Federal Government Walks Back
Home Care Nursing Hours

Older people and their families need to pay attention to recent changes in staffing in nursing homes. Decades of work on this issue resulted in the Biden administration mandating 3.5 hours of care per resident per day and an RN on site at all times. Although the number was lower than supporters wanted, at least it was a win.

Because of lawsuits on the part of corporations, the guidelines were never implemented. In July, as part of Trump’s budget bill, Medicare was prohibited from implementing the new staff standards before 2034, and then the Centers for Medicare and Medicaid Services repealed the standards completely.

It is estimated that these regulations could have saved 13,000 lives a year, according to an analysis by University of Pennsylvania researchers.

Nursing homes have usually had a hard time filling vacancies for staff due to low pay and poor working conditions. According to Sen. Elizabeth Warren’s website, “the average nursing home loses more than half of its nursing staff within a year due to poor pay, lack of benefits, high workloads, inadequate training, poor management and lack of career advancement.”

It is clear that these changes could be due in large part to donations by 40 nursing home entities of $250,000 each to Trump’s campaign, with some like Ensign Group donating $750,000, and NHS Management giving $600,000 (NYT, 1/28/26). All of these would eventually total nearly 4.8 million for MAGA Inc, the super PAC. According to Sen. Warren's website, CEOs for three of the largest publicly-traded nursing homes were paid nearly $70 million in 2023, on top of $650 million in dividends and compensation for shareholders and executives between 2018 and 2022.

The White House made final the repeal of the minimum staffing regulations by putting the old rules back in place. An RN is required to be on site only eight hours a day, and staffing levels have no minimum numbers in the nation’s 15,000 nursing homes; instead, they say they must be “sufficient to meet patients’ needs,” which certainly is too vague to help patients much.

As reported by the New York Times (Jan. 17, 2026), Sam Brooks, director for the National Consumer Voice for Quality Long-Term Care, said, “It’s clear CMS has no interest in ensuring adequate staffing.”

Senators Warren, Sanders, Blumenthal, and Schakowsky wrote, “It is insulting that the for-profit nursing home industry, which receives billions of taxpayer dollars annually to run its operations, appears to prefer lining the pockets of its executives and shareholders rather than creating sustainable conditions for nurses and staff. The basis of your opposition to minimum staffing standards appears to be quite simple: greed.”

Since most people want to “age in place," a major concern is the cost and availability of home care help. On this front, there was another rescinded regulation, even more unexpected than the nursing homes staffing rules. In July, the Department of Labor re-turned to a policy of excluding home care workers from the federal Fair Labor Standards Act (FLSA). That act mandated that workers receive the federal minimum wage (which is currently only $7.25 an hour) and get overtime pay. This seemed to treat home care workers as teenage babysitters with no particular skills.

After 40 years of lobbying, the Labor Department included home care workers under the labor act in 2013. However, there were many complaints of non-compliance and home care agencies have had to pay about $158 million in back wages.

But in July that department said it would return to 1975 regulations, saying it “hindered consumer access to care.”

With the anticipated $914 billion cut to Medicaid in the next decade, it is clear that the United States has never committed to funding long-term care of seniors.

Although Harris and Trump tied at 49% among voters 65 and older in the 2025 election (AARP.org), those Americans who helped return Trump to the White House may die from a lack of care, not only in nursing homes but also at home.