Key Takeaways:
– Republicans are likely to reverse a contentious nursing home staffing law introduced by the Biden administration before it becomes effective.
– The reversal will ease the nursing home industry, which believes the mandate does not appropriately address present workforce issues.
– Public health experts and consumer advocates fear that revoking the rule could harm long-term care facility workers and residents.
– Two resolutions to overturn the rule, introduced in the House and Senate, have not yet passed, and the rule is set to come into full effect by 2027 for urban facilities.
– Republicans have proposed to entirely repeal the rule as part of a preliminary offer for health care policies added to the continuing resolution Congress is working to pass.
GOP’s Concerns about the Rule
The GOP is expected to withdraw the Biden administration’s contested nursing home staffing rule ahead of its implementation. This comes as a welcome move to the nursing home industry, which argues the mandate fails to effectively address the current workforce challenges. However, public health experts and consumer advocates who have advocated for the rule are anxious that its repeal could adversely affect both residents and workers in long-term care facilities.
More than 200,000 nursing home and long-term care residents have died in the first two years of the COVID-19 pandemic. The spread of the virus and resulting fatalities have been linked to staff shortages. In response, the Biden administration proposed three reforms, including establishing a national minimum staffing requirement.
Under the rule, nursing homes would be required to provide each resident with not less than 3.48 hours of nursing care each day. This includes a minimum of 0.55 hours of registered nurse care and 2.45 hours from a nurse aide. The rule would also enforce a registered nurse’s continual presence on site to ensure residents can access critical care at any time.
Obstacles Ahead for the Biden Administration’s Staffing Rule
The rule has encountered bipartisan opposition, with Republicans particularly opposed to the staffing mandate. Since its finalization, both the House and Senate have introduced joint resolutions to overturn the rule under the Congressional Review Act (CRA).
Despite this, the rule is slated to fully take effect for urban facilities in 2027, and rural nursing homes by 2029. GOP lawmakers have suggested the rule be completely rescinded as part of a preliminary offer for health care policies included in the ongoing resolution Congress is working on passing by December 20.
Incoming GOP Majorities, Industry Support, and Legal Battles
Under the incoming Trump administration, the rule’s implementation could be blocked or even revoked entirely. The narrow GOP majorities in both the House and Senate could pass legislation like the Midnight Rules Relief Act, which would modify the CRA to permit Congress to overturn federal regulations enacted during the last year of the current administration.
The nursing home industry has urged Republicans, and some Democrats, to scrap the rule alleging that it sets an unrealistic and costly standard for facilities to meet, which will only worsen resident care and result in closures. Alongside this, the Trump administration could roll back the current rule or eradicate it.
Costs and Benefits of the Rule
Industry estimates suggest that the nursing home industry would need to hire approximately 100,000 more nurses and nursing aides to ensure that every facility meets all three of the rule’s requirements. This substantial increase in staffing would cost around $6.5 billion a year. In contrast, federal estimates put the cost of executing the final rule at $43 billion over a decade.
Despite these costs, labor unions, consumer advocates, and public health experts argue that the rule will ultimately improve the health and safety of nursing home residents and staff.
The Future of Nursing Home Staffing
The rapport between sufficient staffing and better patient outcomes is well-known. A 2024 study discovered that nursing homes with more registered nurses had fewer residents visiting emergency rooms or being hospitalized.
Despite its opponents deeming the rule costly and illogical, its proponents contend that it aims to enhance care at the worst-performing facilities in the country. It is not a “one-size-fits-all” mandate. Instead, the rule appears designed to increase the standard of care in such facilities.
Long-term, the survival of this rule is indeed paramount. Legally and legislatively, it hangs in the balance, with incoming Republican trifecta and ongoing legal battles offering potential platforms for the rule to be overturned. However, rescinding the rule would arguably undermine the health and safety of nursing home residents and staff. Advocates are therefore lobbying lawmakers to resist any legislation or year-end deal that might stall or eliminate the rule.