PHI Statement on the Overturning of the Nursing Home Minimum Staffing Standards

PHI holds deep concern and resolve regarding this week’s decision by Judge Matthew J. Kacsmaryk of the US District Court for Northern Texas, overturning the Biden Administration’s minimum nursing home staffing standards rule.

As formally proposed in 2023 and affirmed by the Centers for Medicare and Medicaid Services (CMS) in April 2024, the rule represented the most significant nursing home regulatory reform in decades. In his ruling, Judge Kacsmaryk asserted that only Congress has the authority to establish staffing standards for nursing homes and that CMS had exceeded its authority. As recently as within the past week, current administration officials were defending the staffing mandate, but no signal of continued support for it has yet emerged from the Trump Administration.

Why It Matters: Lost Gains

Judge Kacsmaryk’s ruling will erase gains to the quality of direct care jobs, and to the quality of care for older adults and people with disabilities. Targeted through this ruling are:

• The first federal minimum staffing level for nursing homes, split between nurses and certified nursing assistants (CNAs). This minimum staffing level established a baseline expectation for staffing levels needed to ensure workforce safety and promote quality care for residents.
• A requirement for nursing homes to have a Registered Nurse (RN) on-site 24 hours a day, seven days a week—a vital step in effective supervision, workforce and resident safety, and appropriate care for residents.

“Americans deserve high-quality care and support in the settings of their choice, and that’s only possible if direct care workers hold quality jobs, with adequate compensation, safe working conditions, and effective supervision,” said PHI’s President and CEO, Jodi M. Sturgeon.

“Overturning these standards will create greater challenges for workers, nursing home residents, and family caregivers alike, while making workforce recruitment and retention yet more difficult for providers.”

The ruling comes as Congress seeks to advance tax cuts that would significantly damage Medicaid—and as the Department of Health and Human Services is conducting a reorganization that includes a significant reduction in staff vital to our nation’s long-term services and supports system.

A Call to Action

PHI stands alongside other organizations, including The National Consumer Voice for Quality Long Term Care and Justice in Aging, which have expressed deep concern about this ruling. While the impact of this news could yet change, there is little to suggest that it will without outcry from advocates.

We urge the Trump Administration to signal its support for—and do right by—older adults, people with disabilities, direct care workers, and American families. We urge Congress to codify these nursing home staffing standards into law, and to avoid disastrous cuts to Medicaid. And we urge the Department of Health and Human Services to rehire essential staff.

Americans need and deserve quality care, and the direct care workers who provide it deserve quality jobs. Meeting growing demand for care requires investment in the workforce. Making shortsighted cuts to our nation’s health programs and failing to invest in the direct care workforce will gravely exacerbate the challenges to meeting demand—now and in the years ahead.