Fun fact I bet you maybe knew, I started as a CNA in a nursing home.
I worked nights in a small 4 wing nursing home. There was the acute wing, for people who had just had surgery and were getting better or who just needed a little more time to recover from their injury/illness. And then there were 3 other wings that had 12 rooms each, with only 1 room being private. The other rooms either had 2 patients or 4.
That’s a lot of patients.
I worked nights and it was the four CNAs, one for each wing, a registered nurse for the acute side and a registered nurse for the rest of the hospital. Yep, that is over 100 patients for the sub acute registered nurse to chart and to medicate and to declare death and to call doctors’ offices if there was an emergency overnight.
This is per shift.
I worked 4 nights on with 2 off at the end of the stint.
Not good for the bank account as there were some paychecks that always ended up a bit short.
But the point is that there were at least TWO registered nurses onsite per shift. I believe day shift had more because of med pass.
There has now been a federal staffing rule change from the 2024 federal staffing rule that Biden’s administration put into place.
The Biden’s staffing rule for nursing homes was that
1) there were at least 3.48 hours of nursing care per resident, per day, with 0.55 hours from registered nurses
2) at least 1 registered nurse had to be onsite 24 hours per day, 7 days a week
3) these were the minimum standards for Medicare and Medicaid certified nursing homes. Nationwide.
In late 2025, HHS and the Centers for Medicare and Medicaid Services issues an interim final rule rescinding these mandated staffing levels. Including the hours per resident per day and the 24/7 nursing requirement. But wait, there’s more, they left the assessment and planning expectations in place
This was touted as a savior to the rural and tribal nursing homes due to the, you guessed it, nursing shortage. Folks, there has been a nursing shortage for as long as I can remember. But HHS ran the numbers and realized that 100,000 additional caregivers, CNAs, LPNs, and RNs, would be needed to fulfill the 2024 staffing rules.
There was pearl clutching I am sure.
By the owners, who didn’t and don’t want to hire additional workers to fulfill the 2024 staffing rules.
This is a gift to the nursing home owners.
Registered nurses are expensive. Because they are the front line between their patients, numerous as they are, and HHS. They recognize medication errors and mistakes. They recognize when a patient is not acting as expected and may be having a heart attack or a stroke or sepsis because of a UTI. They do the daily dressing changes and are expected to assess the wounds to ensure healing
Who cares about the disabled person, or the elderly person who will no longer be expecting the minimal level of care? This is a roll back of safety standards. The RNs will be replaced with cheaper staff. No shade to the LPNs but they are different job classes with different job roles. And assessment? Is in the registered nurses’ toolbox.
And if an elderly person dies because of the lack of supervision? Not the nursing home’s fault, they cry.
More savings to HHS and an increase to the profit margin for owners.
It isn’t about the people who have lived entire life times in the beds, it is about the bucks in their pockets.
Dispatches from the Evening Shift 