The New York Times published an article connecting a high-dollar political event involving skilled nursing facility (SNF) executives and President Trump to the death of the Biden Administration’s staffing mandate.

There is no connection. The mandate was already dead.

As someone who had a front-row seat for the first four years of the mandate saga, here is the true sequence of events.

In 2021, the first year of the Biden presidency, the sector fought hard on Capitol Hill for staffing changes. We learned a lot during the pandemic. One of the key lessons was the importance of RNs and infection control experts in our buildings. The data is clear. More RNs and more attention to infection control matter, and the industry stepped up and advocated for more staff and staffing requirements in these targeted areas.

Unfortunately, we didn’t succeed. Our stance ran into opposition as some believed the only way to proceed was to require an overall staffing mandate. We disagreed. There was just no evidence that the sector could comply with a comprehensive mandate. And the clinical evidence wasn’t nearly as compelling as the targeted approach to RNs and infection control that we were taking.

In the end, Congress passed nothing.

Biden Acts Unilaterally

President Biden then did what presidents often do. He decided that if Congress wouldn’t enact a comprehensive staffing mandate, he would do it himself through rules and regulations. Biden announced his administration’s intention to push forward an overall staffing mandate during the State of the Union speech in 2022 and proposed a mandate the following year. His proposal wasn’t our targeted approach. It was an overall mandate that was well intentioned but never serious public policy.

We were deeply disappointed for multiple reasons.

1.     The sector was facing an unprecedented worker crisis. Bureau of Labor Statistics data showed that 250,000 of our workers had left during the pandemic and it was impossible for SNFs to meet the Biden requirement. The workers did not exist. Studies indicated that up to 95 percent of all SNFs would be out of compliance.

2.     There was no funding for the proposal. Even if the workers could somehow magically appear, there was no way to pay for them.

3.     The president had no authority to do this. Congress had previously set the staffing requirements for nursing homes, and a president can’t unilaterally override Congress.

4.     This proposal shifted the attention away from what really needed to be done, which was to figure out a way to get more RNs and infection control preventionists in buildings.

On top of all of it, the penalties for the impossible-to-achieve-regulation were harsh. Thousands of facilities faced closure if the mandate became reality.

SNFs Battle Back

The sector unified and fought the proposal. As worried as we were, we never felt this proposal would happen. Beyond being impossible to get the workers, the administration had gone so far beyond its authority that we were close to certain that the courts would throw it out. We were right. And we thought that even if the courts didn’t throw it out, Congress certainly would. We were also right about that. In fact, by the time of the August 2025 Trump lunch, the proposal was already dead and actually killed a couple of times.

Here are the facts.

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 Centers for Medicare and Medicaid Services (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 into law July 4, 2025, and imposed a 10-year moratorium on the rule’s staffing measures.

All of this prior to the lunch. 

The Times article mentions the AHCA lawsuit but doesn’t describe the nature of the rulings in the cases. The rulings weren’t just going in our favor as the newspaper article said, instead, AHCA was completely winning. And while it would have been possible for an appellate court to reverse a district court, the chances of that happening were very unlikely. 

On top of that, Congress also spoke. There was bipartisan opposition to the rule that was clear throughout the process. Rather than completely revoking the rule, Congress suspended it for 10 years for budget-scoring reasons. This action made it clear that the staffing rule was no more.

If the Times is implying that the August lunch killed the rule, that is just not the case. It had already suffered multiple deaths.

Advocating Is Vital

The nursing home sector, like every sector in the economy, is active politically.  It must be. The work we do in our buildings every day is critical to the lives of millions of people. If we weren’t active our patients and our businesses would be at risk. They would be subjected to well-meaning people who often advocate dumb policies. The staffing mandate is the perfect example.

Is that a news story? Is it shocking that there is political activity in our country? If so, then we need some consistency. According to the Times, the Service Employees International Union (SEIU) spent tens of millions and possibly hundreds of millions on the Biden campaigns in 2020 and 2024. It then became a major advocate for the staffing proposal. In fact, a representative of the SEIU was on the stage when CMS announced the policy. I don’t recall a news story outlining any of this.  

The biggest loss of the entire saga was the opportunity cost. We learned so much during the pandemic. We were and are anxious to grow RN and infection control presence in facilities. Instead, we were forced to fight an impossible-to-implement mandate that would have shut many of us down. We did and we won, and we did it all before the president’s lunch in August of 2025. 

Mark Parkinson is the CEO of long-term care web platform Park Place Live, and the former president and CEO of the American Health Care Association/National Center for Assisted Living (2011-2025).