What the Repeal of the Federal 24/7 RN Rule Means for Families with Loved Ones in Long-Term Care
- HomeRNs+ Editorial Team
- Jan 9
- 3 min read
On December 2, 2025, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule that repeals the federal minimum staffing requirements for nursing homes participating in Medicare and Medicaid — including the much-discussed mandate that facilities must have a registered nurse (RN) on-site 24 hours a day, 7 days a week. This repeal goes into effect on February 2, 2026 and marks a significant shift in federal long-term care policy.
What Changed — In Plain Language
In 2024, CMS finalized a rule establishing the first comprehensive federal minimum nursing-staffing standards for Medicare/Medicaid–certified nursing homes. Among other things, that rule would have required:
A registered nurse present 24/7 in all nursing homes, and
A minimum of 3.48 total nursing hours per resident per day, including specific RN and nurse aide time.
However, under the new interim final rule, these staffing floors — including the 24/7 RN requirement — have been rescinded. Facilities are now only required to meet the previous baseline standard, which generally called for an RN to be onsite for at least 8 consecutive hours a day, 7 days a week (or as otherwise determined by state licensing).
What This Means for Families of Long-Term Care Residents
The repeal matters because staffing levels — especially RN coverage — are closely linked to resident safety and quality of care. According to a poll published by Nurse.org, 94% of nurses believe that eliminating minimum staffing rules will harm patient care quality and increase nurse workload and stress.
Here’s how families may experience the impact:
🩹 1. Less Federal Protection for Around-the-Clock Clinical Coverage
With the federal 24/7 RN mandate gone, there is no guarantee at the federal level that your loved one’s facility must have a registered nurse available night and day.
Some nursing homes may continue to provide 24/7 RN coverage voluntarily.
Others may scale back depending on staffing availability, budgets, or state requirements.
This change places greater responsibility on families to ask directly about actual RN coverage schedules at their loved one’s facility.
📉 2. Care Quality Could Vary More Between Facilities
Without a universal staffing floor, quality differences between nursing homes are likely to grow:
High-performing facilities may maintain strong RN staffing.
Lower-staffed homes that cut costs could increase the risk of missed care, delayed responses to medical changes, and poor oversight of complex conditions.
This makes comparing facilities’ staffing patterns — not just reputations — crucial when choosing care.
👩⚕️ 3. Nurses on the Floor Are Concerned
The Nurse.org poll shows that frontline nurses overwhelmingly believe that staffing minimums are essential to safe, high-quality care. Nearly 9 in 10 nurses support national staffing standards, and most predict that rolling back requirements will make patient care worse.
This reflects concerns from those who work directly with residents and see the effects of staffing shortages firsthand.
📍 4. State Rules Still Apply — So Local Standards Matter
While the federal requirement has been repealed, individual state licensure and staffing standards still govern nursing homes. Some states require more robust staffing than the federal baseline, especially for RNs.
Families should always review state staffing mandates and enforcement practices in addition to federal policy.
🛡️ 5. Families Will Need to Be Proactive Advocates
Because federal minimum standards are gone, families should consider steps like:
Asking facilities for written RN staffing schedules and policies
Monitoring resident care logs, call-light response times, and nurse availability
Engaging resident/family councils to raise concerns
Filing complaints with state survey agencies if care issues arise
Even without a federal 24/7 mandate, families still have tools to hold facilities accountable when care falls short.
Final Thoughts
The repeal of the federal 24/7 RN requirement for nursing homes represents a major policy shift. While it may offer operational flexibility for facilities facing workforce shortages, it also places greater emphasis on:
✅ Families understanding actual care practices,✅ Comparing facilities based on real staffing data, and✅ Advocating proactively for loved ones.
Frontline nurses, including those surveyed by Nurse.org, warn that eliminating minimum staffing protections could harm resident care quality unless families and regulators remain vigilant.
If you are exploring whether home nursing support is right for your family, we're here to help guide the conversation.
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