Bill to change Florida nursing home standards was drafted by industry, emails say
TALLAHASSEE — A bill to ease staffing standards at Florida nursing homes was originally drafted with help from one of the state’s most powerful nursing lobbying interests. long term.
Under the measure, Senate Bill 804, nursing homes that do not meet state-mandated staffing requirements would no longer be barred from admitting new residents.
It would also expand the types of employees who can be counted in these mandatory minimum staff numbers, which are intended to keep residents safe.
Proponents say such a bill is desperately needed to address a chronic and growing staffing shortage in long-term care facilities. But patient advocates worry the bill as written will lower the standard of care in nursing homes – without increasing the number of staff inside.
“COVID has definitely affected staffing,” said Lindsay Peterson, a professor and researcher at the School of Aging Studies at the University of South Florida. “Is this the answer? I do not know.”
Sen. Ben Albritton, R-Wauchula, the bill’s sponsor, said he tabled the measure after the Florida Health Care Association brought him drafted language. But Albritton said the bill’s language is a starting point meant to bring together on a solution to help alleviate staffing shortages in the long-term care industry.
“They brought forward a bill that I looked at and felt like a starting point – with the absolute intention of doing exactly what we’re doing in the future. And that is, get everyone in the room,” Albritton said. “Anyone else could have brought me the language.”
Emails obtained by the Schedules / Announcement in a request for public records show that from the start, Albritton’s office coordinated the language of the bill with Toby Philpot, the chief lobbyist for the Florida Health Care Association. The association represents nearly 600 nursing homes and assisted living facilities in the state. It is the largest industry group in the state, a dominant player in the multi-billion dollar long-term care space.
On October 25, John Hinchee, Albritton’s assistant, emailed Philpot to let him know that Philpot’s suggested legislative language had been turned into a bill. The assistant asked Philpot to contact him if any changes needed to be made.
A week later, Hinchee wrote to Philpot to tell him that the wording of the bill had been finalized.
“This should reflect the edits you’ve covered,” Hinchee wrote. “Take a look and let us know if it’s ready to file or if it needs any further editing.”
The bill was tabled two days later.
Kristen Knapp, spokeswoman for the Florida Health Care Association, said her group is “always part of the process when it comes to offering forward-thinking solutions and recommendations to our legislators.” His organization launched a social network countryside in support of legislation.
A companion measure, House Bill 1239, was also introduced in the House by Rep. Lauren Melo, R-Naples. Neither bill was heard in the House or the Senate.
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Once his bill was introduced, Albritton organized a meeting among the interests who have the most to gain or lose from changes to staffing in long-term care facilities. On January 18, representatives from groups including AARP, Service Employees International Union, Florida Health Care Association and LeadingAge Florida held an hour-long meeting where they voiced their concerns.
Steve Bahmer, CEO and president of LeadingAge Florida, which primarily represents nonprofit long-term care facilities, said the meeting was a good faith effort to bring the parties together for a compromise.
The parties have yet to agree on the final wording. Once they do, Albritton said he would table a “thanks to all” amendment to his bill – a process that could completely overhaul the legislation.
“It looks at this point it’s going to be something very different,” Albritton said of the bill, which will eventually be heard by a Senate committee.
Quality care related to staffing
In 2001, Florida passed a law that tightened regulations in nursing homes, particularly regarding the time trained staff must devote directly to patient care.
Studies show that the quality of care residents receive is related to the number of highly qualified personnel in an establishment.
This is especially true with regard to nurses, although evidence suggests the same is true for certified practical nurses, who perform less medically complex tasks and provide the bulk of resident care.
Today, practical nurses, colloquially known as CNAs, must provide two and a half hours of direct care daily to each resident of a nursing home.
Due to changes enacted by the Legislature, Florida has been seen as a leader in minimum staffing standards, faring better on measures like weekend and evening staffing than the other states.
Care home industry leaders say the needs of the people they care for have changed over the past two decades and flexibility in staffing is needed to accommodate some of the specialists working with residents.
“We have people coming to us after a stroke or heart attack, younger residents who are suffering from traumatic brain injury or opioid addiction, and a significant number of residents with Alzheimer’s disease and dementia,” Knapp said.
“We’re looking at a more holistic approach, rather than just putting them into a standard that was created in 2001,” she added.
More than 85% of member care homes said they had to limit admissions in mid-January because they did not have enough staff to meet current staffing standards, Knapp said.
“We can’t take patients if we don’t have the staff,” she said. “We have to follow the personnel requirements put in place by the state. This poses an access problem.
Bills proposed by the House and Senate would allow time spent with “non-nursing” direct care staff – such as physical and occupational therapists, activities staff, mental health workers and social service employees – be taken into account in the care hours of nursing assistants.
Under the House bill, orderlies would still have to provide at least 1.8 hours of care per resident per day. No similar requirement for nursing assistants exists in the Senate bill.
The hour of care that nurses are required to provide each resident daily would remain intact in both bills, as would the current ratio of nursing assistants per resident.
But the question of whether a facility is meeting its overall staffing needs would now be based on a monthly, rather than weekly, average of hours of care provided.
Real crisis, contentious solution
Nursing homes and patient advocates agree: The recent surge in the omicron variant of the coronavirus has worsened conditions in nursing homes.
The state’s long-term care ombudsman, Michael Phillips, said he’s seen an increase in staff-related complaints in recent weeks from employees and residents.
But attempts to change nursing home staffing requirements in Florida are not new.
Just last year, the state passed a law that allowed less experienced staff called personal care attendants to count as health care aides for staffing purposes. Personal care attendants typically receive two working days of training before beginning direct resident care and perform less medically complex tasks than nursing assistants.
Nursing home industry proponents marketed the measure as a “caregiver-in-training” program. These attendants would act as an immediate band-aid to the staffing crisis and, ideally, many would pursue certification and become permanent nursing assistants.
About 38% of those personal care workers — 474 of a total of 1,235 to date — have gone on to become practical nurses, according to survey data provided by Knapp.
Still, elder abuse watchdogs and employee unions say changing minimum staffing requirements isn’t the right solution to staffing problems.
“It goes against the welfare of the residents and prevents the facility from being cited for not having enough staff,” Phillips said. “Resident needs are daily, not monthly.”
Specialist staff may not care for all residents, Phillips said. By changing the requirements, care homes will not need to employ as many staff as necessary.
“The lifeblood that prevents bedsores, turning a patient, lifting a patient who is struggling to eat, is what nurses provide,” said Roxey Nelson, spokesperson for the SEIU based in Tampa Bay, which opposes the bills. as written. Other specialized personnel are not equipped and may not want, to handle those tasks, Nelson said.
It’s unclear how long the pandemic – and accompanying staffing shortages across all sectors – will continue.
But the proposed laws, if passed, could survive him.
“Do we need a permanent change for something that is potentially temporary? said Peterson. “That’s the question.”
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