Iowa leads lawsuit against federal nursing home staffing requirement

Iowa, along with 19 other states and nursing home industry groups, is suing the federal government over a rule that would set new minimum staffing requirements in nursing homes.

Iowa Attorney General Brenna Bird is co-leading the lawsuit with Kansas and South Carolina against U.S. Department of Health and Human Services Secretary Xavier Becerra and the Centers for Medicare and Medicaid Services. Seventeen other states’ attorneys general, along with several nursing home industry groups, have also signed on.

The lawsuit claims the new minimum staffing rule spearheaded by the Biden administration exceeds CMS’s authority, and that the "one-size-fits-all requirement" will drive many nursing homes out of business, leaving residents with nowhere to go.

“Our seniors spend a lifetime investing in our communities,” Bird said in a statement. “Now, we need to invest in them by ensuring they have access to the care they need. I am suing to stop the Biden-Harris attack on senior care that will force nursing homes out of business, increase costs for families, and remove access to senior care altogether."

The Biden administration proposed the new standard last year in response to safety concerns in nursing homes stemming from inadequate staffing. CMS finalized the rule in April.

The new staffing requirements will be phased in over three years, and ultimately will require every nursing home to have a registered nurse on site at all times and require residents receive a minimum amount of care from nurses and direct nurse aides daily.

The final rule states it will provide exemptions for the RN requirement based on "workforce unavailability and other factors."

Nursing home industry groups have opposed the rule, saying the staffing requirements will be too difficult to meet due to chronic, long-running workforce shortages, especially in rural areas, forcing facilities who cannot comply to close.

"We aim to continue to support nursing homes in providing exceptional care and service, however the current workforce crisis makes compliance with this mandate an impossibility. It is necessary for the survival and success of our members that they be excluded from CMS’ staffing mandate," said Kellie Van Ree, Director of Clinical Services at LeadingAge Iowa, an organization that represents nonprofit aging services, and one of the plaintiffs on the lawsuit.

The Iowa Health Care Association, which represents the majority of Iowa's nursing homes and is not part of the lawsuit, has long opposed the rule, saying it would require Iowa nursing homes to hire thousands of additional workers who don't exist.

“Unchallenged, the federal government’s unprecedented mandate would throttle access to long-term care in thousands of American communities. That can’t happen. The nation's seniors will see CMS in court," Brent Willett, the president and CEO of Iowa Health Care Association, said in a statement.

Proponents of the staffing mandate

However, proponents of the rule, like labor unions representing nursing home workers, said it would make nursing homes safer, and studies show that when facilities lack sufficient workers, residents are likely to receive poor, inadequate care.

Iowa has one of the worse levels of nursing home staffing in the country, and its federal citations for insufficient staffing in the 2023 fiscal year were more than double the national average, according to the Iowa Capital Dispatch.

The Biden administration said it sought to address concerns of inadequate care with the new staffing mandate in a White House statement released in September 2023.

"The nursing home industry receives nearly $100 billion annually from American taxpayers, yet too many nursing homes chronically understaff their facilities — resulting in poor, substandard care that endangers residents," it said. "When nursing homes stretch workers too thin, residents may be forced to go without basic necessities like hot meals and regular baths, or even forced to lie in wet and soiled diapers for hours."