As a Senate panel passes a reform bill, seniors push to protect their right to sue, and lawmakers face hard choices.
They came in droves _ scores of retirees from across the state dressed in identical blue T-shirts emblazoned with the initials AARP _ and they packed the first dozen rows of the room where state senators had gathered to discuss nursing homes.
Their concern, although welcome, frustrated Sen. Ginny Brown-Waite, the chief architect of the Legislature's effort to overhaul nursing home care and liability.
"I am very concerned about a senior scare tactic out there," Brown-Waite told members of the Senate committee on Health, Aging and Long-Term Care on Wednesday. Seniors are calling her office to protest what they say is a plan to strip them of their right to sue a bad nursing home, the Brooksville Republican said.
"I think they are being misled on purpose by entities that don't want to change," Brown-Waite said. And it's tactics like those, Brown-Waite has said, that cause the nursing home industry to be seen as the "black hats" in this year's biggest public relations battle, between the elder care industry and the trial lawyers.
It's the second year in a row that Brown-Waite and other lawmakers have tried to figure out what is ailing the industry and how they can fix it.
Most agree that the list of issues includes the lawsuits that have brought nursing home chains to their knees, a short supply of nursing aides, skyrocketing insurance costs and a lack of tough regulation by state agencies.
There is no shortage of threats and dire predictions.
"I am convinced if we do not come out with significant reform . . . in the next two or three years, we will be overseeing the total demise of the nursing home industry," said Lt. Gov. Frank Brogan, who chaired a state task force on nursing home care.
He also wants lawmakers to offer more alternatives to nursing homes.
A Senate committee on Wednesday passed a bill that backers say would set new regulations, raise the quality of care in nursing homes and make insurance easier to get for nursing home operators. Senators anticipate that the Senate Judiciary Committee will add restrictions on lawsuit awards and other limits on lawsuits by nursing home residents next week.
The provisions approved Wednesday would beef up state regulation of homes by, among other things, requiring prompt reporting of injuries.
On the insurance front, committee members discussed creating a state insurance pool for non-profit nursing homes but backed off after the insurance industry said that system would backfire.
But the backbone of the bill is an effort to improve the quality of care by adding more nursing assistants. Brown-Waite's bill would increase staffing levels over five years from less than two hours of nursing care per resident per day to 2.9 hours. The state's share of the annual price tag would spill into the tens of millions of dollars.
So how did the state get into this mess? It waited too long to take action, according to Brogan.
Industry analysts agree that the nursing home industry, fed by what federal analysts called "generous" government reimbursements, began an acquisition spree about a decade ago. When Congress reduced those payments after 1997, the companies had to reduce costs.
Those cuts _ combined with Florida law that allows unlimited compensatory and punitive damages and "the lure of add-on attorney's fees," according to a state analysis _ led to an explosion of lawsuits against nursing homes and million-dollar judgments.
Those judgments, in turn, have led to insurance rate increases that some homes have said threaten to put them out of business.
Trial lawyers say caps on lawsuits aren't needed and that if nursing homes would improve their care, they wouldn't get sued. And Brogan's task force found that none of the cases it reviewed were "frivolous."
But Brogan insists that a comprehensive package, including lawsuit limits, is needed to save the industry.
"We are beyond anything less than significant reform."