Nursing homes ponder staffing mandates as direct care costs increase

Nursing home staffing requirements could be on the table in the upcoming 2022 Legislative Session, according to the state’s leading nursing home association.

Florida Health Care Association CEO Emmett Reed said Monday a workforce shortage exacerbated by the COVID-19 pandemic has increased direct care costs at Florida nursing homes by $300 million over the last year.

That’s not to say, though, that the association will be asking for a $300 million increase in funding from the Legislature, Reed said. The FHCA will be meeting with its members next week to finalize its legislative budget proposal and upcoming Medicaid funding requests. Reed said the group may not ask for the full $300 million, which would result in a $19 increase in Medicaid reimbursement per day per patient.

Reed said the $300 million increase in direct care costs could be offset if the Legislature would agree to modify the current staffing requirements.

“The advocates are going to light their hair on fire, I understand that,” he said. “But our staffing model’s over 20 years old now. We take care of a completely different patient than we did 20 years ago.”

AARP Florida State Director Jeff Johnson said the association supports efforts to beef up the state’s nursing workforce and to direct money at recruiting and retaining a skilled workforce so long as there is a transparency requirement that shows how the industry is spending the money. But Johnson made clear that AARP Florida is not open to changing the current nursing home staff requirements.

“There’s more need for skill now than there was decades ago,” he said.

Florida law currently requires nursing homes to provide a minimum 3.6 hours of direct care per resident per day, of which 2.5 hours can be provided by a certified nursing assistant and at least one hour provided by a licensed nurse. A facility may not staff below one certified nursing assistant per 20 licensed nursing staff.

Reed’s group hosted a meeting Monday that included representatives from two statewide hospital associations, home health care providers and assisted living facility providers.

The Florida Hospital Association released a report in September that showed the state needs about 60,000 additional nurses over the next 15 years if the state wants to avoid a double-digit workforce deficit, an analysis of the state’s nursing workforce released Thursday by the Florida Hospital Association and the Safety Net Hospital Alliance of Florida shows.

The Florida Nurse Workforce Projections: 2019 to 2035 analysis projected a 12% shortfall in the number of registered nurses and a 30% shortfall in the number of licensed practical nurses working in 2035 if the state doesn’t move to produce more nurses.

The survey, conducted by IHS Markit, does not include data collected during the COVID-19 pandemic.

Nurses provide health care in various settings, including school clinics, nursing homes and hospitals, and future need varies across all the settings. Hospitals account for 52% of the increased demand for RNs, while nursing homes account for 32% of the projected need increase for licensed practical nurses.

The analysis notes a 22% vacancy rate in Florida RN programs in 2018-2019 and an estimated 26% vacancy rate in LPN programs. The vacancies are due to several factors, from lack of qualified students to lack of clinical access and funds to hire faculty to teach students.