WASHINGTON, D.C. — Seven Democratic senators introduced legislation Thursday aimed at reinstating federal nursing home staffing requirements similar to those repealed earlier this year by the Trump administration, according to reports from Skilled Nursing News.
The proposed Nurses Belong in Nursing Homes Act, led by Senator Ron Wyden of Oregon, would mandate that facilities maintain a registered nurse on-site around the clock and provide at least 3.5 hours of direct care per resident daily. The bill comes after the Centers for Medicare and Medicaid Services' 2024 staffing rule was struck down following legal challenges questioning the agency's statutory authority to impose such requirements.
Joining Wyden in introducing the legislation are Senators Andy Kim and Cory Booker of New Jersey, Richard Blumenthal and Chris Murphy of Connecticut, Elizabeth Warren of Massachusetts, and Ben Ray Lujan of New Mexico, as reported by the news outlet.
According to the bill's sponsors, adequate staffing levels could prevent up to 13,000 deaths annually and reduce incidents including medication errors, inadequate personal hygiene assistance, and other indicators of substandard care. The senators argue that rolling back staffing standards has compromised resident safety and created more challenging working conditions for nursing home employees.
"Republican actions and Trump's backdoor deals with big executives mean your loved one's nursing home will be less safe," Senator Wyden stated, referencing recent reports that nursing home industry leaders made campaign contributions while advocating for permanent elimination of the federal staffing mandate.
Taylor Harvey, chief communications advisor and deputy policy director at the U.S. Senate Finance Committee, explained that the legislation seeks to provide clear Congressional authorization for CMS to establish nursing home staffing standards, addressing the legal issues that led to the previous rule's invalidation.
Industry Opposition Cites Workforce and Funding Challenges
Provider organizations have expressed strong opposition to the proposed mandate, arguing it fails to address fundamental obstacles facing the long-term care sector.
Katie Smith Sloan, president and CEO of LeadingAge, an association representing nonprofit aging services providers, acknowledged that the proposed legislation offers more flexibility than the repealed 2024 rule. However, she emphasized that the core problems of workforce availability and adequate funding remain unaddressed.
"Aging services providers operate in a very challenging labor market, competing with a variety of employers across the health care industry that in many cases have access to far more resources," Smith Sloan stated, as reported by Skilled Nursing News.
According to LeadingAge estimates, complying with a 24/7 registered nurse requirement would necessitate recruiting more than 3,000 additional RNs at an annual cost exceeding $350 million. The organization points to a nationwide nursing shortage projected to continue through 2038, driven by nursing schools graduating insufficient numbers to meet current and anticipated vacancies as the population ages.
Smith Sloan also noted that recent immigration policy changes have intensified workforce pressures by limiting facilities' ability to recruit and retain foreign-born caregivers, who comprise a significant portion of the long-term care workforce.
The funding challenge is equally acute, according to industry representatives. Medicaid covers more than 60% of nursing home residents but reimburses only approximately 80% of actual care costs, creating financial strain for facilities already operating on thin margins.
"The bill stops well short of addressing the fundamental underlying issue: the need to expand the aging services workforce. We do not support it," Smith Sloan said.
Proposed Enforcement and Funding Mechanisms
The legislation aims to establish permanent funding for nursing home inspections, surveys, and enforcement activities to ensure compliance with staffing requirements. Under the proposal, civil monetary penalties collected from facilities found in violation would be reinvested into programs supporting the recruitment and retention of nursing home workers.
Provider advocates argue that Congress should instead focus on expanding the long-term care workforce through targeted investments in recruitment, training, and retention initiatives. They call for addressing Medicaid reimbursement shortfalls and creating new pathways for caregivers to enter the profession, including immigration reform to facilitate hiring of qualified workers from abroad.
The bill's introduction reflects ongoing tension between patient safety advocates pushing for mandatory staffing levels and industry groups emphasizing the practical challenges of implementation. Federal regulations have long required nursing homes to provide sufficient staffing to meet residents' needs, but specific numerical requirements have remained contentious.
The debate over nursing home staffing standards gained prominence following investigations revealing widespread staffing shortages during the COVID-19 pandemic, when many facilities struggled to provide adequate care as the virus spread rapidly through congregate living settings.
Resources for Families
Families with concerns about nursing home care quality or staffing levels can contact their state's Long-Term Care Ombudsman program, which advocates for residents and investigates complaints. The National Long-Term Care Ombudsman Resource Center operates a hotline at 1-800-677-1116 and provides information at ltcombudsman.org.
Residents and family members can also report concerns directly to their state health department or file complaints online through Medicare.gov's nursing home compare tool, which includes facility inspection reports and quality ratings.
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