Texas takes legal action vs. U.S. nursing home staffing rule

TEXAS, UNITED STATES — The State of Texas has taken legal action against the Biden administration, challenging a federal rule mandating minimum staffing levels in nursing homes that receive Medicare and Medicaid funding.
The lawsuit, filed on August 16, 2024, aims to overturn the rule, which Texas claims will impose significant financial burdens on its nursing homes.
Impact on Texas nursing homes
The contested rule, issued in April 2024, requires nursing homes to have a registered nurse (RN) on-site 24/7 and mandates at least 3.48 nursing hours per resident per day. This includes a minimum of 0.55 hours from RNs and 2.45 hours from nurse aides.
Given that 97% of U.S. nursing homes participate in Medicare and Medicaid, the rule is expected to affect nearly every facility nationwide.
Texas claims it will be disproportionately impacted, needing to hire more RNs than any other state and potentially spending $500 million annually to comply. The state contends that these requirements exceed the Centers for Medicare & Medicaid Services’ (CMS) statutory authority and are arbitrary given the diverse needs of nursing home residents.
Legal arguments and broader implications
The lawsuit asserts that the Department of Health and Human Services (HHS) overstepped its bounds under the Administrative Procedure Act by imposing these costly mandates without clear congressional authorization.
Texas invokes the “major questions doctrine,” arguing that such significant economic implications require explicit legislative backing.
This legal move follows a recent Supreme Court decision that limits the deference courts give to federal agencies’ interpretations of statutes. This precedent may bolster Texas’s case by questioning CMS’s authority to enforce uniform staffing standards.
Nationwide healthcare staffing challenges
The staffing mandate aims to address chronic understaffing issues in nursing homes, which serve approximately 1.2 million residents daily. The Biden administration contends that standardized staffing levels can enhance care quality by reducing staff burnout and turnover.
However, critics argue that rural areas will struggle to meet these requirements due to workforce shortages. The U.S. has faced a significant loss of healthcare employees during the pandemic, with an estimated shortage of 100,000 workers by 2028.
Similar legal battles across the U.S.
This lawsuit is not an isolated case, as similar legal challenges are underway. The American Health Care Association has also filed lawsuits against the federal government over these staffing standards.
Similarly, New Jersey nursing homes are contesting 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.
Nationwide implications and workforce challenges
These legal challenges highlight the broader issue of staffing shortages in nursing homes across the United States. The pandemic has exacerbated these shortages, leaving many facilities unable to comply with new staffing mandates despite their best efforts.
As these lawsuits progress, they underscore the need for comprehensive solutions to address workforce deficits while maintaining quality care standards for residents.