An association that lobbies for health care facilities says President Joe Biden’s decision to require nursing homes to comply with federal rules on staffing levels will cost them billions of dollars.

A newly released report from the American Health Care Association (AHCA) focuses on the impact the pandemic has had on nursing homes.

The greatest fear is that Texas now one of the biggest coronavirus hot spots in the country could see mass outbreaks in nursing homes like those that hit the Northeast earlier in the pandemic. We had an opportunity to avoid what were experiencing right now, said Patty Ducayet, Texas long-term care ombudsman, an independent watchdog for the states nursing homes. Around Memorial Day, when the governor opened up all these things, they thought everythings open, go back to normal including workers in the nursing homes, Huang said. In the Houston area, Harris County has assembled a strike team to help nursing homes with testing and infection control. The devices will be sent to 2,000 nursing homes across the country, according to the American Health Care Association.