When Nursing Home Oversight Disappears, Who Pays the Price?

The federal government is pulling back from nursing home oversight. The minimum staffing rule is gone. Ownership transparency requirements are suspended. CMS has signaled that more rollbacks are coming. A June 5, 2026, opinion piece in McKnight's Long-Term Care News by Vivian Zayas, co-founder of Voices for Seniors and a congressional witness on nursing home accountability, made an argument worth taking seriously: deregulation does not protect nursing home residents. It does not protect their families. And, she argues, it does not protect operators either.

Ms. Zayas lost her mother in a nursing home. She has spent years in legislative hearings, watching what happens when a crisis lands on an industry that cannot point to clear standards it met. Her column in McKnight's was addressed to owners, operators, administrators, and directors of nursing, not to families and not to lawyers. That framing matters. She is not making a plaintiff's argument. She is making a governance argument. The two are not the same, but from where families in Texas sit, they arrive at the same place.

When oversight recedes, residents bear the consequences first. Texas families need to understand what is being removed, why it matters, and what legal protections still exist when a nursing home fails.

What Federal Nursing Home Protections Have Already Been Rolled Back?

The most consequential recent rollback is the federal minimum staffing rule. CMS finalized a rule in 2024 requiring nursing homes to provide a minimum of 3.48 total nursing hours per resident per day, including at least 0.55 hours from a registered nurse and 2.45 hours from a nurse aide. The rule also required a registered nurse to be on-site 24 hours a day, seven days a week. That rule has since been rescinded.

Ownership transparency requirements have also been suspended. Those requirements would have forced nursing homes to disclose the full web of entities involved in their ownership and management, including the related-party real estate companies and management companies that a September 2025 National Bureau of Economic Research working paper found were used to hide 68 percent of the industry's profits from regulators. Without transparency requirements, families and regulators cannot readily identify who is actually responsible when something goes wrong at a facility.

Ms. Zayas described the current regulatory direction as CMS telling the industry that more is coming, more flexibility, more relief, more rollback of what the agency calls burden. The trade associations are being listened to. For families placing a loved one in a Texas nursing home today, the practical consequence is a federal floor that is lower than it was two years ago and getting lower.

What Does Deregulation Actually Mean When Something Goes Wrong?

Ms. Zayas makes a specific argument in her McKnight's column that deserves direct attention from Texas families: when there is no federal floor for staffing, every bad outcome becomes a question of what an owner or operator chose to provide, not what they were required to provide.

That is a legal observation as much as a policy one. In a Texas nursing home neglect case, the standard of care is the central question. It defines what the facility was obligated to do and whether it fell short. Federal regulations are one source of that standard. State regulations are another. When federal minimums are eliminated, the regulatory floor shrinks. The facility's obligation does not disappear, but the clearest external benchmark for what adequate staffing looks like becomes harder to point to.

Ms. Zayas writes that when oversight is weak and something goes wrong at scale, the response is not targeted. It is sweeping. That observation reflects what happens in crisis: the industry as a whole gets scrutinized, good operators and bad ones alike. For individual families, though, the crisis is not abstract. It is the fall that broke a hip. It is the pressure wound that went unnoticed for days. It is the infection that spread because no one caught it in time. Those injuries happen at specific facilities, and they happen to specific people.

The legal question after a preventable injury is always whether the facility met its duty of care. Deregulation makes that question harder to answer with a clear standard, but it does not make it disappear. Texas law imposes its own requirements on nursing facilities independently of federal minimums.

What Legal Obligations Do Texas Nursing Homes Still Have?

Federal deregulation does not eliminate Texas law. The obligations Texas nursing homes carry are grounded in state statute and state administrative code, and they remain enforceable regardless of what CMS does with federal minimums.

Under Texas Administrative Code Chapter 554, Texas imposes specific staffing sufficiency requirements. The standard is functional: staffing must be sufficient to meet residents' needs. There is no fixed numerical floor identical to the rescinded federal rule, but the sufficiency obligation is independently enforceable under state law.

