Jonathan Blum, a top official in the Centers for Medicare and Medicaid Services (CMS) during the Biden Administration, told an audience at the LTC 100 conference in Scottsdale, Ariz., on Monday that if Democrats take control of Congress after the midterms in November, that nursing home staffing mandates will “absolutely” return.

The nursing home sector avoided what many in the business called an “existential threat” when the staffing mandated was killed off last year. The American Health Care Association said the Biden-era mandate was unworkable with so many facilities in need of workers and unable to meet the regulation’s demands.

On the issue, Blum did not parse words, detailing that a main reason for the staffing mandate proposal resulted from the disturbing reports of terrible care not only at nursing homes but a range of care settings under CMS authority.

“When you work at CMS, every Friday afternoon the top 75 people receive a report from the regional teams on quality-of-care actions” that took place during the previous week on mistreatment of people.

“You see the worst of the worst,” Blum said, recalling some of the incidents would “make him sick for the whole weekend.”

The origin of the staffing mandate was an attempt to change the dynamic on quality of care, with provisions written in the regulation to protect staffing levels in rural markets and tight labor localities, he said. The efforts failed when multiple courts tossed out the mandate and the Trump Administration eventually eliminated it through legislation and regulation.

But, Blum said, the issue has never really died for progressive Democrats, saying if given the opportunity after the midterms, “absolutely” a Democratic House or Senate would bring back the rule.  He mentioned that on the Senate side, Sen. Ron Wyden (D-Ore.) would push the staffing mandate “hard.”

Mandate Timeline

Some facts on the mandate -

1.     Judge Matthew J. Kacsmaryk of the U.S. District Court for Northern Texas on April 7, 2025, found in favor of four nursing homes, the American Health Care Association and LeadingAge, ruling that a 24/7 requirement for registered nurses exceeded the authority of the CMS.

2.     U.S. District Judge Leonard T. Strand of the U.S. District Court for Northern Iowa, on June 20, 2025, ruled that the staffing requirements exceeded the legal authority of CMS.

3.     The One Big Beautiful Bill Act was signed by President Trump into law on July 4, 2025, and imposed a 10-year moratorium on the rule’s staffing measures.

Mandate Rules

The CMS mandate as finalized in early 2024 would have required:

• 24-hour registered nurse coverage on-site

• 3.48 hours per resident day of total nurse staffing

• 0.55 hours per resident day of RN time

• 2.45 hours per resident day of nurse aide time 

  
  

Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com.