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Nursing home staffing bill gets praise, opposition

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SB 1088 prompts debate

There's debate over whether SB 1088, filed by Sen. Ben Albritton (R-Bartow), would lead to fewer CNAs in nursing homes in Florida. Albritton represents counties including DeSoto and part of Charlotte.

A bill to change nursing home staffing requirements in Florida would modernize the system and lead to better care, according to proponents.

However, according to opponents, the bill (SB 1088) from Sen. Ben Albritton (R-Bartow) doesn’t compute and isn’t good for elderly residents.

Albritton represents counties including DeSoto and part of Charlotte. His bill would increase the weekly average amount of “direct care” each nursing home resident gets to at least 3.9 hours per day.

Right now under Florida law, residents get at least 3.6 hours of care from CNAs or licensed nurses per day.

Direct care is defined in the bill as coming from individuals — not necessarily CNAs or licensed nurses — who give care and services to nursing home residents, not including administrative tasks.

According to a legislative analysis, the federal government requires training for CNAs in medicare and medicaid-certified nursing homes on topics including residents’ rights, abuse, neglect, exploitation, infection control and more.

But that requirement doesn’t apply to personal care aides who are also working in some nursing homes and are referred to as direct support professionals or personal care attendants.

The bill passed through a Senate committee unanimously Monday, despite a handful of organizations and businesses opposed to it.

“To be clear, I am for raising the standards of care for our nursing home residents while making sure that the bad actors are called out for their lack of focus on these real needs,” Albritton told the Sun. “This bill makes sense to me and can make a positive change.”

He said he wants to make sure the direct care hours provided to nursing home residents are raised, and that care given is based on actual needs.

However, American Association of Retired Persons Advocacy Manager for Florida Jack McRay said the bill “would open the door for nursing homes to use direct care services by persons who are less qualified than CNAs, although possibly less expensive for nursing homes to use, or who provide services that questionably relate to direct care.”

And he added the bill would reduce the minimum amount of care provided by CNAs in nursing homes.

“A formula that increases care by reducing care is a formula that doesn’t compute,” McRay told the Sun. “AARP contends there are other ways to augment direct care in nursing homes without sacrificing CNA care.”

A Jacksonville area nursing home CEO, Martin Goetz, from River Garden, told members of the Florida Senate’s Health Policy Committee this week that Albritton’s bill would actually cut required CNA staffing in half, and he said he was opposed to that.

Albritton agreed with the bill’s opponents that CNAs are the boots on the ground in a nursing home.

But he disagreed with their assertion that the bill is an attempt to cut CNA staff.

“We’re working through this to make sure concerns are dealt with,” Albritton told the committee Monday.

Even though the bill got 10 votes in favor from the committee and none against, Senate Health Policy Chairwoman, Sen. Gayle Harrell (R-Stuart) said all the opposition to the bill is a concern. If it’s not worked out soon, she said votes on the floor could change.

“AARP cannot support legislation which diminishes CNA care in nursing homes,” said McRay. “AARP has advised Sen. Albritton and the other stakeholder representatives that it will consider other options and work with them to craft legislation which meets the future needs of the nursing home industry and which enhances, rather than detracts from the current standards of care in nursing homes.”

Meanwhile, the Florida Health Care Association applauded Albritton for the bill, and said nursing home care in Florida has changed dramatically over the years.

“While residents are receiving more nursing care than most other states, the standards from 2001 focus more on the basic care needs that certified nursing assistants are providing,” said Kristen Knapp, spokesperson for the FHCA. “Many of our residents are living with Alzheimer’s disease or some form of dementia, require dialysis because of diabetes, need oxygen or a ventilator due to breathing problems.”

Knapp said Albritton’s bill “will modernize Florida’s staffing standards.”

“Giving nursing homes the flexibility to staff their centers with specialists in mental health, activities, respiratory therapy, specialized feeding and other direct care services means better outcomes for residents and improved quality of life,” she said.

A Sun investigation in 2018 found more than half of Medicaid-receiving nursing homes serving Punta Gorda, Port Charlotte, Venice, North Port and Englewood, are involved in negligence lawsuits filed within the past year. Despite many of the facilities receiving high rankings from the federal government, much of the litigation focused on allegations of inadequate staffing in the name of corporate profit.

Steve Bahmer, president of Leading Age Florida, also opposes Albritton’s bill as currently written because he said it would eliminate the required hours for CNAs in nursing homes. He said more staff who are of higher quality — such as CNAs often tasked with dressing, bathing, feeding and toileting — means better care.

Asked if that could also lead to fewer nursing home negligence lawsuits, Bahmer said “you would hope.”

“There’s a direct connection between staffing and quality,” he added.

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