• Forrest Bohler and Eli Y Adashi.
• Oakland University William Beaumont School of Medicine, 586 Pioneer Drive, Rochester, MI, 48309, USA. forrestbohler@yahoo.com.
• J Gen Intern Med. 2025 Jan 14.

AbstractOn April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) announced new staffing mandates for long-term care (LTC) facilities in an effort to improve care quality in nursing homes (NHs). The guidelines require a minimum of 3.48 h of daily care per resident, including 0.55 h provided by registered nurses (RNs), 2.45 h by nurse aides (NAs), and an additional 0.48 h by other care staff. These requirements, including a 24/7 RN presence, aim to address chronic understaffing that has been linked to poor outcomes such as increased emergency visits and lower compliance with quality standards. However, concerns from for-profit NHs and the American Healthcare Association (AHCA) suggest that many facilities are ill-prepared to meet these standards, citing financial and staffing challenges, particularly in rural areas. In addition, a lawsuit from Texas Attorney General Warren Paxton argues that CMS overstepped its regulatory authority. Despite these challenges, workforce shortages may be alleviated by the CMS initiatives, which include a $75 million national campaign to grow the NH workforce. This commentary discusses the implications of the CMS staffing rule, the legal challenges it faces, and the potential to improve RN work conditions and resident care. The paper concludes with recommendations for expanding workforce capacity and enhancing compliance through financial investment and policy reform.© 2025. The Author(s), under exclusive licence to Society of General Internal Medicine.

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