As lawmakers aim to overhaul the nation’s long-term care (LTC) system, with proposals addressing nursing home ownership transparency and staffing standards, providers are seeking adjustments while expressing support for many of the proposed changes.
Senate Finance Committee Democrats, led by Ranking Member Ron Wyden, who issued a request for information (RFI) on Friday, are seeking to increase nursing home ownership transparency, limit private equity (PE) influence, strengthen oversight and renew staffing standards.
“There is real common ground contained in this RFI,” Zach Shamberg, chief of government affairs at Saber Healthcare Group, told Skilled Nursing News. He added, however, that he opposes reinstating the 2024 staffing rule, which was ultimately repealed.
“Fixing the CNA training lockout, modernizing training requirements, expanding immigration pathways for caregivers, promoting quality of care, instituting ‘deemed status’ for nursing homes through the Joint Commission, and strengthening accountability and oversight by adopting already-proven Change of Ownership and Change of Operator policies would make an immediate difference for our sector,” he said.
The senators state that long-term care has been severely damaged by nearly $1 trillion in Medicaid cuts enacted under the budget reconciliation bill, commonly called OBBBA, and changes are urgent.
For the skilled nursing sector, the RFI calls for improvements in nursing home quality and workforce reform. It proposes that states report how much of their Medicare payments go to direct care workers. Moreover, the senators are also proposing a federal spending floor, requiring nursing homes to direct a specific minimum percentage of Medicare and Medicaid reimbursement toward direct resident care, rather than management fees, rent to related-party entities, or corporate profits. The RFI seeks feedback on what percentage threshold is most effective and how federal policy can mirror those state models.
States such as Massachusetts, New York and New Jersey have already enacted similar requirements, the RFI document notes.
For the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), the largest national organization representing nursing homes and other long-term and post-acute care providers, President and CEO Clif Porter said the organization is eager to work on the proposal.
“[W]e continue to support bold, commonsense policies that expand access, strengthen the workforce, invest in innovation, and most importantly, drive quality,” Porter said in an emailed statement to SNN. “AHCA/NCAL remains committed to working with lawmakers and other stakeholders to develop supportive and sensible solutions to move long-term care forward and ensure seniors receive the high-quality care they need, when and where they need it.”
The senators are also proposing stronger transparency and accountability for nursing home ownership, including reinstating detailed ownership-disclosure requirements to the Centers for Medicare and Medicaid Services (CMS), which were suspended by the Trump administration as well as limiting private equity involvement in nursing home operations. In addition, they aim to expand the Corporate Transparency Act’s beneficial ownership reporting to nursing homes and require CMS to scrutinize operator track record before approving ownership changes.
“Long-term care and the decisions that surround it are among the most personal and sensitive any American family must face,” Wyden said. “Today, those decisions are too often driven by financial considerations rather than what is best for a loved one and their family.”
Renewed focus on staffing
The RFI document states the legislators’ intent to improve staffing, noting that stronger staffing mandates must be paired with higher wages, training pipelines and curbs on corporate profit-taking.
The current federal floor — just 18 minutes of direct care per resident per day — has been unchanged for nearly 40 years, the RFI notes. The Biden administration’s 2024 rule raising the floor to 3.48 hours per resident per day (HPRD) and mandating a registered nurse (RN) on-site 24/7 was blocked by Congress and rescinded by the Trump administration in December 2025.
The RFI also highlights Illinois as a model: its value-based Medicaid payment incentives tied to staffing ratios produced an 11% increase in staffing levels from 2022 to 2026, rising four times faster than the national average during the same period.
Proposals also include increasing the weight of the staffing domain in the Five-Star Quality Rating, adding staffing instability, with a measure for day-to-day variation, as a new metric, and reducing reliance on self-reported data, which the RFI notes can be manipulated without improving actual care quality.
The RFI proposes updating the current 75-hour certified nursing assistant (CNA) training standard, only 16 of which are clinical, creating portable and universal care worker credentials, developing competency-based training frameworks for CNAs and personal care aides, and expanding federally supported apprenticeship models. It also proposes requiring the HHS Secretary to review and update LTC training standards every two to four years.
While nursing home provider welcome bolstering staffing, they don’t support bringing back the staffing mandate.
“To be clear: we have seen this staffing mandate before. It was rejected by the courts, by Congress and by CMS because there are not enough nurses to meet it and no funding to pay for it. Reviving it would not add a single caregiver. The better path is already in this document: fixing the CNA training lockout, modernizing training, opening legal immigration pathways for caregivers, and rewarding providers that invest in staff,” Shamberg said.
Shamberg said he was encouraged that the Finance Committee is asking about alternatives to a one-size-fits-all staffing mandate.
“Incentive-based approaches that pair staffing goals with adequate Medicaid funding have a far better track record than unfunded mandates, which would force facilities, especially rural ones, to limit admissions or even close their doors altogether,” Shamberg said.
Senate Democrats are also soliciting feedback on reviving and legislating these standards through the Nurses Belong in Nursing Homes Act introduced in February 2026. The proposals include requiring a 24/7 RN presence in all nursing homes, setting an initial minimum of 3.5 hours of nursing care per resident per day, establishing regular, evidence-based updates to staffing standards, including for residents with Alzheimer’s or dementia, providing permanent mandatory funding for nursing home inspections and enforcement, and reinvesting civil monetary penalties from non-compliant facilities into workforce recruitment and retention.
Linda Couch, senior vice president of policy at LeadingAge, the association of nonprofit and mission-driven providers of aging services, said the proposal is headed in the right direction.
“LeadingAge is encouraged by the Senate Finance Committee Democrats’ focus on how our nation meets the needs of older adults. Ensuring access to affordable, high-quality care and services is both a policy imperative and a reflection of our nation’s values,” Couch said. “We appreciate the Committee’s engagement with stakeholders, including LeadingAge, through a series of discussions that helped inform the development of this RFI. We look forward to collaborating with members and state partners on a response to the request.”
Comments may be submitted to [email protected] no later than December 18, 2026.
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