(Iowa Capital Dispatch) – The state of Iowa, where nursing homes have compiled one of the nation’s worst records for staffing-level violations, has joined 19 other states in suing the Biden administration to block the implementation of new staffing requirements. According to the Iowa Capital Dispatch, the lawsuit, filed in U.S. District Court for the Northern District of Iowa, seeks to overturn the nursing home staffing requirements approved earlier this year by the Centers for Medicare and Medicaid Services. In their petition, the 20 states and more than a dozen industry associations argue that the new staffing requirements pose “an existential threat to the nursing home industry as many nursing homes that are already struggling will have no choice but to go out of business. And the main victims will be the patients who will have nowhere else to go.”

The lawsuit is in response to CMS’ decision in April to finalize new minimum staffing standards that will require homes to conduct assessments of their residents’ needs and provide 3.48 hours of direct nursing care per resident, per day. The rule also requires the homes to have a registered nurse available 24 hours per day, seven days a week. Earlier this year it was reported that Iowa nursing homes have the sixth-worst record in the nation for staffing-level violations. Data from CMS show that 14% of the state’s 422 nursing facilities were cited for insufficient staffing in fiscal year 2023. That was more than double the national average, which was 5.9%. Only five other states — Hawaii, Michigan, Montana, New Mexico and Oregon — had a worse record of compliance with the sufficient-staffing requirement. Des Moines’ Fleur Heights care facility compiled Iowa’s worst record of compliance.

Image from the Association of Healthcare Journalists

Federal data suggest many care facilities already meet the new standards, but industry officials allege nursing homes will need to hire an additional 27,000 full-time registered nurses and 78,000 full-time certified nurse aides, at a cost of more than $7 billion, to meet the requirements. The lawsuit alleges the new requirements, which apply only to homes that accept taxpayer money through Medicaid and Medicare funding for resident care, are “not even close to lawful.” Congress, the lawsuit points out, chose not to take action on complaints regarding the rule on “sufficient” staff.s.

Another point of contention referenced in the lawsuit is the new rule’s lack of recognition for the use of licensed practical nurses. The plaintiffs argue that the rule creates an incentive for facilities to fire LPNs and replace them with less skilled certified nurse aides. The rule “pressures long-term care facilities to replace experienced LPNs” with less-qualified new hires, the lawsuit alleges. The lawsuit seeks a declaration by the court that CMS lacks the authority to impose the new requirements as well as orders vacating and setting aside specific requirements such as the 24/7 requirement for a registered nurse.

The defendants, CMS and the U.S. Department of Health and Human Services, have yet to file a response to the lawsuit.