80% failed the staffing rules.
Washington has stepped back from nursing home staffing. New York has, for the first time, started fining homes that do not have enough people on the floor. Here is what changed this quarter, and what it means for your loved one.
The second quarter of 2026 marks a turning point in New York nursing home liability. At the federal level, enforcement has weakened sharply. CMS repealed the 2024 minimum staffing mandate in December 2025, a Texas federal court had already vacated the rule, and Congress wrote a decade-long moratorium on staffing rules into law. Regional HHS Office of General Counsel branches, including New York’s, have closed. The Special Focus Facility program has been de-emphasized.
New York has stepped into the gap. In February 2026 the Department of Health issued its first-ever civil staffing penalties, $4.26 million across 20 facilities, and acknowledged that roughly 80% of facilities statewide failed one or more staffing components during the initial enforcement period. Attorney General James’s settlements with Centers for Care and Van Duyn set successive records for nursing home operators.
In the courts, the climate on liability remains favorable to residents. A Nassau County court upheld a $5 million verdict, including punitive damages, under Public Health Law § 2801-d. The Second Department kept the COVID-era docket alive. But the Governor’s fourth veto of the Grieving Families Act continues to limit what families can recover when a resident dies, and that gap shapes every resident-death case.
New York sits barely above its own minimum
Total nurse staffing, in hours of care per resident per day. New York ranked in the bottom ten states.
Sources: Long Term Care Community Coalition analysis of CMS Payroll-Based Journal data, Q2 2024; AARP, Q1–Q2 2025; PHL § 2895-b. About 80% of New York facilities staffed below the 4.1-hour level identified in the 2001 federal study.
The federal staffing rule is gone
The most consequential development of the quarter is the effective end of the 2024 CMS minimum staffing rule. It was vacated, frozen and repealed in under nine months.
CMS has restored the pre-2024 federal floor set by OBRA-87: RN coverage eight consecutive hours a day, seven days a week, and a full-time Director of Nursing. There is no federal minimum number of care hours per resident. The facility-assessment requirements from the 2024 rule remain in place.
The practical result for families is simple. Any enforceable minimum number of care hours now comes from state law. In New York, Public Health Law § 2895-b and 10 NYCRR 415.13 require 3.5 hours of care per resident per day, including 2.2 hours from nurse aides and 1.1 hours from licensed nurses, and that law is now being enforced.
Washington steps back, Albany steps in
How federal staffing enforcement unwound, and New York’s response.
- Federal rule vacatedA Texas federal court vacates the 2024 CMS minimum staffing rule in American Health Care Ass’n v. Kennedy. A Northern District of Iowa ruling follows.
- Ten-year moratoriumP.L. 119-21 § 71111 bars implementing or enforcing any CMS minimum staffing rule through September 30, 2034.
- Appeal droppedThe federal government voluntarily dismisses its Eighth Circuit appeal.
- Rule repealedCMS restores the pre-2024 floor: eight consecutive RN hours a day, seven days a week, and a full-time Director of Nursing.
- Watch list changesFalls replace staffing as a selection factor for the Special Focus Facility program.
- New York’s first staffing finesThe Department of Health fines 20 nursing homes $4.26 million for 2022–2023 shortfalls.
- Penalty rules revisedCMS revises its survey and penalty manual to allow per-instance or per-day fines.
- Fines go publicFederal civil money penalty data begins appearing on Medicare’s Care Compare.
Sources: Am. Health Care Ass’n v. Kennedy, Nos. 2:24-CV-114-Z-BR, 2:24-CV-171-Z (N.D. Tex. Apr. 7, 2025); Pub. L. No. 119-21, § 71111; CMS final rule (Dec. 2025); CMS QSO-23-01-NH (rev. Jan. 28, 2026); CMS State Operations Manual chs. 5, 7 (rev. Apr. 2026); NYS DOH.
Fines too small to matter
CMS did strengthen its penalty tools in April 2026, permitting per-instance or per-day civil money penalties, refining Immediate Jeopardy definitions and standardizing survey timelines. Penalty data began appearing on Care Compare on June 24, 2026.
