Nursing homes are once again caught in the crossfire of politics and policy. The Trump administration has formally rolled back a Biden-era regulation that set national minimum staffing requirements for nursing homes—a move that’s sparking intense debate across the eldercare community. The repeal comes at a time when Long Island facilities are already facing critical shortages of nurses and aides, leaving many wondering: what happens next for America’s aging residents?
The U.S. Department of Health and Human Services (HHS) announced on Tuesday that it is rescinding rules introduced by the Centers for Medicare and Medicaid Services (CMS) in 2024. Those rules required nursing homes nationwide to provide residents with at least 3.48 daily hours of nursing care, broken down into 2.45 hours from a nurse’s aide and 0.55 hours from a registered nurse. The policy also demanded around-the-clock on-site supervision by at least one registered nurse. Although the rule had not yet taken effect—it was scheduled for gradual implementation starting next year—it faced legal and political hurdles from the moment it was proposed.
A rule long under fire
Critics of the now-repealed regulation called it a “one-size-fits-all” mandate. In fact, a federal district court had already blocked its enforcement earlier this year, and the sweeping “One Big Beautiful Bill Act” passed last summer included a 10-year moratorium on its implementation. HHS Secretary Robert F. Kennedy Jr. defended the repeal, arguing that “safe, high-quality care is essential, but rigid, uniform standards risk doing more harm than good when they ignore real-world staffing challenges.”
But eldercare advocates see things very differently. Richard Mollot, executive director of the Long Term Care Community Coalition, accused the Trump administration of “putting profits before people,” saying the repeal undermines resident safety and dignity. According to his organization’s analysis of federal data, only about 31% of Long Island nursing homes currently deliver the recommended 3.48 hours of daily nursing care. Even more concerning, only four Long Island facilities—John T. Mather Memorial Hospital in Port Jefferson, Northwell Health’s Orzac Center in Valley Stream, Jefferson’s Ferry in South Setauket, and Northwell Health’s Stern Family Center in Manhasset—meet their individualized staffing benchmarks derived from resident counts and care needs.
What the numbers reveal
Federal data paints a troubling picture: most Long Island nursing homes are falling short of federal staffing expectations, and watchdog groups warn that lifting the rule will deepen the workforce crisis. This staffing shortage is not limited to Long Island—it’s a nationwide trend tied to low pay, high turnover, and an aging workforce.
Long-term care advocates point to past studies such as a 2001 CMS-funded report, which recommended an even higher threshold—4.1 hours of nursing care per resident per day. Mollot argued that while the Biden administration’s target was lower than what advocates hoped for, it “at least would have raised the floor and improved quality of life for many residents,” especially in states like New York, which historically reports some of the lowest staffing levels in the country.
State rules still stand—but rarely enforced
Though the federal repeal wipes away national requirements, New York State’s own staffing regulations remain intact. Passed in 2021, the state law requires nursing homes to provide at least 3.5 hours of direct care each day, including 1.1 hours from licensed nurses and 2.2 hours from nurse’s aides. Facilities that fail to meet these state-set minimums can face penalties—but industry experts note enforcement has been inconsistent at best, with few nursing homes facing real consequences.
An industry under pressure
The timing of this repeal could not be more contentious. Nursing homes across the U.S. are still grappling with severe shortages of registered nurses, a situation exacerbated by burnout and wage stagnation. Industry leaders argue that increasing staffing mandates without adjusting Medicaid and Medicare reimbursement rates would make compliance impossible.
Clif Porter, CEO of the American Health Care Association and National Center for Assisted Living—which successfully challenged the CMS rule in court—celebrated the reversal, calling it “a victory for our nation’s seniors and their families.” He contended that the previous rule “would have devastated countless facilities and displaced vulnerable residents,” estimating that full compliance would require hiring approximately 102,000 additional nurses at an annual cost of $6.8 billion.
Michael Balboni, head of the Greater New York Health Care Facilities Association and a former Long Island state senator, applauded the repeal but urged regulators to modernize staffing metrics. He argued that positions like physical, occupational, recreational, and respiratory therapists should count toward staffing totals, emphasizing the need for flexibility over rigid formulas. “We support safe staffing,” Balboni said, “but the workforce simply doesn’t exist to satisfy those unrealistic mandates.”
The big question
So, who’s right—the policymakers who warn against overregulation, or the advocates fighting for higher standards of care? The answer may lie somewhere in the middle. While flexibility is vital, the reality on the ground shows that without strong staffing expectations, vulnerable seniors may bear the cost. And this is the part most people miss: residents’ safety isn’t just about policy—it’s about people showing up, day after day, to care for them.
Should the federal government stay hands-off, letting states manage their own care standards? Or do national staffing requirements create the accountability that the industry clearly lacks? Share your thoughts below—because this debate touches families, workers, and communities nationwide.
