Florida lawmakers on Thursday agreed to spend $100 million to increase for three months the amount of money the state pays 692 private nursing homes to care for poor and elderly residents who require institutional care.
In addition to approving funding for the private nursing homes, the Joint Legislative Budget Commission also agreed to earmark more than $4.4 million to the Florida Department of Veterans Affairs to cover contracted costs of nursing care through January at five facilities it operates.
Florida nursing home occupancy rates are plummeting, meaning nursing homes have less revenue coming in. Additionally, nursing care costs are increasing in Florida, and nationwide, because of a tight labor market.
But some lawmakers expressed their doubts about the funding.
For instance, legislative budget commission member Sen. Audrey Gibson asked Medicaid Director Tom Wallace to share nursing home census data with her.
Rep. Carlos Guillermo Smith, who does not serve on the joint legislative spending panel, told Florida Politics the Legislature should require nursing homes to submit to the state Medicaid office audited financial statements. That way, he said, the state can examine the industry’s finances to ensure its claims about skyrocketing direct care costs are true.
“We can’t just give them all of this money and hope and pray that they’ll spend it the right way and that things will improve. We need receipts and Floridians deserve accountability for their taxpayer dollars going into these homes,” he said.
Meanwhile, nursing home associations released statements following the approval thanking members of the spending panel.
“This much-needed Medicaid funding will help Florida’s nursing centers begin to emerge from this double-edged workforce and economic crisis so they can continue providing the highest quality of care possible to those they serve,” Florida Health Care Association CEO Emmett Reed said in a prepared statement.”Allowing providers the means to offer competitive wages so they can attract and retain employees is a significant step in ensuring that Florida’s long-term caregivers are supported and that our seniors have access to the quality long-term care they expect and deserve.”
LeadingAge Florida President and CEO Steve Bahmer also issued a statement.
“The increase in Medicaid funding will provide essential short-term relief for many nursing homes to address the ongoing impact of the pandemic, which has included dramatically increased costs, reduced occupancy, and a crisis-level workforce shortage,” Bahmer said in a prepared statement. “However, there is still more work to do. There are nursing homes throughout the state that will not receive any assistance from this funding increase, even though these facilities are also experiencing the same financial challenges as other long-term care providers.”
Meanwhile, a recently released report commissioned by the Florida Hospital Association and the Safety Net Hospital Alliance of Florida shows there was a 5% shortfall in the number of registered nurses since 2019. But the COVID-19 pandemic, which led to some front-line nurses retiring and disrupted the training of new nurses, exacerbated the problem.
Florida Nurse Workforce Projections: 2019 to 2035 estimates the state will need 60,000 additional nurses over the next 15 years if the state wants to avoid a double-digit workforce deficit. The 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.
While nurses can, and do, provide care across a variety of different settings, from school clinics to doctors offices, hospitals account for 52% of the increased demand for registered nurses. Nursing homes account for 32% of the projected need increase for licensed practical nurses.
There are six skilled nursing facilities and one assisted living facility operated by the Florida Department of Veterans Affairs that currently are operational. Another two homes are poised to open in spring 2022, according to the agency.
VA Executive Director James Hartsell told Florida Politics Monday that before the COVID-19 pandemic the facilities were at 98% capacity. There was a wait list at the VA facilities because there weren’t open beds, but the workforce, he said, was stable.
But now there are wait lists at the six operational nursing facilities as well as two new nursing home facilities the state wants to open early next year. Those wait lists aren’t because the homes are at capacity, they are due to lack of staffing.
After the height of the COVID-19 pandemic, Hartsell said, lower paid certified nurse assistants, with young school age children or children in child care, didn’t want to return to work.
Moreover, Hartsell said his “seasoned senior wonderful workforce got tired. They got burnt out. They didn’t quit, they retired.”
As of Monday there were 256 open nursing positions at the six VA skilled nursing facilities.
According to the LBC budget documents, the state has had to rely on outside contracted staff at all but one of the state VA nursing homes. But the Department of Veterans Affairs doesn’t have enough funding to cover contract costs. The nearly $4.5 million bump in funding will cover contract costs through January.
Reed said earlier this week the costs for nursing care had increased by $300 million for nursing facilities this year. Those costs, he said, could be held down if the state changed the existing mandates for direct nursing care. Skilled nursing facilities currently are required to provide residents with 3.6 hours of licensed nursing care per day, of which 2.5 hours can be provided by a certified nursing assistant.
To that end, Sen. Ben Albritton on Wednesday filed SB 804, which would reduce the 3.6 hour nursing care requirement to 1 hour. And in lieu of the 2.5 hours of CNA care, Albritton’s bill would allow nursing home facilities to provide what is called 2.5 hours of “direct care,” instead.