Under 26 Tex. Admin. Code §554.701(a), every licensed nursing facility in Texas must provide care that meets the needs of its residents and maintains their highest practicable physical, mental, and psychosocial well-being. In fact, under 26 Tex. Admin. Code §554.1921(a), Texas nursing homes are not even allowed to have a resident in their facility whose needs they cannot meet. That is not a suggestion. It is a statutory obligation, and it applies to every facility in the state whether or not a federal staffing minimum is in force.

Under 26 Tex. Admin. Code §554.1001, Texas requires facilities to provide adequate nursing staff to meet each resident's assessed needs around the clock. A facility that runs short on nursing staff and a resident is harmed as a result is not protected from liability simply because a federal rule no longer specifies the minimum number of hours required.

The Texas Health and Human Services Commission enforces these standards through surveys and inspections. When a facility falls below them, CMS can still issue deficiency citations under 42 CFR Part 483 for Medicare and Medicaid-certified facilities. The rollback of the staffing minimum rule does not eliminate the broader federal conditions of participation that all certified facilities must meet.

For purposes of a civil negligence claim, the standard of care is not defined by federal regulation alone. Courts look to accepted professional standards in the nursing home industry, expert testimony, and the specific circumstances of the resident's care. A facility that provided staffing levels its own clinical assessments showed were insufficient to meet a resident's needs is not shielded by the absence of a federal floor.

Why Does Ownership Transparency Matter to a Texas Family?

The suspension of ownership transparency requirements has a direct practical effect on families pursuing legal claims. It makes it harder to identify the full set of entities responsible for a resident's care.

Modern nursing home ownership is frequently structured across multiple entities. The licensed facility is one entity. The real estate may be owned by a separate company. Management may be contracted to another. Staffing may run through a separate employer of record. These structures are documented in the NBER working paper by Gandhi and Olenski, which found that 77 percent of U.S. nursing homes transact with related parties and that those transactions are a primary mechanism for moving profits and assets off the facility's books.

When a resident is harmed, a lawyer needs to know which entities were involved in operational decisions, which entities hold assets that can satisfy a judgment, and how those entities relate to each other. Transparency requirements that forced disclosure of ownership structures made that analysis faster and less expensive. Their suspension means the information still exists but requires more work to uncover, through discovery, corporate filings, and regulatory records requests.

Ms. Zayas puts it directly in her McKnight's column: when ownership structures are opaque, every tragedy invites scrutiny of everyone because no one can quickly identify who is actually responsible. That is as accurate a description of the litigation discovery process as it is of the regulatory one.

What Is the Argument That Deregulation Actually Hurts Operators?

Ms. Zayas directs her column at owners, operators, administrators, and directors of nursing, not at families or advocates. Her argument to them deserves a fair summary because it reinforces the case for standards from an unexpected direction.

Her core claim is that the absence of enforceable standards does not protect an operator when something goes catastrophically wrong. It exposes them. Without a federal floor to point to, a bad outcome becomes a question of what the operator chose, not what was required. Without transparency requirements, a crisis sweeps across the industry without distinguishing good actors from bad ones. Without clear standards, the operators who are doing things right have no way to demonstrate that publicly.

She writes that she has been in congressional hearings and has seen what happens when an industry cannot point to standards it met and say, here is the proof. The absence of standards does not protect operators. It leaves them exposed to the same scrutiny as the worst facilities in the country.

From a litigation standpoint, that analysis is correct. A facility that can demonstrate it met or exceeded every applicable standard is in a fundamentally stronger position than a facility operating in a deregulated environment where what it provided is the only reference point. Standards create a floor. They also create a ceiling that good operators can point to and say they cleared.

What Should a Texas Family Do If a Loved One Was Harmed in a Nursing Home?

The rollback of federal nursing home oversight makes it more important, not less, to act quickly and document carefully if something goes wrong. Texas law still provides a legal remedy. Take these steps immediately.

• Obtain your loved one's complete medical records. Under Texas Health and Safety Code §241.154, a patient or authorized representative has the right to request records, and the facility must respond within a specific time period. Send that request before anything is altered, lost, or made unavailable.

