A client of mine, due to physical and mental decline and with no family to care for him, was forced to move into a local skilled nursing facility. A friend went to visit him and found he had ants in his hair and severe bed sores. He was moved to another facility where he is receiving care now under the watchful eye of several friends.
This is not an isolated incident. There are many horror story’s regarding patient neglect at skilled nursing facilities. Yet, after a decades-long fight to pass federal requirements for staffing the Trump administration’s Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) have officially repealed the 2024 federal minimum staffing standards for nursing homes.
The repeal effectively halts the first-ever national mandate that would have required nearly all U.S. nursing homes to provide a specific number of care hours to residents. The 2024, originally finalized under the Biden administration, was designed to address chronic understaffing that was exposed during the COVID-19 pandemic. The rescinded minimum stands would have required:
— Total care: A minimum of 3.48 hours of nursing care per resident per day.
— Specific roles: This included at least 0.55 hours from a registered nurse (RN) and 2.45 hours from nurse aides.
— 24/7 presence: A requirement for an RN to be on site 24 hours a day, seven days a week.
Under the new interim final rule, the government will revert to prior standards, which only require an RN to be onsite for eight consecutive hours per day.
Some of you may be reading this and saying to yourself, “they repealed a requirement that people in need receive at least a minimum of 3.48 hours of care a day?”
Certainly, nursing facilities provide more than 3.48 hours of care and have a nurse there all the time? At least you’d hope they did but it’s painfully obvious that if that’s the number HHS came up it’s not the case.
What makes it worse is that in July 2025, President Trump signed the One Big Beautiful Bill Act, which included a 10-year moratorium on enforcing federal staffing minimums until 2034.
“Safe, high-quality care is essential, but rigid, one-size-fits-all mandates fail patients,” said HHS Secretary Robert F. Kennedy, Jr. “This Administration will safeguard access to care by removing federal barriers—not by imposing requirements that limit patient choice.”
How is 3.48 hours of care a barrier? To me the lack of higher standards is the barrier.
The National Consumer Voice for Quality Long-Term Care agrees and strongly condemned the repeal, noting that the original rule was projected to save 13,000 lives annually. Advocates argue that without these standards, residents remain at risk of neglect due to “unsafe and unreasonable workloads” for the remaining staff.
You are probably thinking that Michigan’s requirements have to be better than 3.48 hours of care. Well, the answer is yes and no.
The no is that Michigan only requires a minimum of 2.25 hours of nursing care per patient per day. This standard, one of the lowest in the nation, established under the Michigan Public Health Code (MCL 333.21720a), has remained largely unchanged for several decades.
The yes is that In addition to the daily hour requirement, Michigan law dictates specific maximum staff-to-patient ratios based on the time of day:
— Morning shift: 8:1 (one staff member for every 8 patients)
— Afternoon shift: 12:1 (one staff member for every 12 patients)
— Night shift: 15:1 (one staff member for every 15 patients)
In addition, every facility must employ at least one Registered Nurse (RN) with specialized training or experience in gerontology to serve as the director of Nursing. Plus, at least one licensed nurse must be on duty at all times (24/7).
Although the staffing requirements may be adequate and the inclusion of 24/7 RN coverage looks good, the minimum 2.25 hours of daily care still leaves patients unattended for huge periods of time every day, which leads to situations like my clients.
Michigan will revert back to the states lower standard on Feb. 2, when the federal governments final rule goes into effect.
Medicare note: Medicare 101 at Traverse District Library Thursday, Feb. 19 at 6 p.m. Call 231-944-1400 to reserve your seat.