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Florida lawmakers open debate over staffing in nursing homes

The industry says less-trained “personal care attendants” can ease staffing shortages, but advocates predict a decline in quality.
Staff members assist residents at Gulf Shore Care Center in Pinellas Park, where administrators have decided against using personal care attendants during the pandemic. New legislation would make the attendants a permanent part of Florida's long-term care system.
Staff members assist residents at Gulf Shore Care Center in Pinellas Park, where administrators have decided against using personal care attendants during the pandemic. New legislation would make the attendants a permanent part of Florida's long-term care system. [ MARTHA ASENCIO RHINE | Times ]
Published Feb. 13

The coronavirus pandemic has pulled at the seams of Florida’s nursing homes — requiring more hands-on work from an industry already hit with a staffing shortage.

Still, Louise Merrick, administrator of Gulf Shore Care Center, a nursing home in Pinellas Park, decided not to take advantage of a state emergency order allowing facilities to hire less-trained “personal care attendants” to help with basic duties.

“In our facility we took the stance that we’d rather have someone with more advanced training who has finished their (certified nursing assistant) class,” Merrick said. “We just feel it’s a safer environment for our patients with the most highly qualified people we can provide.”

But even if some facilities don’t plan to use them, personal care attendants could become a permanent fixture in Florida’s long-term care system under two bills proposed for the upcoming legislative session.

Senate Bill 1132 and House Bill 485 would allow the attendants to work for four months, providing they complete eight hours of training. After that, they would be required to pass a certified nursing assistant exam to continue working in their facilities.

The bills were introduced by Sen. Aaron Bean, R-Fernandina Beach, and Rep. Sam Garrison, R-Fleming Island.

While making the program permanent could help ease the staffing shortage, experts argue it may lower the quality of care at nursing homes to dangerous levels — especially after a pandemic that emphasized the need for more staffing.

The industry had a workforce shortage before COVID-19 hit, said Kristen Knapp, spokeswoman for the Florida Health Care Association, the industry group representing nursing homes. The pandemic exacerbated the staffing issue, with some certified nursing assistants unable to work due to sickness or family care needs.

The ability to bring in personal care attendants helped ease the problem, Knapp said.

The required eight-hour training program includes three clinical hours and five hours of classroom instruction, she said. Then the personal care attendant works alongside certified nursing assistants, helping with basic duties such as answering residents’ questions, changing bedsheets and assisting residents with oxygen.

The on-the-job training helps prepare attendants to take the certified nursing assistant certification exam, Knapp said.

Florida’s staffing standards require nursing homes to provide each resident with at least 3.6 hours of direct care each day, Knapp said. Certified nursing assistants must deliver at least 2.5 hours of direct care, and at least one hour of direct care must be delivered by either a licensed practical nurse or a registered nurse.

Personal care attendants are counted toward helping the facility meet its direct care requirement, Knapp said.

Almost 2,000 attendants have been hired since March 2020, she said. More than 85 percent of personal care attendants who have sat for the certified nursing assistant exam are serving in certified nursing assistant roles.

“A lot of our facilities have said that this is a great program, because it really does provide an entry point and career pathway for those individuals to come in to help, support nursing center staffing, and also gives people a training point that they can strengthen our workforce,” Knapp said.

The program has been a great way to get additional staffing, said Eleanor Heaton, vice president of clinical services for Clear Choice Health Care, which operates Sun City Senior Living and other facilities in Florida, plus one in Colorado. The company has 32 personal care attendants in roles across its facilities.

“Oftentimes it was folks who thought, ‘I’d really like to be a (certified nursing assistant)’ or ‘I’d really like to be a nurse, but I’m not sure if I could really do that job,’” Heaton said. “And then they could decide pretty early on, ‘Is this for me? Or is this not for me?’ without having to invest a lot of time or money.”

So far, 23 of the company’s attendants have gone on to become certified nursing assistants, Heaton said.

The program is a good idea when approached as a pre-professional role, not as a way to make up staffing requirements, said Jeff Johnson, state director for the AARP.

“Conceptually, it’s a good way to develop what amounts to an apprentice program or a training program for people who might be good candidates to become certified nursing assistants,” Johnson said. “And if it provides extra help for the facilities that’s great.”

But personal care attendants receive much less training than the 120 hours required of certified nursing assistants, he said.

“Our concern is that facilities are looking for an opportunity to reduce their costs by shifting work from (certified nursing assistants), who are not making that much to begin with, with even less expensive workers,” he said. “And health care is going to suffer as a result if that’s the direction.”

Nearly 10,000 residents and staff of Florida long-term care facilities had died from COVID-19 as of Thursday, the state reported. And the rate of nursing home deaths has increased since November, according to a dashboard maintained by the AARP.

Personal care attendants can help out in nursing homes quite a bit, said Lindsay Peterson, research assistant professor of aging studies at the University of South Florida. But, she said, supervision and proper training is key.

The more training a person receives, the more professional they become, Peterson said. And eight hours of training is not very much for those serving people with various health needs, she added.

“The concerning thing about it is if it leads to a de-professionalization or erodes the training requirements,” Peterson said, referring to the proposed legislation. “Because training is really important, and there’s a lot of research that shows that the level of training a person receives makes a difference in the quality of care that residents receive.”

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