But a March 2026 Rockefeller Institute policy brief found that for more than half of penalized facilities, total annual penalties came to less than 0.25% of net patient revenue. For a home with $40 million in revenue, that is under $100,000 a year.
Regulatory fines alone do not deter. That finding is the strongest argument for private enforcement through lawsuits under Public Health Law § 2801-d.
The watch list stops watching staffing
Effective January 28, 2026, CMS replaced staffing with “prevalence of falls” as a selection factor for its Special Focus Facility list, citing a September 2025 HHS Inspector General finding that 43% of falls with major injury went unreported. A separate Inspector General report concluded the program “has not yielded lasting improvements.” It remains capped at 88 facilities nationally. The Center for Medicare Advocacy criticized dropping staffing, the most reliable predictor of quality.
New York’s first staffing fines
In February 2026 the Department of Health issued civil penalty notices to 20 nursing homes for violating the state staffing law, the first enforcement of its kind since the mandate took effect in 2022.
Total assessed across 20 facilities for Q2 2022 through Q4 2023, after statutory mitigating factors.
Facilities statewide that failed at least one of the three staffing components: 3.5 total hours, 2.2 aide hours, 1.1 licensed-nurse hours.
Maximum daily penalty per quarter of noncompliance, reducible to $300 a day for extraordinary circumstances.
Potential exposure had every noncompliant facility been fined the maximum from Q2 2022 through Q3 2025.
The Department adopted a three-part evaluation, one for each staffing measure, with escalating penalties for repeated annual noncompliance. Unpaid penalties go to the Office of Administrative Trials and Hearings.
Why it matters in a lawsuit. The Department’s own findings are a ready-made basis for liability. A family’s lawyer can obtain the facility’s penalty notice, or its absence, early in the case and use the Department’s methodology to calculate the facility’s staffing shortfall on the day the resident was hurt.
Tighter review of new owners
In June 2025 the Public Health and Health Planning Council formed a committee to tighten certificate-of-need review. It adds character and competence standards for new applicants, more rigorous financial review, and closer scrutiny of consulting agreements and related-party transactions, the same self-dealing structures the Attorney General targeted in Van Duyn and Centers for Care. Our report Profits Up, Care Down examines those structures in detail.
In the Legislature
- Grieving Families Act: vetoed a fourth time (Dec. 5, 2025; A.6063). New York’s 1847 rule limiting wrongful death recovery to economic loss stands. The Governor cited insurance and health care costs. New York and Alabama remain the only states without non-economic wrongful death damages.
- Residents’ rights claims survive death. A Public Health Law § 2801-d claim may be brought by the resident’s estate, consistent with Hauser v. Fort Hudson Nursing Center, 202 A.D.3d 45 (3d Dep’t 2021).
- Nursing home closure bill (S.4275). Passed the Senate in 2025; would require 90 days’ notice and a Department-approved closure plan. A prior version was vetoed in 2024.
- Justice for Nursing Home Victims Act (A.896). A COVID-19 compensation program; pending in committee.
Three settlements, one pattern
Attorney General recoveries from nursing home operators, in millions of dollars.
Source: N.Y. Attorney General announcements. Settlements entered without admission of wrongdoing.
Alleged diversion of funds through inflated rent. $8.75 million Medicaid restitution, a $35 million resident care fund, and independent monitoring through July 2026.
Alleged self-dealing mortgage and salaries for work not performed, conditions the AG said contributed to two deaths. $2 million Medicaid restitution and a $10 million resident care fund.
Alleged years of neglect from 2018 to 2023, including an Immediate Jeopardy finding and failure to give a resident anti-seizure medication.
All three cases involved money moved out through related-party deals: inflated rent, management fees and salaries for work not performed.
Criminal prosecutions
The Attorney General’s Medicaid Fraud Control Unit also prosecutes individual caregivers. In Glen Cove, an aide was convicted of two felony counts of endangering the welfare of a vulnerable elderly person for sexually assaulting two disabled residents. In Rochester, an aide pleaded guilty to third-degree grand larceny for using a resident’s debit card for 220 withdrawals totaling more than $60,000 over seven months.
