Florida nursing homes want money and leeway from lawmakers. Will residents be safe?

An AARP report issued Monday shows Florida’s legislative changes over the last few years in staffing requirements at nursing homes and assisted-living facilities have eroded the quality of care for the vulnerable residents who live in them.

The report comes at a pivotal time for the industry whose lobbyists are asking for even more leniency from lawmakers in the legislative session that begins Tuesday. Florida’s long-term care industry — home to nearly 200,000 residents — wants more government funding, immunity from wrongful-death lawsuits brought by resident’s adult children, and continued easing of staffing requirements.

Families of residents say these changes put their loved ones at greater risk.

The AARP report released Monday details how significantly direct-care requirements in Florida’s long-term care facilities have declined over the last decade. It also reveals that these requirements dropped just as residents have become needier with dementia, chronic diseases like diabetes, and heart conditions.

In 2010, certified nursing assistants at Florida’s long-term care facilities were required to provide each resident with at least 2.7 hours of care per day. That requirement dropped to 2 hours in 2022. Another big change approved last year: the 3.6-hour daily average required for nursing assistants and nurses can now include time spent by other types of workers, such as physical therapists and occupational therapists.

Lindsay Peterson, an assistant professor at the University of South Florida who collaborated with AARP on the report, told the Sun Sentinel that after looking at dozens of research studies, she concluded that higher nurse staffing levels result in fewer bed sores, less catheter use and overall better care.

“We wanted to look back so policy makers had a clear sense of the staffing history,” said Jeff Johnson, Florida director of AARP. “This report shows the changes the legislature undertook during the last sessions endangered patient care. For many legislators, long-term care isn’t their area of expertise and yet they are critically important in the decision making for the industry and the residents who live there.”

Shirley Vyent, a CNA for 17 years at a Miami nursing home, said staffing levels need to be higher. She has too many patients to provide the personal care each one deserves, she said.

“We are not able to give our patients the care we used to give them before COVID-19,” Vyent said. She attributes that to low pay, CNAs leaving the profession, and changes in requirements that have allowed facilities to get by with fewer direct-care staff.

“I would like lawmakers to have a walk in my shoes for one day,” Vyent said. “Sitting in their offices passing laws won’t work. They need to be there and see what’s happening. Then they can come up with bills.”

When lawmakers meet in Tallahassee over the next two months, several nursing home safety issues are at stake.

The right to sue

One of the most controversial proposed laws would prevent adult children or family members from suing a long-term care facility for neglect or abuse that leads to the death of their loved one. Only offspring under 25 or a surviving spouse could sue, and the proposed law makes that more difficult by putting restrictions on acceptable evidence and expert testimony.

Mary Daniel, who fought for family rights of nursing home residents during COVID, finds that concerning.

“Lobbyists for the industry have so much money and their own vested interests instead of the interests of the actual people who live in their buildings,” Daniel said.

Bruce Mandelblit has initiated a lawsuit against an Orlando nursing home/rehabilitation, claiming his mother’s death in July 2022 came in part from multiple horrific bed sores she got in the facility. Mandelblit, 63, would not be able to sue under this new law.

“Every person in a nursing home is loved by someone,” Mandelblit said. “Everyone is entitled to get proper care and consistency in their care and we need to be able to hold these places liable when that doesn’t happen.”

Nursing home complaints and incidents are on the rise.

According to records obtained by the Tampa Bay Times, serious violations have spiked over the past four years. Since 2019, violations have nearly doubled compared to the previous six years, the media outlet found. Last year, Florida nursing homes were cited 83 times for putting their older adult residents at risk of immediate danger.

Proposed staffing changes

With staffing shortages, the industry is supporting a proposed bill that would allow certified nursing assistants to get training and give out certain medications, easing the strain on registered nurses.

Senior advocates believe that could be helpful.

“If the training piece is there, this could give CNAs a chance to build on their career ladder,” said Johnson at AARP. “The devil in the details ... it’s good as long as it’s not being used to cut staffing levels.”

Vyent is skeptical and concerned. “Why would you want to let CNAs give out medication and do patient care when they already are overburdened? This leaves room for a lot of errors.”

At the same time, an additional proposed law, if approved, would give certified nursing assistants immunity from criminal prosecution or civil liability when they carry out a directive given by a facility administrator.

Three nurses in a Hollywood Hills nursing home were charged with aggravated manslaughter after 12 patients died from sweltering heat at the Broward County nursing home where they worked after a 2017 hurricane knocked out power. The charges were later dismissed.

Daniel said she and most family members would oppose this law.

“Nurses want to be treated as professionals, and giving them immunity tells me they are not capable of making the right decision and saying ‘no I’m not going to do that because I don’t think it’s a good idea.’” Daniel said.

Personal-care attendants

Sen. Lauren Book also is proposing accountability for the new category of nursing home worker approved by the Florida Legislature last year. In summer 2021, Gov. Ron DeSantis signed a law allowing nursing homes to hire employees, known as personal-care attendants, to supplement the work of nursing assistants. With 16 hours of training, these less-experienced workers can care for residents and continue to learn on the job for up to four months. After that, they must take the exam to become a certified nursing assistant.

Now, Book’s proposed Health Care Provider Accountability law wants the Agency for Health Care Administration to provide an annual report on the success of the personal-care attendant program to the governor and the Legislature.

USF’s Peterson said further research need to be done to know if personal-care attendants go on to take the CNA exam after four months as required by law and if they are positively or negatively affecting quality of care.

Vyent, a CNA, says the personal-care attendants haven’t been the solution she and her colleagues had hoped. “They don’t know the residents. They don’t know what’s going on. Most of the time it’s more load on us because they dont know what to do. They ask us for assistance, so we are helping them and doing our own work.”

Who owns Florida nursing homes

Lawyers like Michael Brevda of Fort Lauderdale, who bring cases against nursing homes on behalf of families, say the convoluted ownership of these facilities opens the door to shielding income from the state and residents’ families.

Now, Rep. Michele Rayner-Goolsby of Clearwater wants to force nursing homes to disclose ownership interests in companies that do business with their Florida locations.

Nick Van Der Linden, a spokesman for LeadingAge Florida, which represents hundreds of senior living and long-term care facilities in the state, says his association supports additional transparency. It supports Rayner-Goosby’s entire bill, which also includes an increase in government funding for care for residents.

“That funding is more appropriate now than ever given the staffing crisis,” Van Der Linden said. “What we are hearing from our members is staffing remains one of their biggest challenges. They are doing everything from competitive wages to better benefit packages to hire more staff.”

Vyent said while better wages help, dedicated CNAs “don’t just do it for the money, Our patients become our family.” She wants lawmakers to hold nursing homes to a higher standard than now exists.

“The people who live in nursing homes built a better world for us, and now to treat them, this is not the right thing to do.”

Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com or Twitter @cindykgoodman.