Nursing homes ponder staffing mandates as direct care costs increase

Should lawmakers lower nursing home staffing requirements to help the industry?

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.

Christine Jordan Sexton

Tallahassee-based health care reporter who focuses on health care policy and the politics behind it. Medicaid, health insurance, workers’ compensation, and business and professional regulation are just a few of the things that keep me busy.


  • Alex

    November 1, 2021 at 1:55 pm

    Most nursing homes are nightmarish for the residents already.

    The Republicans in the Legislature will fuck over Grandma and Grandpa to save a buck and “help business”

  • Sophia

    November 3, 2021 at 9:31 am

    As a longtime Certified Nursing Assistant (CNA) in a Florida nursing home and a member of 1199SEIU United Healthcare Workers East, I know this situation intimately. Yes, COVID-19 has made the plight of patients and caregivers worse, but more than that, the pandemic has exposed deep, long-standing problems in our nursing home care system. We love our patients, but caring for the most frail, sick and elderly Floridians is an extremely demanding job for very little pay. A significant percentage of my fellow CNAs live in poverty and many can’t even afford health coverage for themselves or their families. That is an especially cruel irony. Meanwhile the big nursing home companies have perfected the dark art of making millions of dollars on the backs of underpaid staff and at the expense of patient care. Most of this money is from our tax dollars, yet the majority GOP party in Tallahassee for the past 20 years has allowed this industry and its lobbyists to steadily reduce care standards, depress caregiver wages and maximize profits. For them to now cry about an awful system and business model that they’ve created and exploited for so long…is rich. It’s sad but not surprising their “solution” along with complicit legislators is to again lower staffing requirements so they can hire less-qualified workers at even lower wages. That’s not problem-solving, that’s profiteering. For a genuine fix, committed caregivers like me need to be fairly paid and protected, and to be invited to the table in developing laws and care standards. We hope someday soon that new leaders in Tallahassee will have the insight and courage to do this and to save our spiraling long-term care system.

    • David

      November 3, 2021 at 10:34 am

      Very cogent response Sophia. I agree with you. I also think you might have more opportunities for yourself in Florida. Can you contact me directly? I would love to chat about this and potential alternatives for you. My email for this purpose will be chocolattellc at gmail com. Thanks!

Comments are closed.


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