• Document everything visible. Photographs of injuries, pressure wounds, or unsafe conditions. Written notes of every conversation with staff, including dates, times, and the names of anyone present. Electronic health records in nursing facilities carry audit trails, and those trails are evidence.
• Contact a Texas medical malpractice attorney before the statute of limitations runs. Under Texas Civil Practice and Remedies Code §74.251, the general limitations period for medical malpractice claims is two years from the date the claim accrues, with specific rules governing when that period begins in nursing home cases. The clock starts running whether or not you have retained counsel.

• File a complaint with the Texas Health and Human Services Commission. Regulatory findings do not replace a legal claim, but they generate an official record that can be important evidence in litigation and that may prompt an inspection of the facility.

• Ask an attorney to investigate the full ownership structure of the facility. Related-party entities that received management fees, rent payments, or other transfers from the facility may hold assets relevant to any eventual recovery. That investigation begins with corporate records, cost reports, and targeted discovery.

We Can Help

At The Borah Law Firm, PLLC, we represent patients and families across Texas in medical malpractice cases. We only handle these cases — nothing else. If you believe a loved one received substandard nursing home care, we can help you understand whether a case exists and what your options are.

Contact us today for a confidential case review.

Frequently Asked Questions

Did the federal government eliminate nursing home staffing requirements entirely?
The specific federal minimum staffing rule finalized in 2024, which required 3.48 total nursing hours per resident per day and a 24-hour registered nurse presence, has been rescinded. That does not mean nursing homes face no staffing obligations. CMS conditions of participation under 42 CFR Part 483 still require facilities to maintain sufficient nursing staff to meet residents' needs. Texas imposes its own staffing sufficiency requirements under Texas Administrative Code Chapter 554. Both remain enforceable.

Can I still sue a Texas nursing home for understaffing if federal minimums have been removed?
Yes. A medical malpractice claim under Texas Civil Practice and Remedies Code Chapter 74 does not depend on the existence of a federal staffing minimum. The standard of care is established through state law, accepted professional standards, and expert testimony. A facility that provided staffing levels its own clinical assessments showed were insufficient to meet a resident's needs can be held liable for resulting harm regardless of whether a federal rule specified a numerical floor.

What is Voices for Seniors?
Voices for Seniors is a Long Island, New York-based grassroots organization co-founded by Vivian Zayas and other families who lost loved ones in nursing homes. Ms. Zayas testified before the Select Subcommittee on the Coronavirus Pandemic in May 2023 and has advocated for nursing home residents and their families at the state and federal level. Her June 5, 2026, opinion piece in McKnight's Long-Term Care News addressed nursing home owners, operators, and administrators directly, arguing that deregulation exposes the industry to greater liability and reputational harm when crises occur.

What is the ownership transparency requirement that was suspended?
CMS had proposed requiring nursing homes to disclose the full network of entities involved in their ownership, management, and operations, including related-party real estate companies and management companies that share ownership with the facility. That requirement has been suspended. The practical effect is that families and regulators cannot as readily identify all entities involved in a facility's operations from public disclosures alone. A September 2025 NBER working paper by Gandhi and Olenski documented that these ownership structures are used by 77 percent of U.S. nursing homes to move profits into related entities.

Does deregulation affect my ability to collect a judgment against a nursing home in Texas?
Potentially yes, in two ways. First, the suspension of ownership transparency requirements makes it harder to quickly identify all entities that hold assets traceable to the facility's operations. Second, the rollback of the minimum staffing rule removes one clear external benchmark that plaintiffs have used to establish what constitutes adequate care. Neither change eliminates a legal claim, but both affect the investigative and evidentiary work required to pursue one effectively. An attorney experienced in Texas nursing home cases can advise on discovery strategies for tracing ownership structures and establishing the applicable standard of care.


About the Author: J.T. Borah is a Texas medical malpractice attorney and founding attorney of The Borah Law Firm, PLLC, in Austin, Texas. His practice is limited exclusively to medical malpractice cases involving hospitals, nursing homes, and other medical institutions. He has been recognized as a Texas Super Lawyer. He is often asked to lecture at legal seminars on medical malpractice issues and has lectured to attorneys from 18 states.

​AI writing tools assisted Mr. Borah in preparing this article. All legal standards, citations, and factual claims were reviewed by Mr. Borah as a licensed Texas attorney.

This article is for general informational purposes only and does not constitute legal advice. Reading this article does not create an attorney-client relationship.