New York’s unit recovered $627.8 million for Medicaid from fiscal 2019 through 2025 and is one of four states that account for half of national civil recoveries. Its fiscal 2026 funding is $70.8 million, 75% of it federal. The Attorney General has warned that federal cuts may limit future enforcement.
Four decisions that matter
A jury found pressure-wound neglect violating PHL § 2801-d and awarded $1 million for conscious pain and suffering plus punitive damages, $5 million in all. The court denied every post-trial challenge. The jury did not find the neglect caused death, so the full award rested on the neglect itself and the resident’s suffering.
Affirmed a verdict that failing to place a bed alarm departed from accepted practice and caused a resident’s fall and hip fracture. A strong statement of deference to juries in fall cases.
Four companion decisions held that repeal of COVID-era immunity is not retroactive, but that facilities could not win dismissal where families adequately alleged gross negligence. Dismissals reversed.
A facility was not sanctioned for erasing fall video under its normal retention schedule because no claim had been made. The lesson: demand preservation of evidence immediately.
Serrapica is a trial-court decision. Sapphire, Nugent and Van DeVeerdonk bind trial courts in the Second Department; elsewhere they are persuasive.
Below the unsafe line, nearly every day
Share of days on which one New York nursing home provided fewer than 2.0 nurse aide hours per resident, the threshold below which care is considered unsafe.
Source: CMS Payroll-Based Journal data for one New York facility; 2.0-hour threshold per Institute of Medicine.
New York’s required daily care hours per resident: 2.2 from aides, 1.1 from licensed nurses.
Average aide hours at noncompliant New York homes, 30% below the mandate and below the 2.0-hour unsafe threshold.
New York facilities (255) reporting zero medical director hours in Q2 2024. New York ranked last for administrator time per resident.
Nurse aide turnover nationally in 2025. AARP ranks New York among the least competitive states for direct-care wages.
Closures
Since 2019 New York has lost more than 5,600 nursing home beds to closures and decertifications, out of roughly 599 facilities statewide. Cold Spring Hills Center for Nursing and Rehabilitation on Long Island closed around May 15, 2025, after bankruptcy, a failed sale and an Attorney General lawsuit with a court-appointed monitor.
Who really owns the home
Since January 1, 2026, every skilled nursing facility must disclose its ownership to CMS on a revised Form CMS-855A. The form must identify governing-body members; officers, directors, partners, trustees and managing employees; “additional disclosable parties,” including entities with operational or financial control, landlords with a 5% or greater interest, and management, consulting and financial service providers (42 C.F.R. § 424.502); and the full organizational structure (42 C.F.R. § 424.516(g)). A facility that fails to report risks losing Medicare billing privileges.
These disclosures are a roadmap to the related landlords, management companies and consultants the Attorney General has targeted. Families’ lawyers can obtain them through records requests or subpoena and compare them with certificate-of-need filings.
New money for homes
The fiscal 2026–27 state budget, enacted in late May 2026, adds $480 million in Medicaid rate funding for nursing homes beginning April 1, 2026, plus about $385 million in managed-care-tax funding and about $57 million in restored capital reimbursement, more than $920 million in all. The industry argues that even a 5% rate increase falls far short of the roughly 20% needed to meet staffing requirements.
Six recommendations for plaintiff’s counsel
For lawyers handling nursing home negligence, wrongful death and Public Health Law § 2801-d claims in New York.
Anchor liability in the state staffing law
With the federal rule gone, plead violations of PHL § 2895-b and 10 NYCRR 415.13 as regulatory predicates for § 2801-d claims. The Department’s own finding that about 80% of facilities were noncompliant, and New York’s bottom-ten ranking, support a systemic understaffing narrative.
Lead with § 2801-d and build for punitive damages
Serrapica shows punitive damages can survive post-trial motions where the conduct exceeds ordinary negligence. Plead specific violations of 42 C.F.R. §§ 483.10, 483.24, 483.25 and 483.35 alongside payroll staffing data and Department penalty findings to show willful or reckless disregard.
Send preservation demands on day one
After Van DeVeerdonk, a litigation-hold letter should go out immediately to preserve fall video, payroll staffing records and MDS and care-plan documents before routine destruction forecloses a CPLR 3126 remedy.
