Opponents and supporters of a federal nursing home staffing mandate flooded the Centers for Medicare & Medicaid Services with nearly 47,000 letters during the rule’s formal comment period.

By Nov. 6, the agency had heard from 46,881 commenters, more than 30,000 of them offering unique criticisms or arguments. Each requires a federal response.

The proposed rule would require nursing homes to staff registered nurses around the clock, provide 0.55 hours of direct RN care per patient per day, and ensure another 2.45 hours of certified nurse aide care daily.

Associations  representing nursing homes and their members contributed tens of thousands of those comments, but so, too, did frontline workers whose unusually high level of participation was well organized by local and national union leaders.

The massive outpouring likely means a lengthy delay, possibly a year or more, before CMS can proceed with any final action.