On February 2, 2026, the federal minimum staffing mandate officially disappeared from the books.
The rule that would have required nursing homes to provide 3.48 hours per resident day of nursing care, including 24/7 registered nurse coverage, is gone. The nursing home industry called it a victory. Resident advocacy groups called it a disaster. And administrators across the country were left wondering: what does this actually mean for how we operate?
Now that we're several months past the repeal date, the dust has settled enough to see what's really changed—and what hasn't. If you're running a skilled nursing facility, assisted living community, or long-term care facility, here's what you need to understand.
What Actually Got Repealed
Let's start with the specifics. The December 2025 interim final rule eliminated:
The requirement for nursing homes to provide a minimum of 3.48 hours per resident day (HPRD) of total nursing care, broken down as 0.55 HPRD from registered nurses and 2.45 HPRD from nurse aides.
The requirement for a registered nurse to be on-site 24 hours a day, 7 days a week.
What remains is the prior federal standard: RN services for at least eight consecutive hours daily, seven days a week, plus a full-time RN serving as director of nursing (unless a waiver is granted).
The estimated "savings" to the industry? Approximately $2.18 billion annually, according to CMS calculations. The estimated lives the original rule would have saved? 13,000 per year, according to University of Pennsylvania researchers.
What's Still in Effect (And This Is Critical)
Here's what many administrators missed in the headlines: the enhanced facility assessment requirement remains fully in effect.
This provision, which took effect in August 2024, requires facilities to evaluate and document staffing based on the actual needs of their residents. It's not a numerical mandate, but it's not optional either.
Under the enhanced facility assessment, your facility must:
Assess the specific needs of each resident in the facility. Include input from facility staff, including nursing home leadership, management, and direct care workers. Incorporate feedback from residents, resident representatives, and family members. Develop a staffing plan that addresses how you will meet those assessed needs. Adjust the assessment as necessary based on significant changes in the resident population.
This requirement was unaffected by the congressional moratorium that delayed the numerical standards, and it was unaffected by the repeal. It remains enforceable.
What this means practically: if your resident population includes individuals with complex medical needs, dementia care requirements, or high acuity levels, you cannot simply staff to the old 8-hour RN minimum and call it compliant. Your facility assessment must justify your staffing levels based on actual resident needs—and CMS will continue to monitor through the existing survey process.
State Regulations Didn't Go Anywhere
The federal repeal only affects federal standards. State-level staffing requirements remain fully in force.
Several states have staffing requirements that exceed what the federal rule would have mandated:
California requires 3.5 hours of direct care per resident per day, with at least 2.4 hours from certified nursing assistants. New York requires 3.5 hours per resident per day, with 2.2 hours from CNAs and 1.1 hours from RNs or LPNs. Massachusetts, Florida, and Rhode Island also maintain rigorous staffing minimums.
If your facility operates in a state with its own staffing standards, the federal repeal changes nothing about your compliance obligations. You're still bound by state law.
Even in states without numerical mandates, enforcement hasn't disappeared. The "sufficient staffing" requirement that has existed since the 1987 Nursing Home Reform Law remains in place. Facilities that fail to meet resident needs—regardless of whether they hit a specific HPRD target—remain subject to citations, fines, and enforcement actions.
Quality Outcomes Still Matter
The repeal removed a regulatory requirement. It did not change the relationship between staffing levels and care quality.
The research remains clear: higher staffing levels are directly associated with better resident outcomes. Lower staffing is associated with more falls, more pressure ulcers, more infections, higher hospitalization rates, and higher mortality.
CMS continues to track and publish staffing data through the Payroll-Based Journal system. Quality ratings on Care Compare still incorporate staffing levels. Families researching facilities can still see how your staffing compares to state and national averages.
Facilities that use the repeal as justification to cut staffing will likely see consequences through:
Lower Five-Star ratings, which affect referrals and reimbursement negotiations. Increased citations during surveys, particularly related to the facility assessment requirement. Potential legal liability if inadequate staffing contributes to resident harm. Difficulty recruiting staff, as nurses increasingly avoid facilities known for understaffing.
The repeal offers flexibility. It does not offer immunity from the consequences of poor staffing decisions.
The Real Challenge Hasn't Changed
Here's the uncomfortable truth: the staffing mandate was repealed in part because so many facilities couldn't meet it.
The American Health Care Association estimated that 94% of facilities would have failed to meet at least one of the proposed staffing requirements. CMS projected that the industry would need to hire 12,000 additional registered nurses and 77,000 nursing aides to achieve compliance.
Those workers don't exist in the current labor market. The nursing shortage remains at 8.06% nationally. LPN shortages have hit 20% and are projected to nearly double by 2036. CNA turnover exceeds 42% annually.
The repeal didn't solve these problems. It just removed the regulatory pressure to address them.
Facilities that were already providing adequate staffing will likely continue doing so. Facilities that were chronically understaffed now have less regulatory incentive to improve—but the same operational challenges remain.
What Smart Administrators Are Doing Now
The facilities that will thrive in this environment are taking a strategic approach:
Taking the facility assessment seriously. Rather than treating it as a compliance checkbox, forward-thinking administrators are using the enhanced assessment process to genuinely evaluate what their resident population needs and building staffing plans accordingly. This isn't just about avoiding citations—it's about running a better facility.
Building flexible workforce models. The facilities with the most resilient staffing aren't relying solely on permanent employees. They're combining a core team with reliable per diem and contract professionals who can provide coverage during census fluctuations, call-offs, and peak demand periods.
Establishing staffing partnerships before they need them. Facilities that only call staffing agencies during emergencies pay premium rates and often can't get coverage at all. Those with established relationships get priority access, better rates, and professionals who already understand their systems.
Investing in retention. With 55% of healthcare workers planning to change jobs in 2026, the competition for talent is fierce. Facilities that offer scheduling flexibility, career development, and a culture of respect are keeping their best people while competitors struggle to fill shifts.
Documenting everything. If your staffing approach is ever questioned—by surveyors, families, or in litigation—your documentation is your defense. Clear records of your facility assessment process, staffing decisions, and rationale will matter.
The Bottom Line
The federal staffing mandate is gone. The underlying challenges that prompted it are not.
Facilities now have more flexibility in how they approach staffing—but with that flexibility comes responsibility. The enhanced facility assessment requirement remains in effect. State regulations still apply. Quality outcomes still matter. Families still research staffing levels before choosing a facility.
The repeal is not a free pass to understaff. It's an opportunity to build a more sustainable, strategic approach to workforce management—one that meets resident needs, supports staff retention, and positions your facility for long-term success.
The facilities that use this moment to cut corners will face consequences. The facilities that use it to build stronger staffing infrastructure will emerge ahead.
How FlexForce Medical Staffing Can Help
Navigating the post-repeal landscape requires a staffing partner who understands both the regulatory environment and the practical realities of healthcare workforce management.
At FlexForce Medical Staffing, we provide credentialed RNs, LPNs, CNAs, and allied health professionals for per diem, contract, and permanent placements. Our rigorous credentialing process ensures every professional meets your facility's standards and is ready to provide quality care from day one.
Whether you're building a hybrid staffing model, preparing for seasonal demand fluctuations, or need reliable backup when the unexpected happens, FlexForce is the partner you can count on.
Ready to discuss your facility's staffing strategy?
Contact FlexForce Medical Staffing today.