Industry-backed nursing home bill heads to DeSantis. Will seniors suffer?

TALLAHASSEE — Opponents of a bill that would upend staff standards in Florida nursing homes now have one final hope: the veto pen of Gov. Ron DeSantis.

House Bill 1239 cleared the Legislature Monday with bipartisan support after a contentious campaign waged by labor and elder advocates groups, who claim it will lower the quality of care for nursing home residents.

“If the governor chooses to veto this, he’s signaling to seniors in Florida and across the country that he will continue to support policies that put them first,” said Zayne Smith, associate state director of advocacy at AARP Florida. “Signing this legislation would only tell seniors that the interests of the for-profit nursing home industry are more important than their health and dignity.”

If the legislation becomes law, Florida nursing homes would be required to provide each resident with two hours of care from a certified nursing assistant daily — a 30-minute reduction in the amount of care each resident must currently receive.

The bill does not change the overall number of hours — 3.6 — that facility staff must spend caring for patients every day under state law. But it changes who can provide them.

The remaining hours of care a resident must receive could now be provided by other types of “direct care” workers — such as physical therapists, activities staff and feeding assistants.

The bill’s Republican sponsors have argued the measure will give the state’s nursing homes greater flexibility to provide care that fits the specific needs of residents. They’ve said the bill will also help ease the staffing shortage that has created problems for those facilities in the wake of the coronavirus pandemic.

“If I really, really believed that this was going to injure a resident, my name would not be on the bill,” Sen. Ben Albritton, R-Wauchula, said Friday.

Since COVID-19 descended on Florida two years ago, DeSantis has made elder care a key part of his policy agenda. For months during the pandemic, his administration’s mantra was “Seniors First.” He ensured the first available coronavirus vaccines went to the state’s elderly and has pushed a bill dramatically expanding the rights of loved ones to visit residents in nursing homes.

So far, DeSantis has remained mum about the bill.

“The governor continues to evaluate this legislation and will make a decision when it is in final form,” spokesperson Bryan Griffin wrote in an email.

The measure began as a proposal written by the Florida Health Care Association, a lobbying group for the nursing home industry. That fact led opponents to speculate the effort to change staffing rules was never about making sure residents got the care they needed.

“This is about saving the nursing homes money,” said Rep. Carlos Smith, D-Orlando, while the House debated it. “It will be a race to the bottom.”

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As the bill made its way through House and Senate committees, it changed considerably. Albritton and the House sponsor, Rep. Lauren Melo, R-Naples, brought interest groups, including patient advocates, to the table to try to hammer out a compromise on the future of nursing home care.

They were at least somewhat successful: The bill is supported by both the nursing home lobby and a group representing Florida’s trial lawyers — two groups that have historically been at odds. The lawyers support the measure because it makes it easier for families to collect damages from nursing homes that act negligently.

But patient advocates have ardently opposed the bill from the start. They argue only certified nursing assistants perform certain essential daily tasks, such as showering or helping clean a resident after they use the bathroom.

Florida has been considered a leader in staffing standards since 2001, when lawmakers increased the number of hours nurses and nursing assistants must spend caring for each resident daily.

These requirements have been whittled down gradually over the years during past legislative sessions. This year’s legislation would be the most substantial change since 2001.

Advocates have gone all out in recent weeks to pressure lawmakers not to vote for the legislation. The Service Employees International Union 1199, which represents health care employees, commissioned a truck to drive around the Capitol blaring a video urging them to vote it down. AARP Florida is calling on seniors across the state to contact DeSantis’ office to dissuade him from signing it into law.

The bill passed in the House on Friday and in the Senate on Monday. In the House, 80 representatives supported the bill — 74 Republicans and six Democrats. In the Senate, the vote was 28-9. Six Democrats voted for the proposal in the Senate, and one Republican voted against it.

Last week, President Joe Biden announced a coming overhaul of nursing home safety standards, including establishing minimum staffing levels facilities must maintain nationwide. It’s unclear how these impending rules, which are expected to be published within a year, will compare to Florida’s proposed new staff standards.

Even if federal guidelines raise minimum staffing levels beyond the Florida proposal, the new regulation will likely take months before going into effect, particularly if the rule is tied up in the courts.

The pandemic spotlighted the importance of adequate staffing inside nursing homes. Better-staffed facilities were associated with fewer resident infections and deaths, a fact that added to years of evidence suggesting residents’ quality of care is linked to staffing levels.

The type of employee matters, experts say — with the number of nurses serving as the strongest predictor of a facility’s quality of care. But state and national research suggests the level of care from nursing assistants also plays a role.

“That’s why we come back full circle to Gov. DeSantis vetoing this legislation,” said Smith of AARP Florida. “Stop the harm before it can occur, you know?”

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