AARP Florida report: Drop in nursing hours increased hospitalizations for nursing residents

AARP Florida continues to express concerns over the quality of care provided to nursing home residents in Florida, releasing a new report showing that hospitalizations for short-stay residents increased after the Legislature agreed to lower the number of nursing hours residents were required to receive.

From 2019-20 to 2022-23, the rate of re-hospitalizations for short-stay residents increased by 12%, with more than one in four residents having to be readmitted to the hospital during their nursing home stay. Emergency department transfers also rose, with nearly 10% of short-stay residents requiring a transfer to the emergency room — a 28% increase since the peak of the COVID-19 pandemic.

“Florida’s nursing homes are facing a critical juncture in delivering quality care to our vulnerable residents,” said Jeff Johnson, AARP Florida State Director. “The correlation between nurse staffing levels and the quality of care is evident, and we are witnessing the consequences of reduced nurse staffing requirements on both short-stay and long-term residents.”

AARP Florida had pushed Gov. Ron DeSantis to veto the 2022 bill, but he quietly signed it instead. Now the Joe Biden administration is proposing new regulations to ensure a minimum level of care across qualifying nursing homes. Florida’s current nursing home staffing levels do not meet the requirements in the new federal proposal.

This is the third report AARP Florida has released since the changes in 2022. All reports have been conducted by University of South Florida assistant professor Lindsay Peterson, from the School of Aging Studies.

“In our first report, we documented the erosion of nurse staffing standards for Florida nursing homes. Our second report showed that, contrary to the arguments made by the nursing home industry, the reductions in nursing staffing standards haven’t been counterbalanced by a meaningful increase in other nursing home staff; the lower standards have just permitted less care for residents,” Johnson said.

“This new report shows that, as the number of qualified hands providing care has declined, hospitalizations have increased, which is a powerful indicator that these new standards are putting frail lives at jeopardy.”

There also is reason for concern for long-term nursing home residents, according to the report.

Following the 2022 changes, Florida long-term nursing home residents experienced a 30% increase in emergency visits, climbing from 0.6 visits per 1,000 days to nearly 0.8 in 2022-23, or six extra emergency visits annually for an average 75-bed nursing home. Unplanned hospitalizations for long-term nursing home residents increased by 20% for long-stay residents.

Florida Health Care Association Senior Director of Strategy & Communications, Kristen Knapp, said the trends of short and long-stay hospitalizations are not a result of Florida policy changes, but rather a function of a post-COVID workforce environment for nursing centers not just in Florida, but across the nation.

“Centers are still having to rely on contract labor to fill vacancies, and agency staff who are less familiar with residents’ day-to-day needs may result in the on-call physician making a hospital transfer order unnecessarily,” Knapp said in a statement. “Nurse training and employee turnover may also be likely to correlate with readmission rates, as well as Florida’s litigation climate, with residents being returned to hospitals sooner to avoid potential lawsuits.”

Knapp also said the FHCA hopes to strengthen the dialogue between clinical personnel in nursing centers and hospitals to improve transitions between care settings to reduce re-admissions. She said the industry also looking at solutions ‘to build a pipeline of caregivers that will help enhance quality care. Perhaps instead of producing alarmist reports and reaching conclusions, AARP should try offering real-world solutions, such as initiatives that will help encourage individuals to seek a career in long-term care to help address our workforce shortages.”

Johnson said AARP does support policy to bolster the long-term care workforce as well as analyze data and produce reports.

“We can do both,” he said.

Meanwhile, AARP’s 2023 Long-Term Services and Supports Scorecard ranked Florida 49th in the nation for the frequency of long-stay hospitalizations, indicating a long-standing issue that may further deteriorate in future assessments.

The newest report also shows improvements in some areas tracked by the Centers for Medicare & Medicaid Services, such as increased functioning of short-stay residents and reduced antipsychotic medication usage. But there’s been a decline in the number of short-stay residents receiving pneumonia and flu vaccinations.

The AARP report also shows that nurse care levels dropped 12% since 2020-21, with CNAs spending 20 minutes less with each resident per day.

“The ongoing struggle of nursing homes to hire and retain sufficient numbers of nurses and nurse aides has been a central theme in the debate over staffing standards,” Johnson said. “The evidence from Florida indicates that minimum nurse staffing requirements do make a difference in staffing levels, as prior AARP reports have shown.”