FL lawmakers consider changing nursing home staffing rules


The bill was drafted by the nursing home industry, but that’s not the end of the story.

That was the assurance given by Sen. Ben Albritton, R-Wauchula, the lawmaker backing Senate Bill 804 — which would make substantial changes to how the state regulates nursing home staffing levels. care. Albritton promised he would work to bring all parties with a vested interest to the table to compromise on industry support legislation. Rep. Lauren Melo, R-Naples, who sponsored similar legislation, House Bill 1239, would do the same.

Today, two amended versions of the bills are being considered in the House and the Senate. It seems that lawmakers have built some consensus. Both the nursing home industry and the lawyers who sue nursing homes on behalf of residents and their families now support the bill.

But groups that directly represent people who live and work inside nursing homes continue to vehemently oppose the legislation. AARP, in a press release, called the House bill “irresponsible” and “unconscionable.” The group predicted that the bills, if passed, would make people suffer from inadequate care.

Modified measures:

Reduce the minimum number of hours that certified practical nurses (CNAs) must devote to the care of each resident of a nursing home from half an hour to two hours per day. Other types of “direct care” employees – such as occupational therapists, mental health counselors and feeding assistants – could now count towards the remaining half hour of care an individual must receive daily under of state law.

Add provisions that make it easier to get money won from long-term care facilities in a lawsuit on substandard care, ensuring that anyone who takes possession of a nursing home with an unpaid judgment becomes responsible for paying it. The bills would also prevent a facility from using proof that it meets minimum staffing standards as sufficient evidence in court that it is adequately caring for a resident.

To give the Agency for Healthcare Administration’s new discretion (under the Senate version of the bill) as to whether it will prevent facilities from admitting new patients if they do not meet the requirements in personnel matters. Currently care homes that are understaffed for two consecutive days must ban new admissions until staff numbers improve.

In a series of recent committee meetings in the Legislative Assembly, unions and patient advocates have clashed with sponsors of the bills and with the nursing home industry over the assertion that which the bills would make patients less safe.

Proponents say the amendments strike a balance: they increase a resident’s ability to seek justice through the court system if they are receiving substandard care, trying to ease the burden of staffing shortages that have long plagued long-term care facilities across the state.

“We want to make sure that we are meeting the needs of our residents with the staff best suited to their psychosocial and physical care,” said Kristen Knapp, spokesperson for the Florida Health Care Association, which represents more than 80% of the population. ‘State. nursing homes and whose lobbyists helped draft the original legislation — a practice not unprecedented in Tallahassee. “And you have these layers of accountability that are going to help ensure that.”

Florida has been considered a leader in staffing standards since 2001, when lawmakers dramatically increased the number of hours nurses and orderlies must devote daily to the care of each resident.

Following a pandemic that shed light on the link between infection control and adequate staffing, other states have recently passed laws increasing the minimum number of nursing staff in their facilities.

But care home industry leaders say the needs of the residents in their care have changed over the past two decades – alleging that many require less care from nursing staff and more time with more specialized employees.

Patient advocates disagree.

An independent study by the University of South Florida, conducted on behalf of the state in 2009, found that the quality of care improved significantly at state facilities after the introduction of the 2001 law. strengthening the standards for nursing assistants.

“Not even a year after enacting [2001 minimum staff standards]we saw a downward trajectory [of] citations and complaints,” Rep. Carlos Guillermo Smith, D-Orlando, said during a House committee meeting Monday, citing the research. “Turn this around by half an hour is going to have dramatic consequences.”

Smith argued that the downsizing amounted to a gift to a powerful industry.

Tom Parker, director of reimbursement for the Florida Health Care Association, disagreed, saying some nursing homes may actually have higher overall costs because of the proposed solution.

“We’re talking about physical therapists, we’re talking about occupational therapists, respiratory therapists — these people all have higher salaries than CNAs,” Parker said. “So I don’t know what the savings would be, because each building is going to hire staff differently, depending on the needs of its residents.”

Aged care advocates say the legislation sacrifices resident safety in its effort to improve nursing home staffing — abandoning preventative care measures in favor of retrospective justice.

“It creates more ability to continue after someone has been hurt,” Zayne said. Smith, associate state director of advocacy at AARP Florida. “That’s great, but why don’t we talk about ‘Let’s prevent harm from happening first?’ ”

Melo, the bill’s House sponsor, said she was open to hearing from AARP and the unions about their concerns. But unlike other parties, these groups were unwilling to compromise, she said.

“I sat down with both of them and made several suggestions asking them if they would then support the bill, and I was told no. They’re literally, ‘This is what we want. We will not compromise,” Melo said. “Which leaves you in the future without really sitting down at the table, because you’re not even willing to tell us what you’d be happy with.”

But AARP Florida’s Smith said the organization is willing to concede a bit — like making the moratorium on new resident admissions optional, a change the group previously opposed — as long as the requirements for nursing staff are not reduced.

“No legislative changes have been made that include suggestions from resident attorneys,” said Smith of AARP Florida. “Are we confident that there is room for an amendment? Absolutely. But the reality of what is actually happening is slim to none.

“Industries like the Florida Health Care Association are major players in political donations and PACs,” she added. “We’re advocating on behalf of residents and their families who are in nursing homes, but we’re advocating for a deficit — because we don’t offer political contributions.”

As long as the proposed legislation includes lowering nursing standards, lawmakers are unlikely to receive support from either group. In turn, it is equally implausible that the nursing home industry would support any bill that does not include such a reduction.

Albritton said he heard “loud and loud” the concerns of residents and workers’ rights advocates.

“I’m going to meet them, I’m going to listen to them very carefully…and we’re going to talk and see what happens,” he said. “Ultimately, my encouragement is that we’ve come so far from where we started with this fictional bill.”

This story was originally published February 16, 2022 12:09 p.m.

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