Nursing home staffing cuts go through House spending panel despite AARP objections

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A House Health Spending Committee has agreed to propose a bill that cuts the time certified practical nurses must spend with residents in long-term care from 2.5 hours to 2 hours.

The bill is a top priority for the industry. Before proceeding to the vote, Rep Bryan Avilachairman of the House Health Care Appropriations Subcommittee, said the chamber had been generous to the nursing home industry, approving a temporary rate increase of $100 million for three months.

Avila said he was aware, however, that some nursing home lobbyists were pushing the Florida Senate — which had already proposed a roughly 10% rate increase for the 2022-23 budget, far more than what the House had proposed – to raise rates further.

“I would be remiss if I didn’t mention that this commitment is kind of leveraged,” he said. “We told the industry that it needed to diversify its business model.”

Before approving HB 1239 by Rep. Lauren Melothe committee rejected three proposed amendments, including one that would have maintained the current 2.5-hour tenure, one that would have capped what nursing agencies could charge, and another that would have ended the 20% one-year reduction after.

AARP Florida supported the amendments, which were defeated. AARP Associate State Director of Advocacy Zayne Smith said the amended bill will not benefit residents of long-term care facilities.

“It’s a race to the bottom, that’s what this legislation is,” Smith said, predicting it won’t be the last time the Legislative Assembly will be asked to consider reducing the number of hours of certified practical nurse managed in the law.

“We know the goal is to get it to zero,” Smith added.

And in a prepared statement, AARP noted nearly 40% of nursing homes in the state are on the AHCA’s watch list. Nursing home staff, AARP said, are facing pandemic fatigue, high resident caseloads, understaffing, physically and emotionally demanding work, higher rates of accidents at work (often without paid leave), limited training, low wages and unaffordable health insurance.

Meanwhile, the Democratic Rep. Carlos Guillermo Smith pleaded with committee members to approve a sunset, arguing that the for-profit care home industry has been struggling to reduce staffing needs almost since their inception.

Smith said he hadn’t committed to a one-year sunset and would be willing to consider a three-year sunset. But Smith said the Legislative Assembly would not be able to pass legislation to increase CNA’s staffing requirement to 2.5 hours.

“We are constantly reducing the quality standards that we have in place in our nursing homes due to a temporary problem, which is the lack of staff,” he said.

Smith said the amendment was “reasonable” and would give the Legislature an “opportunity to reevaluate this dramatic and serious change that awaits us today.”

Smith in a hurry Florida Healthcare Association Director of Reimbursements Tom Parker on whether he could endure a sunset given that the staff crisis was ‘temporary’.

Parker, however, disagrees that the staffing shortage is a temporary problem, noting that nursing homes have struggled for years.

“All COVID has done is just accelerated that,” he said of a CNA shortfall. Parker added that if the industry thought the staffing shortage was temporary, it would not push for the legislation.

Reducing the number of mandatory nursing hours has been a priority for the Florida Health Care Association, which represents the state’s for-profit nursing home providers, for several years. The bill maintains the requirement that residents receive 1 hour of licensed nursing care per day. But the bill imposes an additional requirement of 3.6 hours of “nursing” care and instead says nursing facilities should provide 3.6 hours of “direct care” to the resident.

The bill defines “direct care staff” as individuals who provide care and services to enable residents to achieve or maintain the “highest possible physical, mental and psychosocial well-being.” These staff include, but are not limited to, physicians, occupational therapists, activities staff, speech language pathologists, and mental health service workers.

Nursing facilities may include in the direct care requirement of 3.6 hours the time that paid orderlies and direct care providers spend feeding residents.

The nursing home industry and the trial bar association are generally at odds with each other. But the nursing home industry and the Florida Justice Association (FJA), which represents litigators in the state, worked together on the proposal to find a compromise.

To that end, lawmakers agreed to include language in the bill that makes it clear that care homes‘ audited financial reports will be a public record. This year lawmakers are advancing legislation to require care homes to provide audited financial reports to the state.

The FJA has also pushed for changes to the current law to crack down on nursing homes that don’t pay final judgments or settlements. The bill would require care homes with outstanding unpaid settlements to notify each pending claimant or their attorney of a pending change in ownership. Plaintiffs or their attorneys have 30 days to object to the change of ownership. The agency will need to consider objections when deciding whether to approve or deny a change of ownership request.


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