President Biden has promised to reform nursing homes by setting a national minimum staffing standard. Though nursing homes have been required to have “sufficient staff” to meet each resident’s needs, this is the first time that a president has proposed setting a numerical standard for the minimum number of nurses and aides that a facility must have in order to provide good care.

Unfortunately, the agency charged with developing this rule, the Centers for Medicare and Medicaid Services (CMS), has proposed a rule that is woefully inadequate to meet residents’ needs. The public has until November 6, 2023, to comment on the proposal. It is important that they hear from as many of us as possible that any standard must be truly sufficient to ensure resident safety and dignity!

This page provides easy steps to submit your comments and share them with your representatives and senators in Congress.

To comment on the rule, visit

In the comment section:

  1. Indicate that you are writing in reference to file code CMS–3442–P.
  2. Write a short message about why any staffing rule must be sufficient to ensure that every resident receives appropriate care and humane treatment.
  3. Please say a little bit about why this is important to you.
  4. Feel free to include any of the bullet points provided below.
  5. If you wish, attach a picture or document that is meaningful to you in respect to safe nursing home care.

One last thing… before pressing send, please consider sharing these comments with your Senators and Member of Congress by using our Action Alert. Your federal representatives have a lot of influence on this process. You can write your own message or use our provided template. The message will be automatically sent to your federal representatives. Click here to contact your federal representatives.

Key Points to Consider Including in Your Comments:

  • Numerous studies have shown that residents need at least 4.1 HPRD (hours per resident day) of nursing time just to meet basic clinical needs.
  • 4.1 HPRD must be a starting point for acceptable nursing home care, not left up to providers to voluntarily fulfill.
  • The 4.1 HPRD minimum should include at least .75 HPRD of an RN’s time.
  • I support CMS’s proposal for 24-hour RN staffing. However, it is crucial that the RN be in the building, not merely available at a different location.
  • The 24-hour RN requirement should be modified to require at least one RN per 100 residents 24-hours per day. Otherwise, residents in larger facilities will not have access to vital RN monitoring and care.
  • CMS should commit to undertaking an evidence-based study of the staffing needs for residents to live safely and implement the findings of that study within two years.
  • Any staffing standard must include sufficient time for treatment with dignity and appropriate infection control protocols, as long required by the Nursing Home Reform Law. It is unacceptable that CMS ignored these needs in developing its proposed standard.
  • Facilities should not get waivers for failing to comply with any of the requirements. If a facility falls below the minimum standard, it must be prohibited immediately from taking in new residents. A nursing home should not be run like a warehouse for vulnerable elderly and disabled individuals.
  • Implementation of the final rule should take place within two years for all facilities. It is unacceptable to allow delays for rural facilities. The residents in rural communities are entitled to the same quality and safety as those in urban and suburban areas.
  • No waivers and no delayed implementation of the staffing standards. If a facility is unable to maintain safe staffing levels it must be required to stop accepting new residents. CMS must stop putting the financial priorities of the nursing home industry above the basic needs and dignity of nursing home residents.