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Alabama Attorney General Joins Multi-State Lawsuit to Block Federal Nursing Home Staffing Rule: Key Issues at Stake

The Alabama Attorney General, alongside those of 20 other states, has filed a lawsuit opposing the new federal nursing home staffing mandates. These regulations, introduced by the Centers for Medicare and Medicaid Services (CMS), require nursing homes to provide at least 3.48 hours of care per resident each day and ensure that registered nurses (RNs) are available 24/7 by 2026. While the rules aim to improve care standards, the lawsuit warns that they could lead to widespread facility closures and disruptions in care, particularly in rural communities.

state of alabama government building

Key Issues at Stake 

1. Why would Alabama’s Attorney General oppose higher care standards? 

The lawsuit argues that the federal mandate imposes excessive financial burdens on nursing homes already struggling with staff shortages. The attorneys general claim the rule could force many facilities, especially those in rural areas, to shut down, leaving residents without access to essential care. The legal challenge contends that CMS overstepped its regulatory authority, implementing a costly “one-size-fits-all” policy without Congressional approval. 


But how many of the staff shortages are due to low pay? While the regulations will cut into the profits of nursing homes, given the large number of issues experienced by residents and patients of nursing homes, it appears that we need to step up the requirements in order to ensure the safety of our loved ones. It is important to regulate the minimum standards as so much of what happens at nursing homes are not witnessed by those capable of complaining or making changes.

 

2. Shouldn’t the priority be providing better care for elderly residents? 

Supporters of the mandate argue that ensuring continuous staffing is necessary to improve safety and quality of life for residents. However, opponents contend that improving care cannot come at the expense of access—if nursing homes are forced to close, patients will have fewer options. The lawsuit emphasizes the delicate balance between care quality and operational viability, highlighting the risk of reduced care availability if the mandate proceeds unchecked. 


But if a facility cannot meet certain minimum staffing requirements, then would the patients be better off without it? Do we simply want warehouses where our loved ones are housed but not treated properly? These changes came about because of the horror stories people have seen and experienced in under-staffed nursing homes. Our loved ones deserve more.

 

Legal and Practical Implications 

The lawsuit claims that CMS’s new nursing home staffing rule violates the "Major Questions Doctrine," a legal principle restricting federal agencies from implementing major policies without clear legislative approval. The states argue that, while CMS offers hardship exemptions to facilities struggling to meet the requirements, these exemptions are not enough to prevent large-scale disruption. Many facilities may still be forced to close or reduce services due to the staffing mandates, creating a ripple effect across the healthcare system. 

 

This lawsuit underscores the broader challenges faced by the nursing home industry. It highlights the difficult decisions involved in balancing financial sustainability with the need to improve resident care. The outcome of this case will likely shape the future of nursing home operations, setting a precedent for how far federal agencies can go in imposing healthcare regulations.

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