A federal judge in Texas last month overturned the first-ever minimum staffing requirement at most of the nation’s nursing homes, including in Colorado — gutting what some call crucial safety and quality of care measures.

On April 7, U.S. District Court Judge Matthew Kacsmaryk ruled in a summary judgement that while “rooted in laudable goals,” the rule set by the Biden administration’s Centers for Medicare and Medicaid Services was an overreach and that any changes to federal nursing home statues must be done by Congress.

“Separation of powers demands more than praiseworthy intent,” Kacsmaryk wrote in his ruling.

The decision was seen as a victory for the nation’s nursing home industry, which had sued the Biden administration in the Texas court, calling the requirements too costly and unworkable for facilities already struggling to lure workers.

In a broader sense it is also a win for the Trump administration, which had targeted the staffing minimums for potential elimination as part of its ongoing push for deregulation.

Finalized in April 2024 and scheduled to be phased in over the coming years, the measure included a requirement of at least 3.48 hours of total nursing care for each resident per day.

That included 0.55 hours from a registered nurse and at least 2.45 hours from a nurse aid. The remainder could come from either a registered nurse, a licensed practical nurse or other nursing staff.

In addition, facilities were to have a registered nurse on site 24 hours a day, tripling the prior requirement.

In Colorado, the state currently only requires facilities to staff “according to the needs of their residents,” the Colorado Department of Public Health and Environment said in an email. However, facilities must provide no less than a total of two hours of nursing or caretaking per resident per day, the agency said.

Nationally, just 19 percent of the nation’s 14,500 nursing homes met all the staffing ratio requirements as of last year, according to an analysis by KFF, the national health care research and information organization previously known as Kaiser Family Foundation.

In Colorado, only 22% of the state’s nursing homes met all the requirements, the KFF analysis showed.

A Denver Gazette breakdown of CMS data found that as of last month in Colorado’s 211 nursing homes, just more than half — or about 51% — met the required 3.48 hours of overall nursing care. Five facilities did not report.

Further, The Denver Gazette analysis found that while about three-quarters of the state’s nursing homes would meet the required 0.55 hours of daily registered nurse care per resident, less than one in four complied with the minimum 2.45 hours of care from a nurse aid. That is significant because nurse aids perform much of the hands-on duties in nursing homes and monitor residents for safety.

The nursing home industry has said facilities nationwide would have to add more than 100,000 new nurses and caretakers to comply with the stricter requirements – something it argued is unrealistic amid health care worker shortages. Some homes could have shut down under the new rules, according to the industry.

And while the measure did include a hardship exemption, the industry said in its lawsuit it was inadequate.

Elder care advocates have long said staffing ratios are an important metric of overall quality of care. In fact, some criticized the Biden-era rule for not going far enough.

A July 2024 University of Pennsylvania study, commissioned by U.S. Sen. Elizabeth Warren, D-Mass., concluded that the federal minimum staffing rule when fully implemented could have saved 13,000 lives per year.

“When residents are thriving, are doing well, the staffing levels are adequate. When residents aren’t doing well and suffering, we hear concerns at the bedsides of residents that there is not enough staff,” said Leah McMahon, Colorado State Long-Term Care Ombudsman.

A full, well-trained staff provides a watchful eye that helps prevent falls and makes sure medication is administered properly, she said. Wounds, such as bed sores, are monitored so they do not accelerate to sepsis, which can be fatal, she added.

The Trump administration’s U.S. Department of Health and Human Services, which oversees nursing homes, has until next month to appeal the Texas decision, but that is considered unlikely since it has not happened yet.

Both HHS and CMS declined to comment on the ruling or if the administration will appeal.

During his confirmation hearing in January, Robert F. Kennedy Jr., now head of HHS, was critical of the requirements, which he said created a hardship for facilities, especially in rural areas where hiring is often a problem.

He told lawmakers that while “noble” in its intention to provide more comprehensive care for elderly and vulnerable residents, the measures were “a disaster.”

And in a March email from the Trump administration’s Council of Economic Advisors to White House staff that touted deregulation efforts to “end senseless red tape,” the nursing home staff requirement was cited as an overly expensive Biden administration initiative.

Two lobbying groups for the nursing home industry, American Health Care Association/National Center for Assisted Living and LeadingAge, filed suit in Texas against the Biden administration in June 2024 asking for the CMS rule to be struck down. The Texas Health Care Association and three Texas nursing home facilities were also part of the legal challenge.

The case landed in front of Kacsmaryk, a U.S. District Judge for the Northern District of Texas in Amarillo, nominated to the bench by President Donald Trump in 2017 and confirmed two years later.

Kacsmaryk, known for his conservative views, rose to the national spotlight in 2023 when he ruled that the U.S. Food and Drug Administration’s approval of the abortion drug mifepristone be put on hold. The U.S. Supreme Court later overturned that ruling.

In his nursing home decision, Kacsmaryk left in place portions of the Biden-era rule, including some Medicaid reporting requirements, but revoked the staffing requirements which were considered the heart of the measure.

That led to both cheers from the nursing home industry and dread from those who say it potentially puts lives in jeopardy.

“Today’s ruling from the Northern District of Texas is a victory for our nation’s seniors and their families,” Clif Porter, president and CEO of Washington D.C.-based American Health Care Association and National Center for Assisted Living, said in a statement last month.

“As we have said all along, nursing homes would love to hire more nurses and caregivers, and despite limited resources, we are doing everything within our power to grow our workforce,” his statement added.

The group, which represents more than 15,000 facilities, said in an email it remains confident the Trump administration will not appeal, and that the judge’s ruling will stand. It also will push for Congress to repeal the mandate “so it is a statute and not an issue for future administrations,” the email to the Denver Gazette said.

In Colorado, the state chapter of LeadingAge, which represents non-profit aging service providers, said in its statement to The Denver Gazette it is “grateful for this common-sense ruling.”

“A mandate like the one struck down cannot be effective without adequate funding for Medicare and Medicaid and more incentives for the workforce – especially as we work to care for the fast-growing 65-and-older population in Colorado and across the country,” the statement said.

Colorado has the third-fastest population growth rate in the nation of people aged 65 to 84, increasing more than 300,000 in the past decade and projected to grow by another 265,000 in the coming one, according to the 2020 U.S Census.

That is precisely why some say the staffing minimums were so important.

“I’m absolutely worried,” McMahon, the state ombudsman, said. “I worry that (this ruling) says we don’t care and that residents will think we don’t care and that their quality of life and care doesn’t matter.”

“There is no incentive to improve,” agreed Robert Blancato, national coordinator for the 3,000-member Elder Justice Coalition and a board member for the Denver-based Next50 Foundation, a nationwide advocacy group for seniors. 

The staffing requirement, although not perfect, was necessary to help guarantee better care as the nation’s population ages, said Ernest Tosh, a Texas attorney who specializes in cases of elder abuse across the country.

“We thought we had our first step,” Tosh said, “and now we have a monumental step back.”