Why Help at Your Nursing Home Will Be More Scarce, and Other Elderly Care Retreats

Nursing homes residents may have less face-time with their caregivers after a law that revises minimum staffing levels takes effect this week.

And nursing-home residents hoping to make it back to their own home, where their care can be paid for–at lower costs to taxpayers–through a federal grant, are out of luck.

The law is part of an effort to help nursing homes deal with the $187.5 million in Medicaid cuts outlined in the state’s budget. A House-Senate budget committee rejected the first stage of a $35.7 million federal grant to help move some nursing-home residents to community-based services, including home care, with Republicans complaining that accepting the money could create a program the state would later be unable to fund.

The 8-6 vote by the Legislative Budget Commission came on a request from the Agency for Health Care Administration to use a $1.9 million installment and a $200,000 planning grant to begin laying the ground work to implement the program.

The grant might have fallen victim to the complicated politics of health care; the federal Money Follows the Person program was most recently extended in the controversial health-care reform law that Congress passed last year.

Senate Budget Chairman J.D. Alexander, R-Lake Wales, and Sen. Joe Negron, R-Stuart, voted with Democrats to approve the change. Three other Senate Republicans voted with House Republicans to block the move. Amendments in the LBC require a majority vote of the members from each chamber to pass.

Lawmakers have long looked for ways to move nursing-home residents into the community-based programs. But Republicans said some of the new initiatives would have duplicated existing state programs, and that the state would eventually have to foot the bill for the program after the grant ran out after the 2015-16 budget year.

Supporters said the move was short-sighted. Senate Minority Leader Nan Rich, D-Weston, urged other lawmakers to support the proposal. She said serving people outside of costly nursing homes would save money for the state.

“Certainly, anyone that would be pulled out would save us Medicaid money in the long run,” Rich said.

The AARP also blasted the move in a statement issued late Friday.

“This would not only have been less expensive for taxpayers, it would have helped people with mental or physical disabilities get out or stay out of nursing homes and remain where they want to be — in their homes,” said Jack McRay, the organization’s advocacy manager. “It also would have kept tax dollars paid by Florida taxpayers in Florida — rather than having them spent in other states.”

The rejection of the federal grant compounds other potential reduction in services or care at nursing homes in Florida, such as the staffing-level reduction.

Beginning this week, nursing home residents will be entitled to 3.6 hours of direct care per day, down from 3.9.

The state requires 2.5 of those hours to be from a certified nurse, down from the current requirement of 2.7 hours. In 2007, the Legislature passed a law requiring 2.9 hours of care.

Negron, who sponsored the bill, said the move could save the nursing home industry about $40 million per year, allowing them more flexibility to deal with budget cuts. Nursing homes will lose about 7 percent of their budgets.

“We were requiring these nursing homes to meet this standard, but we weren’t giving them the money to do it,” he said. “Some of these nursing homes are barely breaking even.”

Many states have no minimum staffing ratios, Negron added.

Some nursing homes may choose to offer more than the minimum hours of care, but many rely heavily on Medicaid and have already announced staff reductions as a result of the lowered requirement, said Dale Ewart, vice president of healthcare union 1199 SEIU.

Ewart said that union caregivers delivered petitions to the administrations of 41 nursing homes last week, urging them to maintain their staffing levels.

Medicaid pays for 61 percent of the total billable days in nursing homes, Medicare pays for 19 percent and the remaining 20 percent is paid for through private sources such as insurance or residents’ personal funds, according to data from the Agency for Healthcare Administration.

Cloreta Morgan, who has worked at Unity Health and Rehabilitation Center in Miami for 38 years, said the nursing home laid-off 23 staff members in light of the lowered requirements. Her job was spared because of her seniority, she said.

“We submitted a petition asking them to ignore the changes to the law, but administration never addressed it with us,” she said.

Unity Health and Rehabilitation Center did not respond to calls from a Health News Florida reporter.

Ralph Marrinson, president of Senior Care Residences in Fort Lauderdale, said most nursing homes have no choice but to cut back on staff, but that he is looking for ways to keep care consistent by decreasing paperwork and other inefficiencies that stand in the way of bedside time.

“Everyone is going back in and digging into their budget and trying to find a way to save without impacting the level of care,” he said.

Florida first implemented minimum staffing levels in nursing homes in 2001. One 2002-2007 study, funded by the Agency for Healthcare Administration and carried about by the University of South Florida, found that higher staffing levels mean fewer falls and bedsores for residents.

Face-time with caregivers also helps patients stay mentally active, said Dr. Robert Schwartz, professor and chair of the University of Miami’s Department of Family Medicine and Community Health.

“I can understand the state in terms of looking for areas to cut their budget, but as a physician it’s tough to justify that as an area that should be cut,” he said.

–Brandon Larrabee, News Service of Florida, Brittany Davis, Health News Florida, and FlaglerLive