Staffing shortages in nursing homes are more than an inconvenience—they’re dangerous
There's big news in long-term care that could potentially affect the safety of nursing home residents in Georgia and nationwide. The Centers for Medicare & Medicaid Services (CMS) is moving to repeal the federal minimum staffing standards for nursing homes that were finalized in 2024. Multiple industry outlets report that an interim final rule (IFR) titled “Repeal of Minimum Staffing Standards for Long-Term Care Facilities” is under review at the White House Office of Management and Budget (OMB). This is the last stop before publication in the Federal Register.
In 2024, CMS issued the first-ever national staffing baseline for nursing homes: 3.48 hours of nursing care per resident per day (HPRD) with at least 0.55 HPRD from a registered nurse (RN) and 2.45 HPRD from nurse aides, plus a 24/7 RN presence. Those requirements were set to phase in over several years with hardship exemptions.
Since then, the rule has run into headwinds. Courts in multiple jurisdictions struck at key provisions in 2025, with one widely covered ruling from the Northern District of Texas vacating the 24/7 RN requirement and the HPRD minimums nationwide. Appeals followed, and Congress weighed in with proposals to delay, defund, or overturn the mandate. In early September 2025, sector reporting indicated CMS had drafted an IFR to repeal the federal minimums outright and had sent it to OMB for review.
Why does this matter?
Staffing levels are closely tied to resident outcomes such as pressure ulcer rates, avoidable hospitalizations, and mortality. In many cases, staffing shortages lead to increased nursing home abuse and neglect.
Proponents of the 2024 rule argue that a clear national floor would improve safety and consistency across facilities, while giving families a transparent benchmark. CMS framed the rule as a quality and safety measure informed by lessons of the pandemic and longstanding concerns about understaffing.
Providers countered that the mandate was unworkable in a constrained labor market and would divert scarce dollars from care innovations and retention incentives. Trade associations and many state officials pushed for a rethink, and courts questioned whether CMS had the statutory authority to set hard numeric staffing minimums. If the IFR to repeal is finalized, the immediate federal pressure to hit the 3.48 HPRD threshold and 24/7 RN presence would lift (at least for now).
What happens next?
OMB review is the staging area. The administration can clear, modify, or return the IFR. If cleared and published, an interim final takes effect upon publication while CMS accepts public comments. This is a faster path than the standard propose-then-finalize sequence. Expect another round of litigation, no matter what. If CMS rescinds, consumer advocates may sue; if it hesitates, operators may continue challenges against the existing rule.
For facilities, residents, and families, the practical takeaway is to plan for variability. If the federal floor disappears, state rules, survey enforcement, public reporting, and payer expectations will carry even more weight. Facilities can use this moment to revisit staffing strategies. This could align schedules to resident acuity, strengthening recruitment and retention, and monitoring Payroll-Based Journal (PBJ) data for transparency.
What are the dangers of staffing shortages in nursing homes?
Short staffing in nursing homes isn’t just an operational headache. It’s a safety risk with real, measurable harms for residents and staff. Here’s what the evidence shows:
- Missed care: Essential daily tasks are more likely to be omitted, increasing the risk of adverse outcomes.
- Skin integrity harms: Lower staffing is linked to a higher risk of pressure-related injuries.
- Infection risks: Prevention efforts weaken, making outbreaks and transmission more likely.
- Avoidable transfers: More residents are sent to the hospital or emergency department for issues that could often be managed on site.
- Higher mortality in crises: During emergencies, limited staff reduce the ability to respond quickly and effectively.
- Medication safety issues: Heavier workloads raise the likelihood of errors and omissions.
- More falls and injuries: Insufficient supervision and delayed assistance increase the chance of accidents.
- Delayed recognition of decline: Early warning signs are missed, leading to later, more serious illness.
- Burnout and turnover: Ongoing strain fuels exhaustion and departures, creating a self-perpetuating staffing gap.
What are my legal rights if my loved one was harmed due to a staffing shortage?
When something feels wrong at your loved one’s nursing home, you need more than sympathy. You need a team that knows how to uncover the truth and force change. Johnson Greer Law Group represents families across Atlanta and all of Georgia in nursing home neglect and assisted living abuse cases. We move fast to protect your loved one, secure medical care, preserve evidence, and put the facility on notice. From staffing-shortage injuries to medication errors, falls, pressure injuries, malnutrition, and preventable infections, our focus is accountability, safety, and full compensation for what was taken.
Your free consultation is a working session, not a sales pitch. You will speak with a compassionate attorney who listens, maps the timeline, reviews any photos or records you have, and outlines immediate next steps to safeguard evidence and your loved one’s well-being. We explain the process in plain language, including Georgia deadlines, potential claims, and how damages are calculated. If we take your case, we work on a contingency fee basis, which means you pay nothing up front. Our fee comes from the recovery, and if there is no recovery, you owe no attorney’s fee.
We serve clients throughout Georgia and can help you report urgent concerns to the proper authorities while we begin your investigation. If your loved one was harmed or neglected, let Johnson Greer Law Group be your advocate and your voice, so your family can focus on healing while we focus on results. Contact us today to book a free consultation.
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