20 U.S. states sue to block nursing home staffing mandate

IOWA, UNITED STATES — In a significant legal challenge, 20 state attorneys general have filed a lawsuit against the Centers for Medicare & Medicaid Services (CMS) to halt the implementation of a federal nursing home staffing mandate.
The lawsuit, filed in the U.S. District Court for the Northern District of Iowa, is led by Iowa Attorney General Brenna Bird and supported by Kansas Attorney General Kris Kobach and South Carolina Attorney General Alan Wilson.
This legal action is backed by 19 state affiliates of LeadingAge, a network of nursing home industry groups. It marks a substantial opposition to the staffing rule introduced earlier this year.
Concerns over mandate’s impact on care
The controversial rule requires nursing homes to provide 3.48 hours of daily nursing care per patient and maintain a registered nurse on duty 24/7 by 2026. While proponents argue these measures are crucial for ensuring quality care, opponents claim they impose unsustainable burdens on facilities, particularly in rural areas facing staffing shortages.
“Our seniors spend a lifetime investing in our communities,” Bird stated. “Now, we need to invest in them by ensuring they have access to the care they need.”
Industry leaders criticize new regulations
Steve Bahmer, President and CEO of LeadingAge Southeast, voiced concerns that while they share CMS’ goal of quality care, the staffing mandate “misses the mark” by imposing financial burdens that could jeopardize essential services.
“Our members are dedicated to delivering high-quality care, and this mandate threatens their ability to do so by introducing onerous requirements that jeopardize the very services residents rely on,” Bahmer added.
The lawsuit contends CMS enacted the rule without adequately considering national nursing staff shortages and argues it could lead to widespread closures of nursing facilities.
Broader implications and similar legal challenges
This lawsuit is part of a broader legal battle against the staffing mandate. A similar case, filed on August 16, is progressing in Texas federal court.
Both lawsuits argue that the Department of Health and Human Services (HHS) and the CMS lack the authority to enforce such sweeping changes without congressional approval. The outcome of these cases could significantly impact nursing home operations across the U.S. as states and industry groups continue to challenge federal regulations.
New Jersey nursing homes are also contesting the state staffing quotas that have resulted in $2.93 million in fines this year for non-compliance. The Health Care Association of New Jersey, representing the state’s long-term care industry, argued that the shrinking direct care workforce cannot meet the demands of a growing elderly population.
“There are too few healthcare workers available to satisfy the law,” the association stated, highlighting the inevitability of widespread noncompliance with the staffing mandate.
Nationwide staffing shortages exacerbate challenges
The Biden administration’s staffing mandate aims to address chronic understaffing issues in nursing homes, which serve approximately 1.2 million residents daily. However, critics argue that rural areas will struggle to meet these requirements due to workforce shortages exacerbated by the pandemic.
A study by AMN Healthcare also revealed that over one-third of nurses are contemplating a career change in 2024, following staffing challenges exacerbated by the recent federal staffing mandate. Specifically, 35% of the 1,155 nurses surveyed are considering leaving the medical profession.
This potential workforce exodus could further strain existing staffing shortages and compromise patient care.