Minimum Staffing Standards for Nursing Homes Rolled Back

AARP fought for regulations that would require more nurses and aides, but these rules are now being rescinded

Molly Snow,

AARP

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Published December 10, 2025

a man using a walker being helped by a nurse

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The Trump administration is rolling back federal minimum staffing requirements for nursing homes, which advocates say are key to resident safety and easing chronic understaffing as facilities recover from the pandemic.

On Dec. 2, the U.S. Department of Health and Human Services (HHS) announced an interim final rule rescinding specific federal staffing requirements, including having a registered nurse on-site 24/7 and guaranteeing a minimum amount of time caring for individual residents. The rules, which apply to nursing homes receiving Medicaid and Medicare funding, were originally slated to take effect in 2029.

But federal officials said they determined the rules, adopted under President Joe Biden’s administration, were too costly and disproportionately burdened facilities serving rural and tribal communities that already struggle to recruit and retain health care workers.

Congress first delayed implementation until 2034 through the One Big Beautiful Bill Act signed on July 4. The latest change, effective February 2026, suspends these provisions.

However, it left intact other aspects of the rules related to facility assessments and Medicaid payment transparency.

AARP urged protections for residents, staff

Alongside other patient advocacy groups, AARP championed these staffing baselines, citing studies and academic research that link higher quality of care in nursing homes with more staff and fewer adverse outcomes.

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One estimate by University of Pennsylvania researchers found the staffing rules would save about 13,000 lives each year.

“Every nursing home should be required to meet these bare minimum standards needed to provide safe, dignified care,” wrote Bill Sweeney, AARP’s senior vice president of government affairs, in a May letter to House lawmakers.

The proposed rule required a registered nurse on-site at all times. It also stipulated a minimum of 3.48 hours of direct care per resident each day. Of that, about half an hour had to come from a registered nurse and roughly two and a half hours from a nurse's aide.

In addition, nursing homes were directed to improve their facility assessments to better reflect patients’ needs and staffing plans for more health care workers.

The rules also upped reporting requirements for nursing homes to publicly disclose Medicaid spending on pay for direct care workers (nursing or therapy staff) and support staff (drivers or maintenance personnel).

Nursing homes will still need to meet the facility assessment requirements as well as the Medicare spending disclosures.

Rollback leaves expectations for staffing open-ended

The staffing standards were born from broader efforts in 2022 to improve the safety and quality of service in America’s 15,000 nursing homes after the COVID-19 pandemic illuminated severe understaffing, burnout among frontline workers and slipping standards that resulted in harm to residents.

Medicare- and Medicaid-funded nursing homes provide long-term care for nearly 1.2 million people nationwide.

Federal regulations require covered nursing homes to have “sufficient” staff, and each nursing home also provides data to Medicare, which evaluates various factors like turnover and the needs of residents, to score a facility based on staffing.

But advocates say there lacks more concrete national standards for what staffing should look like, which they fear allows individual nursing homes to run on dangerously low staffing levels. The rules sought to address this by setting minimum standards for the number of “direct care” hours residents receive, while also giving facilities flexibility to include other qualified nursing staff in meeting those requirements.

A 2024 analysis by KFF found that rural nursing homes would be as likely as urban ones to meet the final rule’s staffing standards, but they’d have more time to comply with the requirements.

The policy shift comes at a time when more and more Americans are serving as caregivers, while an aging population in the U.S. threatens an already overburdened health care system that struggles to keep up with the needs of older households.

“The answer to staffing shortages is accountability and better jobs, not permitting facilities to admit vulnerable people without the staff required to care for them,” the Long Term Care Community Coalition said in a statement.

For more information on how nursing facilities compare, check out AARP’s Nursing Home Quality and Safety Dashboard.

And if you’re concerned about a loved one’s care, your state’s long-term care ombudsman may be able to help. Find more information here.

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Molly Snow is a writer for AARP covering advocacy issues and state news. She also writes AARP's Today's Tips podcast. She previously worked at other news outlets, including Federal Times, McClatchy and Gannett.