A Step Backward for Seniors: The Looming RN Staffing Crisis in Nursing Homes

Critical Update for Families: Effective February 2, 2026, federal regulations requiring nursing homes to have a Registered Nurse (RN) on-site 24/7 are set to be repealed. 

This reversal means facilities will only be required to have an RN present for eight consecutive hours a day, leaving residents without high-level clinical oversight for the majority of the time. At Fiffik Law Group, we believe this change poses a direct threat to the safety and well-being of Pennsylvania’s seniors.

As Pennsylvania elder law attorneys, we are deeply concerned by this recent shift. For decades, advocates have fought for a definitive step up in the standard of care: the simple requirement that a registered nurse be on-site around the clock. However, with the repeal of the federal staffing mandate, we are facing a future where clinical expertise is treated as a part-time luxury rather than a necessity.

The Danger of "Part-Time" Clinical Oversight

Under the reinstated rules, for 16 hours out of every day, including the overnight shift when residents are often most vulnerable, there may be no RN in the building. This creates several high-risk scenarios:

• Delayed Diagnosis: RNs have advanced training to spot subtle clinical changes that signal life-threatening issues like sepsis, stroke, or heart failure.

• Emergency Response: When a medical crisis occurs at 3:00 AM, the difference between an RN being down the hall versus "on-call" at home can be the difference between life and death.

• Documented Risks: Research consistently shows that higher RN staffing levels correlate with fewer pressure ulcers (bedsores), fewer falls with injury, and lower mortality rates.

The Pennsylvania Context

While Pennsylvania implemented state-level staffing increases in 2024, the federal repeal creates a dangerous "race to the bottom." Without a federal floor ensuring an RN is always present, there is a significant risk that facilities will prioritize profit margins over the specialized clinical care our seniors deserve.

Family Advocate Checklist: Red Flags of Understaffing

Because staffing levels are the single most important factor in resident safety, families must look for these "silent" indicators that a facility is spread too thin:

• The "Echo" of Call Bells: Listen during your visit. Are call bells ringing for 15 minutes or longer without being answered?

• Hygiene "Shortcuts": Are your loved one’s nails untrimmed, hair unbrushed, or clothing stained? Poor grooming is often the first thing skipped when staff is overwhelmed.

• Physical Red Flags: Look for unexplained bruises, skin tears, or the development of "red spots" on the heels or tailbone (early stage bedsores).

• The "Ghost Town" Effect: Do you have trouble finding any staff member when you walk through the hallways or common areas?

• Staff Mood & Burnout: Do the caregivers seem visibly rushed, frustrated, or dismissive? High stress among staff is a primary mirror of unsafe staffing ratios.

• Meals Left Untouched: Is a tray sitting in front of a resident who clearly needs help eating, but no one is available to assist?

Questions Families Should Ask Now

Don’t wait for 2026 to start asking these critical questions:

1. "Do you currently have an RN on-site 24 hours a day, or only for the required 8 hours?"

2. "In February 2026, does this facility plan to reduce RN coverage to the minimum legal requirement?"

3. "What is the specific clinical protocol when an emergency occurs during hours when no RN is in the building?"

4. "How does the facility use its 'Facility Assessment' to ensure staffing levels actually meet the medical needs of its specific residents?"

Protecting Your Loved One’s Rights

Staffing shortages are not just a "logistical challenge," they are a safety hazard. When there aren't enough qualified professionals on the floor, medications are missed, residents aren't moved to prevent bedsores, and calls for help go unanswered.

Call Fiffik Law Group today.

If you suspect that your loved one has suffered an injury, a decline in health, or was otherwise harmed due to insufficient staffing or the absence of a qualified nurse at a Pennsylvania facility, you have rights. We are here to investigate the care your loved one received and fight for the justice and safety they deserve.