Written by Ashton Snyder on
 October 13, 2024

Iowa, 19 Other States Challenge Federal Nursing Home Staffing Policy

A coalition of 20 states has taken legal action against the Biden administration over a contentious new nursing home staffing policy.

The group contends that the Biden administration requirements, which demand a continuous presence of registered nurses and a specific amount of care per resident, are untenable and threaten the viability of current facilities, as The Hill reports.

The coalition, led by Iowa's Attorney General Brenna Bird, filed its lawsuit last Tuesday in the Northern District of Iowa.  Also spearheading the legal action are Kansas and South Carolina, with 17 more states participating, including Alabama, Alaska, and Arkansas, among others. The states seek to have the mandate annulled and aim for a permanent injunction against its enforcement.

States Argue Against Federal Authority on Nursing Rules

The central argument by the states is that the Biden administration overstepped its bounds. By implementing this policy without Congressional approval, they argue it surpasses the jurisdiction of the Centers for Medicare and Medicaid Services (CMS). This regulatory move calls for nursing homes receiving federal funds to maintain a registered nurse onsite around the clock and to ensure at least 3.48 hours of nursing care per resident each day.

The policy is controversial, having faced opposition from the nursing home industry and political figures from both parties, largely due to a crippling shortage of staff worsened by the COVID-19 pandemic. Officials from the Department of Health and Human Services project the policy could cost the industry $43 billion over a decade.

The rule's rollout will occur in stages, with nonrural facilities compelled to comply by May 2027, while rural nursing homes have until May 2029. Temporary exceptions may be granted for homes struggling with workforce shortages, provided they can show earnest attempts at hiring.

Broader Impact of Staffing Mandates Under Scrutiny

Bird has been outspoken, suggesting that instead of alleviating the difficulties nursing homes face, the administration has chosen an overbearing mandate. Her concerns are echoed in the lawsuit, which warns that this rule presents a potential threat to the industry's survival.

The complaint cautions that numerous nursing facilities, already having a hard time, could be forced to shut down, leaving vulnerable residents without alternatives.

Concerns over chronic understaffing and the resulting lowered standard of care have prompted these new guidelines as a response from regulators.

Additional lawsuits have been filed in Texas, one by the state itself and another by a group representing the nursing home sector and several operators. These cases highlight a broader resistance facing the new federal rule.

Potential Closures and Healthcare Access Concerns

Bird, in her recent public statement, pointedly criticized the policy as failing to engage with the genuine challenges currently affecting nursing homes. The coalition underscores that the rule poses a peril to these institutions' existence, which could lead to closures and leave residents without necessary care options.

The objective of the implemented rule was to address longstanding staffing deficiencies that contributed to inadequate care standards in the industry. However, the backlash from states and industry players suggests a significant disconnect between federal regulatory intentions and operational realities.

In conclusion, the coalition of states insists that the federal government has overstepped its legal limits, pushing a policy many find impractical amid a staffing crisis. The rule's financial implications and phased implementation continue to be points of contention. The pursuit of this litigation reflects a broader debate on balancing patient care needs and feasible regulatory demands.

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About Ashton Snyder

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