US Senator Kevin Cramer (R-ND) criticized the new federal minimum staffing rule for nursing homes during a speech on the Senator floor Tuesday, saying the mandate will exacerbate staffing shortages, reduce access to care and potentially lead to more nursing home closures in rural communities.
The Centers for Medicare & Medicaid Services announced its final rule in April, which, among other things, will require nursing homes that receive Medicare and Medicare funding to provide at least 3.48 hours of direct nursing care per resident per day and to have an RN onsite 24 hours a day, seven days a week, to provide skilled nursing care.
Cramer said on the floor of the Senate that these requirements will be nearly impossible for facilities to meet, particularly in rural areas.
“These are already institutions that are already woefully understaffed because of a lack of workforce,” he said. “Most burdensome is the new requirement to have a registered nurse on site 24 hours a day, seven days a week, rather than the previous eight hours a day, seven days a week. Less than a quarter of North Dakota facilities meet this requirement, and among rural facilities, only 14% will meet that mandate.”
Because of existing staffing shortages, Cramer said nursing homes in North Dakota and other states would be forced to reduce the average number of residents they serve in order to meet the new requirements. He noted that facilities that cannot meet the requirements would face potentially severe civil monetary penalties that could further negatively affect their bottom line and ability to operate.
“In my state, we’ve had six facilities close since 2021, indicating the already challenging operating environment,” Cramer said. “I fear this misguided rule will supercharge this trend and deprive rural individuals the opportunity to receive care in their own communities, near the people they love and know the best: their families, and their friends, their loved ones.”
The American Health Care Association/National Center for Assisted Living on Wednesday seized on Cramer’s floor speech, noting similar strong concerns in other states including Idaho and Maine.
“Outside of North Dakota, nursing homes across the country are facing unprecedented labor shortages that are leading to widespread closures and concerns about access to care for America’s seniors,” AHCA said in a press release. “Thousands of seniors and their families have increasingly fewer options when it comes to long term care, and the federal staffing mandate will only exacerbate this crisis.”
A recent AHCA report found that nearly 800 nursing homes across the US closed between February 2020 and July 2024.
In October 2023, Cramer led a bipartisan letter to the CMS administrator requesting the agency refrain from finalizing the rule and work with Congress on other more flexible solutions.
The staffing rule has faced criticism from congressional members on both sides of the aisle, including Sen. John Tester (D-MT), a vocal opponent of the staffing mandate.
Senate Republicans said last week they would not force a vote on a Congressional Review Act resolution to overturn the staffing rule, due to the likelihood of a presidential veto. They indicated they were exploring other options to block implementation of the rule.
