December 2025

CMS Rescinds Nursing Home Staffing Protections

CMS issued an interim final rule rescinding part of the minimum staffing rule in nursing homes. CMS cited Congress’s postponement of the rule’s implementation until 2035 and two federal court cases that found parts of the rule to be invalid as reasons for the rule’s rescission. The interim final rule rescinds the minimum hours per resident day requirements (0.55 Registered Nurse, 2.45 nurse aide, and 3.48 total nurse staffing) and provisions requiring a registered nurse onsite 24 hours, 7 days per week. It does not, however, rescind other portions of the rule regarding enhanced facility assessment requirements, and provisions requiring that states disclose Medicaid spending on care staff. The interim final rule was published in the Federal Register and goes into effect 2/2/2026. CMS is accepting comments on the rule until that date.

There is a Job Quality Crisis in Nursing Homes

Nursing homes with high staff turnover experience increased instances of abuse, perform poorer on all five-star quality measures, and are subject to more substantiated complaints. With the average nursing home losing 50% of its staff each year, the answer is not only how nursing homes can find more staff, but how can they address job quality to retain staff and also attract new workers.

According to research:
• 91% of CNAs are women, with 61% being people of color.
• CNAs are paid, on average, $18.83 per hour.
• CNAs are five times more likely to experience workplace injuries compared to the average worker.

Most commonly, high turnover is the result of poor wages and benefits, lack of training, poor management, lack of career advancement, and impossible workloads. Poor job quality results in higher staff turnover making turnover arguably the most important barometer of nursing home job quality.

Fortunately, there is a clear pathway to better jobs and better care. By lifting up nursing home workers, turnover will be reduced, which will result in better care for residents and in turn better health outcomes.

Workforce Retention Linked with Supervisor Support

At the Leading Age 2025 Annual Meeting, long-term care experts emphasized that investing in training and supporting frontline supervisors is one of the most effective steps providers can take to address persistent workforce challenges. Speakers highlighted updated leadership- development tools such as the expanded Nurse LEAD program and PHI’s coaching-based supervisor curriculum, which aim to equip new and existing supervisors with both soft skills—like communication, coaching, and conflict resolution—and practical competencies in administration and risk management.

Study Ties Use of Advanced Practice Providers to Improved Patient Outcomes

A new study from the University of Pennsylvania’s Perelman School of Medicine found that nursing homes that moderately increased their use of advanced practice providers (APPs)—such as nurse practitioners and physician assistants—saw measurable improvements in patient outcomes. Between 2012 and 2019, 41% of facilities boosted APP involvement, with about one-third

increasing APP visits by 5 to 40 percentage points. These facilities experienced a 1.1% reduction in 30-day rehospitalization rates among recently discharged acute-care patients. APPs can conduct visits, manage conditions, prescribe medications, and coordinate care.

Elder Justice “No Harm” Newsletter Volume 7 Issue 6 Now Available

This special issue of the Elder Justice Newsletter takes a close look at what “Special Focus Facility” status – the status given the worst performing nursing homes – really signals for residents and families, and why repeated deficiencies in these homes remain one of the clearest warning signs of risk to health, safety, and dignity.

Declining Quality Following Private Investor Acquisition

AARP’s series of reports on the Florida nursing home system, found that between 2019 and 2024, 425 (over 60%) nursing homes changed ownership, including 156 facilities that were acquired by private equity. Following their acquisition by private equity, these 156 facilities reduced staffing by 33 minutes per resident per day, and doubled the number of 1-star rated facilities while halving the number of 5-star rated facilities. In addition, AARP found in a separate report that “Medicare costs per resident were $1,000 higher in private equity-owned facilities, with more frequent hospitalizations.”

The report highlights the urgent need for greater transparency and accountability in ownership reporting, yet the next article below describes CMS’s suspension of its national revalidation program.

CMS Suspends Nursing Home Revalidation Effort Indefinitely

CMS announced an indefinite suspension of its national revalidation program for skilled nursing facilities (SNFs), citing technical issues with the Provider Enrollment, Chain, and Ownership System (PECOS). The program, which required federally funded nursing homes to report expanded ownership and investor details, had faced multiple deadline extensions, with the most recent set for Jan. 1, 2026.

In Kentucky’s LTCOP, our staff and volunteers make a real difference in the lives of those we serve. Check out some awesome advocates below!

Learning Opportunities

Podcast on How Nursing Homes Respond to Government Inspections

In a new episode of the Pursuing Quality Long-Term Care podcast, economists Yiqun Chen and Marcus Dillender discuss their revealing studies on how nursing homes respond to government inspections. They explain how facilities often make short-term changes—like boosting staff and discharging patients—just to look better during inspections, only to revert immediately afterward. Despite this gaming, inspection ratings still offer meaningful insights into resident outcomes.

The conversation covers why some citations lead to real improvements while others don’t; how inspection ratings relate to mortality risk; and what policymakers can do to make oversight more effective and less predictable. This episode offers a candid look at the strengths and blind spots of government monitoring, and what it means for the future of elder care.

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