Lawmakers to consider changes to nursing home staff requirements; AARP Florida says its recommendations have been ignored

Lawmakers this week will consider bills that reduce the number of nursing hours facilities are required to provide to patients and allow facilities that don’t meet the requirements to accept new residents.

Supported by the state’s two nursing home associations, the House bill reduces the amount of nursing care residents must receive, paring back minimum certified nursing assistant requirements from 2.5 hours each day to 1.8. The legislation also allows the facilities to fill the gap with non-nursing “direct care staff.”

The industry has tried to reduce the minimum hours over the years, but those calls have grown louder since the COVID-19 pandemic.

AARP Florida opposes HB 1239 as well as its Senate counterpart (SB 804), which will be heard Wednesday by the Senate Health Policy Committee.

Zayne Smith of AARP told Florida Politics the watchdog organization worked with LeadingAge Florida and SEIU in 2019 when the bills were last considered as potential solutions to increasing staff at long-term care facilities.

Smith said some short-term solutions include authorizing “limited licenses” for retired health care professionals who want to return to work. AARP said the state could also cap what nursing staffing agencies pay workers.

Long-term solutions include requiring the long-term care facilities to spend 75% of Medicaid reimbursements on nursing care.

But none of the ideas are included in the bills under consideration.

“We’ve had ongoing communications with them over the past few years,” Smith said. “It’s kind of an eye opener. Our concerns and our suggestions have gone largely ignored.”

The Tampa Bay Times reported that Florida Health Care Association lobbyist Toby Philpot had been emailing Sen. Ben Albritton about the nuances of the bill before it had been filed. Albritton, the paper reported, also had an hour-long meeting with AARP Florida, SEIU, LeadingAge Florida and the Florida Health Care Association (FHCA).

Florida nursing homes 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 (CNA).

The push this year to change the standards come at a time when lawmakers may extend lawsuit protections for nursing facilities and increase Medicaid reimbursements by hundreds of millions of dollars.

The House bill changes the mandated 3.6 hours of “nursing” care into a requirement that the facilities provide 3.8 hours of direct services care. The House bill keeps a 1-hour requirement for licensed nursing care, but reduces the 2.5-hour CNA mandate to 1.8 hours instead. 

The bill would allow the 0.7-hour difference to be provided by physical therapy staff, occupational therapy staff, speech therapy staff, respiratory therapy staff, activities staff, social services staff, or mental health service workers.

The Senate bill would reduce the 3.6 hour per day nursing requirement to 1 hour of licensed nursing care instead. The remaining 2.5 hours of CNA care could be provided by “direct care,” staff and not CNAs.

Steve Bahmer, president and CEO at LeadingAge Florida, says his board supports maintaining the CNA mandate.

AARP’s Smith notes that the move to change staffing requirements comes on the heels of the Legislature’s decision last year to allow personal care attendants (PCAs) to be used in nursing homes, a move that AARP Florida opposed. Moreover, lawmakers gave the facilities the green light to count the on-the-job training program toward mandated staffing standards.

FHCA spokesperson Kristen Knapp says the program has been successful and offers an opportunity for people to earn money while learning whether they want to be in the long-term care field.

The FHCA surveyed its members in September and found that 362 people who had worked at member facilities as personal care attendants have gone on to become CNAs.

In all, Knapp said the survey showed nursing facilities had recruited and employed 1,235 PCAs. Of those, about 38% decided to sit for the CNA exam. Of the 474 people who took the exam, 362 passed, she said.

“I don’t think that shows a failure,” Knapp said.