Use ownership and certificate-of-need records
The CMS-855A disclosures and the Council’s tighter review map the related landlords, managers and consultants found in Van Duyn and Centers for Care. Use them to reach past thinly capitalized operating companies.
Set damages expectations for the veto
Until the Grieving Families Act passes, wrongful death recovery is limited to economic loss. Build value through the § 2801-d claim and conscious pain and suffering.
Plead COVID-era gross negligence with specifics
The Sapphire decisions keep 2020 death cases alive where gross negligence is adequately pleaded. Allege concrete, dated institutional failures in staffing, infection control and cohorting to survive CPLR 3211(a) motions.
What this means for your loved one
If a nursing home does not have enough staff, residents are not turned, fed, toileted or watched. That is how pressure wounds, falls, dehydration and infections happen. The state now has its own findings on which homes fell short.
- Request the complete medical record in writing, including nursing notes, medication records, care plans and incident reports.
- Ask that video and staffing records be preserved as soon as you suspect neglect. Facilities may erase them on a routine schedule.
- Look up the facility on Medicare’s Care Compare, which now shows federal penalties, and in the Department of Health’s nursing home profiles.
- Report concerns to the Department of Health and the Long-Term Care Ombudsman Program.
- Mind the deadlines. Injury and wrongful death claims have strict time limits under New York law.
Nursing home abuse and neglect practice
- Am. Health Care Ass’n v. Kennedy, Nos. 2:24-CV-114-Z-BR, 2:24-CV-171-Z (N.D. Tex. Apr. 7, 2025); Pub. L. No. 119-21, § 71111 (2025); CMS repeal of the 2024 minimum staffing rule (Dec. 2025).
- CMS, QSO-23-01-NH (revised Jan. 28, 2026); CMS State Operations Manual chs. 5 and 7 (rev. Apr. 2026).
- HHS Office of Inspector General, OEI-05-24-00180 (Sept. 2025) and OEI-01-23-00050.
- Rockefeller Institute of Government, policy brief on nursing home penalties (Mar. 2026).
- N.Y. State Department of Health, nursing home minimum staffing penalty notices (Feb. 2026).
- N.Y. Attorney General, announcements of the Centers for Care (Nov. 2024), Van Duyn (Aug. 2025) and St. Margaret’s (2026) settlements, and Medicaid Fraud Control Unit prosecutions.
- Serrapica v. South Shore Rehab. & Nursing Ctr. LLC, 2026 N.Y. Slip Op. 50065(U) (Sup. Ct. Nassau County Jan. 19, 2026); Nugent v. Highland Rehab. & Nursing Ctr., 2025 N.Y. Slip Op. 04098 (2d Dep’t July 9, 2025); Lee v. Sapphire Ctr. for Rehab. & Nursing of Cent. Queens, LLC, 2025 N.Y. Slip Op. 06610 (2d Dep’t Nov. 26, 2025), and companion cases (Slip Op. Nos. 06596, 06603, 06636); Van DeVeerdonk v. North Westchester Restorative Therapy & Nursing Ctr. (2d Dep’t 2024); Hauser v. Fort Hudson Nursing Ctr., 202 A.D.3d 45 (3d Dep’t 2021).
- Long Term Care Community Coalition, analysis of CMS Payroll-Based Journal data (Q2 2024); AARP nursing home staffing data (2025).
- 42 C.F.R. §§ 424.502, 424.516(g); Form CMS-855A.
- N.Y. Pub. Health Law §§ 2801-d, 2895-b; 10 NYCRR 415.13; N.Y. State FY 2026–27 Enacted Budget.
- Long Island Press, “Cold Spring Hills Nursing Center to Close by May 15, State Approves” (Feb. 27, 2025), longislandpress.com.
Attorney Advertising. This report is drawn from public federal and state regulatory records, CMS data, court filings, government announcements and news reporting, and speaks as of its publication in July 2026. It is for general informational purposes, is not legal advice, and does not create an attorney–client relationship. Lawyers should independently verify citations before relying on them. Prior results do not guarantee a similar outcome. Descriptions of lawsuits, settlements and investigations reflect allegations and public records; settlements referenced were entered without admission of wrongdoing.