February 12, 2026 Washington, DC—Statement from Katie Smith Sloan, president and CEO, LeadingAge, the association of nonprofit providers of aging services, including nursing homes on the “Nurses Belong in Nursing Homes Act,” introduced in the Senate today by Ron Wyden (D-OR):

“Ensuring older adults and families can receive quality care is a goal that LeadingAge and our mission-driven and nonprofit members steadfastly support. We know that quality care and staffing are tightly connected.

Now more than ever, as America’s population ages and demand for care and services grows, nursing homes, which provide 24/7 care in a setting unlike any other in health care, are a critical element in our country’s long-term care continuum. Without the nurse aides, the registered nurses, licensed practical nurses, and other caregivers who serve nursing home residents, there is no care.

Though we appreciate that Sen. Wyden’s legislation contains more flexibility in mandated staffing than that of the now-repealed April 2024 finalized staffing rule, the core issue with these approaches must be addressed: workforce and funding.

Aging services providers operate in a very challenging labor market, competing with a variety of employers across the healthcare industry that in many cases have access to far more resources.

Consider that by our calculations, more than 3000 additional registered nurses (RNs) would be needed to meet the 24/7 requirement. There are not enough nurses in the United States to fill the positions that are currently open, and schools are not graduating enough nurses to fill either existing open jobs or those that are projected to open. According to the National Center for Health Workforce Analysis, part of the Department of Health and Human Services, shortages of RNs overall are projected until 2038. Competition for RNs across healthcare settings is expected to remain robust in the coming years; demand in aging services will grow as America’s population ages and need for care increases.

Compounding these challenges are the current administration’s changes to immigration policies, which make recruiting and retaining foreign-born staff more difficult and sometimes impossible.

Foreign-born caregivers already make up a significant proportion of team members in the LTSS sector compared to other workplaces. Immigrants working as direct care professionals—which includes nurses—come to the U.S. from at least 163 countries, with the most significant number of foreign-born workers hailing from Mexico (14%), the Philippines (9%), the Dominican Republic (7%), Jamaica (7%), and Haiti (7%).  Policies including the termination of categorical parole for people from Haiti and other countries, and of temporary protected status are forcing providers to let go of qualified and valued staff.

Next, the cost of imposing staffing standards must be addressed. Our initial estimates of the cost of adding over 3,000 additional RNS to meet the 24/7 requirement is almost $350 million per year.

These mandates will add to the already difficult operational and financial landscape that providers face as HR 1 is being implemented and states grapple with the loss of nearly a trillion dollars in federal Medicaid funding. Medicaid is the primary payer for U.S. nursing homes, covering over 60% of residents–but only around 80% of the actual costs of care.

There is a very real threat of undercutting equity and access in care across the aging services spectrum. Nursing homes will be forced to close their doors or limit admissions; hospitals will continue to be backed up with patients who can’t be discharged to nursing homes. Home health providers are already rejecting referrals and some face closure due to financial pressures and workforce shortages. There won’t be anywhere for older adults and families to access care. And, of course, communities of color and less affluent individuals will feel the deepest impact.

The bill stops well short of addressing the fundamental underlying issue: the need to expand the aging services workforce.

We do not support it.

What we need are solutions to address the very real barriers that our nursing home members navigate in recruiting and retaining staff. We urge Congress and the administration to invest in building and sustaining the long-term care workforce by funding recruitment, training, and retention initiatives, addressing reimbursement shortfalls, and creating pathways for new caregivers to enter the field, including through long-overdue immigration reform. Without bold solutions to strengthen the pipeline of qualified professionals, older adults and families will continue to face limited access to care.

Now more than ever, as America’s population ages and demand for care and services grows, nursing homes, which provide 24/7 care in a setting unlike any other in health care, are a critical element in our country’s long-term care continuum. Without staff, there is no care.”