Most U.S. nursing homes will need to add personnel under a new federal rule that for the first time sets minimum registered nurses and nurse aide staffing ratios for homes that care for elderly and disabled people.

The rule, announced Monday by Vice President Kamala Harris, is intended to limit cases of neglect or delays in care, a lingering issue that was exposed when more than 200,000 nursing home residents and staff died from COVID-19 in the first two years of the pandemic.

Experts call the rule a significant step toward bolstering nursing home quality and safety.

‘This is the most important nursing home reform in decades,’ said David Grabowski, a professor of health care policy at Harvard Medical School. ‘We need more staff in nursing homes. This is a big development in terms of setting a floor such that nursing homes can’t grossly understaff facilities.’

However, Mark Parkinson, president and CEO of the nursing home industry group American Health Care Association, blasted the rule as ‘unconscionable’ given the nation’s nursing shortage. ‘Issuing a final rule that demands hundreds of thousands of additional caregivers when there’s a nationwide shortfall of nurses just creates an impossible task for providers,’ Parkinson said in a statement. ‘This unfunded mandate doesn’t magically solve the nursing crisis.’

The White House said in a fact sheet that the new rule requires all nursing homes receiving Medicare and Medicaid to provide staffing that is the equivalent of nearly 3.5 hours of daily care for each resident. The rule also requires that nursing homes have registered nurses on duty 24/7 to ‘provide skilled nursing, which will further improve nursing home safety.’

On average, that means a nursing home with 100 residents would have two to three registered nurses and at least 10 nurse assistants for each shift around the clock.

The Biden administration said the rule will be implemented in phases to give nursing homes, especially those in rural communities, time to hire the additional workers. Nursing homes in communities facing a workforce shortage will get ‘limited, temporary exemptions’ to meet the requirements, the White House said.

The Centers for Medicare & Medicaid Services has never required a specific number of nurses and aides. The agency has only made recommendations – which few facilities followed.

A USA TODAY investigation found nursing homes have rarely been punished for violating existing staffing guidelines and rules – even when inspectors noted low staffing while investigating avoidable deaths and people who suffered broken bones, among other violations. Fines for such violations have been even rarer.

In a related rule also announced Monday, the Biden administration sought to bolster home care for seniors and disabled residents on Medicaid, the federal health program for low-income people. The rule requires companies that provide home care services to spend a minimum of 80% of Medicaid payments on workers’ wages.

Contributing: Jayme Fraser, USA TODAY. 

Oregon has the fewest facilities reporting low staffing and among the highest rates of enforcement, USA TODAY found, including The Oaks at Sherwood Park nursing home in Keizer.