Beginning February 2, 2026, Medicare- and Medicaid-certified nursing homes will no longer be subject to federal minimum staffing levels or a requirement to have a registered nurse (RN) on-site 24 hours a day, seven days a week. The change follows CMS’s repeal of key portions of a staffing rule finalized in 2024 and represents a significant shift in how nursing home staffing is regulated at the federal level.
While facilities will regain flexibility in how they staff their operations, the change raises important questions about resident safety, quality of care, and accountability, particularly for families evaluating nursing home care or responding to injuries and neglect.
Background on the Repealed Staffing Standards
The 2024 staffing rule was developed to address chronic understaffing in nursing homes, a problem linked to higher rates of falls, infections, medication errors, pressure injuries, and avoidable hospitalizations. The rule established baseline staffing guardrails, including:
- 3.48 total nursing hours per resident per day
- Minimum required hours from registered nurses and nurse aides
- A registered nurse on-site 24 hours a day, 7 days a week
CMS emphasized that these standards were intended to be a minimum threshold. Many facilities, depending on resident acuity and medical complexity, would need to staff above those levels to ensure safe and appropriate care. Studies projected that consistent staffing at these levels could prevent thousands of avoidable deaths each year.
What Changes Under the New Rule
With the repeal, nursing homes will return to the prior federal requirement of providing RN services for at least eight consecutive hours per day, rather than continuous coverage. Overnight and weekend RN presence will no longer be mandatory under federal law.
This shift places greater reliance on individual facility policies, state regulations, and internal assessments to determine appropriate staffing levels. As a result, staffing practices may vary significantly from one nursing home to another.
What Requirements Still Apply
Although numerical staffing minimums have been eliminated, nursing homes remain subject to an enhanced facility assessment requirement. Facilities must evaluate resident needs, acuity levels, and care demands and staff accordingly. This obligation is independent of the repealed staffing minimums and continues to apply.
However, without clear numerical benchmarks, enforcement may become more complex, making documentation, monitoring, and resident advocacy even more critical.
Why Staffing Still Matters in Injury and Neglect Cases
Staffing levels are one of the most significant factors in nursing home injury and neglect claims. Insufficient staffing is frequently associated with:
- Delayed medical response
- Falls and fractures
- Undetected infections or sepsis
- Medication errors
- Inadequate supervision
Even without federal staffing minimums, nursing homes have a legal duty to provide care that meets accepted professional standards. When understaffing contributes to injury, decline, or wrongful death, facilities may still be held accountable under state law.
What Families Should Watch For
Families are encouraged to:
- Review publicly available staffing data
- Ask facilities about overnight and weekend coverage
- Monitor changes in care, responsiveness, or condition
- Document concerns promptly
Regulatory changes do not eliminate responsibility. When staffing decisions place residents at risk, legal accountability remains a critical safeguard.
At Baron, Herskowitz, and Cohen, we remain focused on protecting nursing home residents and holding facilities accountable when failures in care lead to preventable harm.
