Nursing homes in Maryland will have a lot of work to do over the next few years to comply with new federal regulations put in place by the Biden Administration.

The rules require nursing homes to have enough registered nurses on staff to give residents about half an hour of care a day. They must also have enough nurse aides on staff to provide two and a half hours of care.

The rules go into effect in 2026 for urban areas and 2027 for rural areas, however, few Maryland nursing homes are currently in compliance.

Only 15% of homes meet the criteria, putting Maryland in the bottom 15 states providing personal medical care in nursing homes, according to new research by KFF.

“Within Maryland, itself, a pretty high share of facilities, about 75% of facilities meet that 30 minutes of RN care requirements,” said Priya Chidambaram, a senior policy analyst at KFF. “It's really the nurse aide requirement that's impacting Maryland's ability to meet the regulations.”

The Biden Administration put the regulations in effect because of issues within nursing homes.

“We are seeing things like substandard facility conditions, residents not being attended to and overall poor patient care,” Chidambaram said. “These issues of understaffing have been going on for a very long time, the pandemic really intensified the consequences of understaffing.”

The Center for Medicare and Medicaid Services estimates about 16,000 RNs and 35,000 nurse aides will need to be hired nationally to meet the requirement.

The administration is providing funding to help beef up the training pipeline and hire more medical workers. The rule includes $75 million for financial incentives like scholarships and tuition reimbursement for people who work in nursing homes, Chidambaram said.

Nursing home companies and groups like LeadingAge are pushing back on the rules stating that they will increase costs.

“The now-final mandates will without question impact our nonprofit, mission-driven nursing homes’ ability to provide care and services,” LeadingAge President and CEO Katie Smith Sloan said in a statement. “In response to CMS’ actions, we are pursuing an aggressive, multi-faceted strategy employing all the tools available to us–legislative, legal, and regulatory–to both address the fundamental issue of building the long-term care workforce and halt the regulation’s implementation.”

However, the effects of understaffing are already being felt in Maryland. Currently, five nursing home residents are suing the Maryland Department of Health for failing to investigate dangerously poor conditions in their facilities.

The plaintiffs are not seeking compensation, but rather are requesting the issues be rectified.

The lawsuit alleges that nursing homes confined mobility-impaired people to their beds for long periods of time and failed to clean them.