What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued a final rule establishing new staffing standards for long-term care facilities, including skilled-nursing facilities (SNFs) and SNFs operated as distinct-part units of acute care hospitals.
What else to know: The regulations are effective June 21. Compliance with overall ratios is required beginning May 2026.
Key requirements for the finalized minimum staffing levels include:
- A registered nurse (RN) on site 24 hours a day, seven days a week
- Total nursing staffing standard of 3.48 hours per resident per day (HPRD)
- Minimum direct RN staffing of 0.55 HPRD
- Minimum direct nurse aide staffing of 2.45 HPRD
Facilities may use any combination of nurse staff (RN, licensed practical nurse, and licensed vocational nurse, or nurse aide) to account for the additional 0.48 HPRD needed to comply with the total nurse staffing standard.
The new requirements will be implemented on a staggered basis, with possible hardship exemptions for qualifying facilities for some parts of these requirements based on workforce unavailability and other factors.
Additional provisions in the final rule address updates to facility assessment related to staffing decisions.
CMS previously announced a national campaign to support staffing in nursing homes, which will provide scholarships and tuition reimbursement to support workforce development. CMS will release more information and a resource hub later this year.
Additional details are available in a CMS fact sheet.
