The contentious “Nursing Home Minimum Staffing Rule,” which sets minimum staffing requirements for federally funded long-term care facilities throughout the U.S., was finalized on April 22, 2024. The rule was initially proposed in September 2023 by the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS), and received almost 47,000 public comments. The rule has been controversial, as many facilities find the requirements unattainable due to practical challenges such as the extensive nursing staff shortages throughout the country.

The final rule requires all nursing homes that receive federal funding to have 3.48 hours per resident per day of total staffing, including a defined number of both registered nurses (0.55 hours per resident per day) and nurse aides (2.45 per resident per day). The rule also requires facilities to have a registered nurse on-site 24/7 to provide skilled nursing care. According to KFF, only 19% of nursing facilities meet these new minimum staffing standards.

The requirements of the final rule will be implemented in phases, to allow facilities time to prepare and come into compliance. The rule provides for limited, temporary exemptions from both the 24/7 registered nurse requirement and the underlying staffing standards for nursing homes that are in workforce shortage areas, demonstrate a good faith effort to hire, and meet other requirements set by HHS and CMS.

The final rule has not yet been published in the Federal Register, but the unpublished version from HHS and CMS can be found here. Several states have previously implemented minimum staffing requirements, and facilities operating in these states must comply with both federal and state laws.

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