As a flurry of regulations and mandates descend upon the nursing home sector, such changes could create legal obstacles, and suggest yet another difficult and onerous year for providers.

Staffing mandates, the aftermath of the end of the public health emergency (PHE), Covid liability and the PREP Act, all create “existential threats” for skilled nursing operators, at a time when so many are still attempting to recover from the last two and a half years.

Providers agree that staffing continues to be the largest challenge facing the industry at this point in time, and that is not expected to change as the federal government works to create its own federal staffing standard.

Several questions surround the looming mandate, including whether it will be achievable, if it will be tied to the presence of staffing, whether it will be phased in or if it will be subject to some sort of pilot program, Reagan said.

Implementing a staffing minimum of 4.1 hours per resident day would require 94% of nursing homes to increase staffing levels just to be in compliance, according to data from accounting and consulting firm CliftonLarsonAllen in partnership with AHCA.