Nursing home minimum staffing rule stopped by federal judge in Texas
AUSTIN (KXAN) — A federal judge in Texas blocked a policy aimed at increasing staffing requirements within long-term care facilities and nursing homes.
Health officials, under former President Joe Biden, finalized a rule to require any skilled nursing facility that receives federal funding through Medicare and Medicaid to offer more standardized nursing care. For example, these facilities would have to provide 0.55 hours of care from a registered nurse to each resident every day, as well as 2.45 hours of care from a nurse aide. It also required facilities to have a registered nurse onsite 24 hours a day, seven days a week.
At the time, federal officials said the rule would increase the quality of care and safety for residents in these facilities. Advocates for the long-term care industry and Texas Attorney General Ken Paxton, however, argued the rule would put pressure on facilities already facing staffing shortages and could force some rural facilities to close — affecting people’s access to care.
On Tuesday, Paxton called the judge’s decision to toss out the rule a “massive victory for Texans who rely on nursing homes for care.” Last year, he sued the Biden administration over the rule, claiming it violated what is known as the Major Questions Doctrine, which forbids government agencies from passing regulations on significant topics that should be handled by Congress.
U.S. District Judge Matthew Kacsmaryk said the rule was not consistent with existing legislation governing nursing homes. In his April decision, he wrote that Congress instituted a baseline of eight hours of a day for a registered nurse to be on staff for most facilities and that a facility’s individual needs be considered when it comes to staffing.
“Though rooted in laudable goals, the Final Rule still must be consistent with Congress’s statutes. To allow otherwise permits agencies to amend statutes though they lack legislative power,” the court document reads.
It’s a similar argument made by the American Health Care Association (AHCA), which represents nearly 15,000 long-term care facilities and nursing homes across the country. It joined the Texas Health Care Association and other industry advocates in suing the federal government over the rule, too, arguing the regulatory bodies “decided to take matters into its own hands” in creating the rule.
AHCA’s president praised the judge’s decision, again calling the rule “unreasonable.”
These associations have been ringing alarm bells about staffing shortages — exacerbated by the pandemic — for years. KXAN investigators have been following the back-and-forth over how to handle the issue since before these increased standards were proposed in 2023.
A group of federal lawmakers stepped in and filed legislation to try and prevent such a rule about minimum staffing standards before it was finalized. Other lawmakers pushed back, supporting stronger requirements for these facilities.
In a House Ways and Means committee hearing on the legislation last year, U.S. Representative Lloyd Doggett, D-Texas, argued companies running these long-term care facilities actually had the funds to address worker shortages. He called on the industry itself to raise pay and better conditions for employees.
“While qualified workers are available, they are not willing to accept minimum wage, no benefits and insufficient support for emptying bed pans, lifting people out of their beds and other demanding tasks,” Doggett said.
Organizations such as AARP and AFL-CIO joined the fight. In a letter opposing that legislation, AARP wrote it had heard from thousands of its members “whose loved ones suffered because of poor staffing in nursing homes.” The letter also pointed to research about the benefits of increased staffing on both patients and the workforce.
The AARP letter read, in part, “taxpayers spend over $80 billion annually through Medicare and Medicaid to provide the hands-on care our most vulnerable seniors need. American families expect that nursing homes are using these federal dollars to provide quality care. Unfortunately, that is not always the case.”
In his recent decision, Judge Kacsmaryk acknowledged failures in the care of the nation’s elderly, adding, “these deficiencies deserve an effectual response.” However, he emphasized that any regulatory response must be consistent with legislation from Congress.
In its statement, AHCA’s president said, “Our nation’s aging population demands that we find a better way. We look forward to working with Congress and the [Trump] Administration to pursue more common-sense workforce solutions.”
