With the federal standards rescinded, nursing home and long-term care operators will revert to state-defined staffing frameworks while advocacy groups continue pressing for federally enforced protections.