For decades, choosing a nursing home meant hoping there were enough nurses to answer the call button at 3:00 AM. In 2024, the federal government tried to replace that guesswork with hard numbers—proposing a rule that would have required 3.48 hours of daily nursing care per resident and 24/7 RN coverage. But in December 2025, that rule was officially repealed.
Now, in 2026, families are left with a patchwork of state standards, voluntary benchmarks, and a lot of unanswered questions. Here’s what the repeal means for your loved one’s care—and your wallet.
1. The 3.48-Hour Benchmark Is Gone—But Still Useful
CMS’s now-defunct rule would have required:
- 0.55 hours of RN care
- 2.45 hours of CNA care
- 0.48 hours from LPNs or other licensed staff
While no longer mandatory, these numbers remain a valuable benchmark for families touring facilities. If a nursing home is still providing only 3.0 hours per resident per day (the national average), that’s a red flag.
2. No 24/7 RN Requirement—Unless Your State Says So
The proposed rule would have mandated a Registered Nurse on-site 24/7. That’s no longer the case. The federal requirement remains at 8 hours per day, meaning your loved one may not have RN access overnight. Some states (like California and New York) have stricter rules, so check your state’s laws.
3. Staffing Shortages Still Drive “Capacity Shedding”
Even without the federal mandate, many facilities are reducing resident counts to improve staff-to-patient ratios. If you receive a “downsizing” discharge notice, it may be a sign the facility is struggling to meet internal or state-level staffing goals.
4. Rural Facilities Face Fewer Requirements
The repealed rule included hardship exemptions for rural facilities. While those are now moot, rural homes still face severe staffing shortages, and many operate with minimal oversight. Always ask: “What is your average RN coverage per day?”
5. Private-Pay Residents Still Foot the Bill
Even without a federal mandate, facilities are raising rates to attract and retain staff. In 2026, many private-pay residents are seeing 5%–10% increases labeled as “staffing enhancements” or “clinical surcharges.” These costs are often used to subsidize care for Medicaid residents.
A New Way to Ask the Right Questions
The repeal of the CMS rule doesn’t mean staffing doesn’t matter—it means you have to ask smarter questions. When touring a facility, request their Payroll-Based Journal (PBJ) staffing data, and ask:
- “How many RN hours per resident per day do you provide?”
- “Do you have overnight RN coverage?”
- “What’s your CNA turnover rate?”
Even without a federal mandate, you can still demand transparency.
Have you noticed any staffing changes at your local nursing home? Share your experience in the comments.
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