FL legislation changes care home staffing requirements

Opponents of a bill that would upend staffing standards in Florida nursing homes now have one last hope: Governor Ron DeSantis’ veto pen.

House Bill 1239 was approved by the Legislature on Monday with bipartisan support after a controversial campaign by labor groups and seniors’ advocates, who claim it will reduce the quality of care for residents nursing homes.

“If the governor chooses to veto this, he is signaling to seniors in Florida and across the country that he will continue to support policies that put them first,” said Zayne Smith, associate director of advocacy at AARP Florida. “Signing this legislation would only tell older people that the interests of the for-profit care home industry are more important than their health and dignity.”

If the legislation becomes law, Florida nursing homes would be required to provide each resident with two hours of daily care from a certified nursing assistant — a 30-minute reduction in the amount of care each resident must currently receive.

The bill does not change the total number of hours — 3.6 — that facility staff must devote each day to patient care under state law. But that changes who can provide them.

The remaining hours of care a resident must receive could now be provided by other types of ‘direct care’ workers – such as physiotherapists, activity staff and feeding assistants.

The bill’s Republican sponsors argued that the measure would give nursing homes across the state greater flexibility to provide care that meets the specific needs of residents. They said the bill would also help ease the staffing shortage that has created major problems for these facilities in the wake of the coronavirus pandemic.

“If I really, really believed this was going to hurt a resident, my name wouldn’t be on the bill,” Sen. Ben Albritton, R-Wauchula, said Friday.

Since COVID-19 descended on Florida two years ago, DeSantis has made elder care a key part of his political agenda. For months during the pandemic, his administration’s mantra was “Seniors First.” He ensured that the first available coronavirus vaccines were for the state’s elderly and pushed for a bill that would dramatically expand the rights of relatives to visit nursing home residents.

So far, DeSantis has remained mum on the bill.

“The Governor continues to evaluate this legislation and will make a decision when it is in its final form,” a spokesperson wrote in an email.

Outpatient coordinator Lantaya Chayten, left, and nurse Lynnette Lee check in on some employees getting vaccinated with the Moderna COVID-19 vaccine at Miami Jewish Health on August 19, 2021. Pedro Portal [email protected]

The care home industry wrote the original bill

The measure began as a proposal drafted by the Florida Health Care Association, a lobby group for the nursing home industry. This fact has led opponents to assume that the effort to change staffing rules was never about making sure residents received the care they needed.

“This is about saving money for nursing homes,” Rep. Carlos Smith, D-Orlando, said as the House debated it. “It will be a race to the bottom.”

As the bill traveled through House and Senate committees, it changed significantly. Albritton and House sponsor Rep. Lauren Melo, R-Naples, have brought together interest groups, including patient advocates, to try to find a compromise on the future of nursing home nursing.

They’ve been at least somewhat successful: The bill is backed by both the nursing home lobby and a group representing Florida litigators — two groups that have always been at odds. Lawyers support the measure because it makes it easier for families to collect damages from care homes that act negligently.

But patient advocates have staunchly opposed the bill from the start. They argue that only certified practical nurses perform certain essential daily tasks, such as taking a shower or helping clean up a resident after using the bathroom.

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.

These requirements have been gradually reduced over the years in recent legislative sessions. This year’s legislation would be the most significant change since 2001.

Lawyers have been doing everything in recent weeks to pressure lawmakers not to vote for the legislation. Service Employees International Union 1199, which represents health care workers, ordered a truck to drive around the Capitol releasing a video urging them to vote against it. AARP Florida is calling on seniors across the state to contact DeSantis’ office to dissuade him from signing it.

The bill passed the House on Friday and the Senate on Monday. In the House, 80 representatives supported the bill – 74 Republicans and six Democrats. In the Senate, the vote was 28 to 9. Six Democrats voted for the proposal in the Senate and one Republican voted against.

New federal staffing rules also expected

Last week, President Joe Biden announced an upcoming overhaul of nursing home safety standards, including establishing minimum staffing levels that facilities must maintain nationwide. It’s unclear how those impending rules, which are expected to be released within a year, will compare to Florida’s proposed new personnel standards.

Even if the federal guidelines increase minimum staffing levels beyond Florida’s proposal, the new regulations will likely take months to take effect, particularly if the rule is stalled in court.

The pandemic has shed light on the importance of adequate staffing in nursing homes. Better-staffed facilities were associated with fewer resident infections and deaths, a fact that adds to years of evidence suggesting that the quality of resident care is linked to staffing levels.

Experts say the type of employee matters, with the number of nurses being the best indicator of a facility’s quality of care. But state and national research suggests that the level of care of practical nurses also plays a role.

“That’s why we’re back to the full loop of Governor DeSantis vetoing this legislation,” said AARP Florida’s Smith. “Stop the bad before it happens, you know?”

This story was originally published March 7, 2022 9:13 p.m.

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