A federal nursing home staffing rule finalized under the Biden administration was later rolled back following private meetings between President Donald Trump and nursing home executives who had donated to his super PAC, according to reports and federal records.

The staffing requirement was designed to address chronic understaffing in nursing homes and reduce neglect and safety risks for residents, particularly in facilities that receive Medicare and Medicaid funding.

On April 22, 2024, the U.S. Department of Health and Human Services, through the Centers for Medicare and Medicaid Services, finalized three major rules aimed at strengthening oversight and improving conditions in federally funded nursing homes. The rules were part of President Joe Biden’s broader Action Plan for Nursing Home Reform and aligned with his April 2023 executive order on increasing access to high-quality care and supporting caregivers.

Biden’s Action Plan for Nursing Home Reform, first announced in 2022, focused on five core areas: establishing minimum staffing standards; strengthening federal and state oversight through increased inspections and enforcement; improving accountability and transparency of nursing home ownership and finances; enhancing resident and family protections; and supporting the long-term care workforce through higher wages, training, and career pathways.

As part of the plan, the administration directed CMS to increase inspections, expand enforcement actions against poor-performing facilities, publicly disclose nursing home ownership structures, and increase transparency around related-party transactions to ensure federal funds were used to improve resident care.

The finalized rules announced in April 2024 emphasized minimum staffing levels, improved job quality and compensation for care workers, expanded care options for older adults and people with disabilities, and strengthened safety and quality standards. The announcement coincided with Care Workers Recognition Month and the Month of Action on Care.

In August 2025, President Trump held private meetings with nursing home industry executives who had made significant donations to Trump-aligned political committees, including his super PAC. During those meetings, industry leaders urged the administration to withdraw the minimum staffing rule, arguing it would increase operational costs and strain facilities.

Less than a month after those meetings, the U.S. Department of Justice stopped defending the Biden-era staffing rule in court. Federal officials then moved to formally withdraw the requirement. In December 2025, the administration repealed the staffing mandate through an interim final rule published on December 3, 2025, rescinding the mandatory minimum staffing standards for federally funded nursing homes.

The rollback of the staffing rule has different implications for the industry and patients. For nursing home operators, removing minimum staffing requirements can lower operating costs, provide greater scheduling flexibility, reduce regulatory exposure, and improve profit margins, especially for multi-state chains or private equity–backed facilities.

For residents, however, experts warn the repeal increases the risk of neglect and preventable harm. Lower staffing levels can lead to less direct care time, higher rates of missed medications, delayed responses to emergencies, more pressure ulcers and infections, and increased worker burnout and turnover. Advocates say the change reduces accountability, as regulators lose a clear enforcement benchmark to prevent chronic understaffing.

The repeal has renewed debate over the influence of industry donations on health care policy and the federal government’s role in regulating long-term care facilities. Patient advocates, labor groups, and watchdog organizations warn that eliminating minimum staffing standards could worsen conditions for vulnerable residents, while industry representatives argue the repeal provides operational flexibility and cost relief.