Texas AG Challenges Biden's Nursing Home Staffing Rule in Court

In a recent legal challenge, Ken Paxton, the Republican Attorney General of Texas, has filed a lawsuit against the Biden administration regarding new federal regulations for nursing home staffing. The suit, initiated on August 14, 2024, aims to block the implementation of these rules, which Paxton argues could force rural nursing homes out of business.

The new regulations, announced in April 2024 by the U.S. Department of Health and Human Services (HHS), require nursing homes to maintain a round-the-clock presence of registered nurses and increase total nurse staffing to 3.5 hours per resident daily. This marks a significant change from the previous requirement of eight consecutive hours of registered nurse coverage per day.

These rules primarily affect facilities participating in Medicare and Medicaid programs, which constitute the majority of nursing homes nationwide. The implementation is set to occur gradually, with rural hospitals given a five-year timeline for full compliance.

Paxton contends that the HHS has overstepped its authority in establishing these rules, arguing that such "major questions" should be decided by Congress rather than a federal agency. He also labels the rule as "arbitrary and capricious," expressing concerns about the nationwide nursing shortage that could make compliance challenging for many long-term care facilities.

"The administration has not explained why the rules are needed or taken into account the massive nationwide nursing shortage that will make compliance for many long-term care facilities a practical impossibility."

The Biden administration initially proposed these regulations in September 2023, aiming to address patient safety concerns in nursing homes, particularly in light of issues highlighted during the COVID-19 pandemic. It's worth noting that the pandemic disproportionately affected nursing home residents, accounting for about 30% of U.S. deaths in its early stages.

This legal challenge comes at a time when the nursing home industry is already facing significant challenges. The average cost of a private room in a U.S. nursing home exceeds $100,000 per year, and staff turnover rates can reach 100% annually in some facilities. Moreover, by 2030, it's estimated that the U.S. will need an additional 1 million nurses to meet growing healthcare demands.

The impact of these new regulations is already being felt within the industry. At least one multi-state nursing home operator, LaVie Care Centers, has cited the staffing rule as a factor in its decision to file for bankruptcy.

As this legal battle unfolds, it highlights the complex balance between improving patient care and the practical challenges faced by nursing homes, particularly in rural areas. With approximately 1.3 million residents in U.S. nursing homes as of 2021, and about 5% of older adults residing in these facilities at any given time, the outcome of this lawsuit could have far-reaching implications for elderly care across the nation.