See what policymakers, healthcare professionals, and more are saying about a potential federal staffing mandate for nursing homes.


“We continue to be concerned that a mandated ratio could result in unintended consequences, such as staffing to the minimum, input substitution (hiring for one position by eliminating another), and task diversion (assigning non-standard tasks to a position), as well as stifling innovation, and would not result in the improved quality and person-centered care that we seek in facilities…”

Senator King

“It’s not enough to say, we’re going to have a good staff and we’re going to have enough staff. I want to hear how you’re going to make that happen, because we’re losing nursing homes generally in Maine, because of a lack of staff.
“And so, let’s have some programs to retain, raises, training, career ladder…whatever it’s going to take, but that’s what I want to hear. And to start with what I believe may be unrealistic standards, it seems to me it’s backwards. We should start with the programs to build the staff and maintain the staff that we have, then talk about increasing.”

Senator Angus King (I-ME)

Letter to CMS from Sen. Tester, Barrasso, Hickenlooper & Daines

Sen. Jon Tester (D-MT)
John Hickenlooper (D-CO)
Sen. John Barrasso (R-WY)
Steve Daines (R-MT)

“We fear a one-size-fits-all staffing mandate would undermine access to care for patients, particularly in rural communities… Instead, we urge you to work with Congress and rural stakeholders on tailored solutions that address the severe workforce challenges in our states’ underserved areas.

Senator Cramer

“I’m a little concerned about the talk of staffing ratio mandates and the impact that would have on an already very stressed situation. How does that policy help? I guess that is the bottom line. Can we please change it, or drop it, or admit we were wrong?

Senator Kevin Cramer (R-ND)


“The coronavirus pandemic has exacerbated longstanding staffing issues for SNFs. Economy-wide wage pressure and ongoing labor market shortages mean that SNFs are competing with other sectors and industries for scarce labor. Despite proportionally large wage increases relative to other sectors (e.g., hospitals, physician offices), SNF employment saw larger declines during the first two years of the pandemic than other sectors. SNF employment has also been slower to rebound and remains below pre-pandemic levels.”

Alex M. Azar & Kathleen Sebelius

“The state of nursing in America is dire, and we’re doing nothing to correct it. Every young American who wants to be a nurse should be encouraged but we deny them a spot in school. Every qualified international nurse who wants to bring their skills and passion to this country should be greeted with open arms but are instead slow-walked through a senseless bureaucratic queue. It doesn’t make any sense.”

Alex M. Azar II, 24th United States Secretary of Health and Human Services from 2018 until 2021.
Kathleen Sebelius, 21st United States Secretary of Health and Human Services from 2009 until 2014.

Other Voices

“Expecting us to comply without giving us the corresponding funding is asking us to do the impossible.”

“We need lawmakers to step up for our nation’s seniors.”

“To only implement a federal minimum staffing requirement without a staffing solution will punish nursing facilities.”

“At the bare minimum, nursing facilities need additional funding in order to close this gap and continue to operate. In the long term, nursing facilities want to partner with lawmakers to create solutions that address the underlying workforce challenges.”

“Investment, not mandates, will best solve long-term care staff shortages.”

“The administration is mandating the impossible without offering any resources to recruit and retain more staff needed to maintain access to care.”

“Unrealistic, unfunded mandates are not what we need. What we need is for our leaders in Washington, D.C., to support nursing homes with funding and policies we need to build a strong workforce.”

“A blanket mandate is not the solution that we need and would only cause further strain.”