“A minute to me is priceless. A minute to me is listening to the sound of the alarms when a resident gets up to prevent them from falling. A minute to me is to walk with a resident so that resident will be able to improve their walking…so a minute to me really goes a far way.”
– Doreen Holm, CNA, Avanté at Lake Worth
November 7, 2011
During this special observance of Residents’ Rights Month, we must stand up and speak for those who cannot speak for themselves. Why can’t they speak? They are lying in beds — often alone and weak. Many do not have family members to come and take them outside to breathe in the fresh air. They are our seniors, and due to budget cuts to health care, they are receiving less bedside care. I know because I am a certified nurse assistant.
My joy in life is to make my patients smile. We owe it to them to speak up on their behalf and encourage nursing home administrators and lawmakers to make safe staffing levels a priority.
Cynthia Wilson – CNA
Tampa
Original Letter Available Here:
“As someone who has been a nursing home caregiver for 30 years, I know what it was like for residents before we were able to get safe staffing passed and strengthened in Florida, and I cannot stand by and let my residents’ health and safety be put in jeopardy. I care for families’ loved ones as if they are a member of my own family.”
Pearl Gooden, Certified Nursing Assistant
Accentia Health and Rehabilitation Center of Tampa
Tampa, FL
September 18, 2011
With the severe budget cuts to Florida’s health care programs, our seniors have truly paid the price.
The reports of abuse, neglect and increased rates of infection in our nursing homes and assisted living facilities are daunting. We are pleased to see that there will be efforts to improve oversight, especially with the heavy patient loads health care workers are carrying.
Inadequate staffing levels can lead to senseless pain and suffering. Safe staffing levels must be a priority to ensure residents have enough bedside care to have some level of quality in their final years of life.
Our seniors deserve at least that much.
BARBARA A. DEVANE
badevane1@yahoo.com
Original Letter Available Here:
http://www.tallahassee.com/article/20110804/OPINION02/108040306/Letters-editor
In response to new state legislation that cuts safe staffing levels and bedside care in Florida nursing homes by 18 minutes per resident per day, 1199SEIU Florida caregivers have launched the “Every Minute Counts” campaign to protect nursing home residents from potentially life threatening health risks. Nearly three-hundred caregivers ratified the campaign at an 1199SEIU Florida Joint Delegate’s Assembly in St. Petersburg, FL in early September.
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After Florida enacted a new law rolling back minimum safe staffing requirements in the states nursing homes on July 1, 1199SEIU members at Avanté at Lake Worth Nursing Home saw an opportunity to maintain higher safe staffing levels by negotiating them in their union contract.
“When we learned the state rolled-back minimum safe staffing levels, we felt like our wings were clipped and wondered how are we going to take care of people’s loved ones in the best way possible,” said Doreen Holm, a CNA with 23 years of experience who has worked at Avanté for four and a half years. “My co-workers and I are overwhelmed and excited that we were able to negotiate a contract that includes safe staffing protections for residents. It’s something we fought for as soon as we found out the state was rolling back staffing levels.”
After negotiating with the company for two months, they finally reached agreement. On August 23, union members at Avanté made history by voting to ratify the first union contract in the state to include safe staffing requirements, which guarantees residents will receive a minimum weekly average of at least 2.9 hours of bedside care per resident per day.
The new contract also provides Avanté workers with wage increases, bonuses, a 401(k) plan with employer-matching contributions, and health insurance and tuition benefits.
“I think this is one of the best contracts we’ve gotten so far,” said Holm. “We’re very excited about how far we’ve come. We did it by standing together.”
By including safe staffing protections in their union contract, Avanté and its workers have sent a strong message to the legislature and nursing homes throughout Florida that care for seniors and people living with a disability must be a priority and should be the last thing to be cut.
Since minimum safe staffing levels were instituted in nursing homes in 2001 with bipartisan support, care in Florida has greatly improved. As a result, Florida has earned one of the highest standards of nursing home care in the nation.
Unfortunately, the new law permanently cuts minimum safe staffing levels in nursing homes from a weekly average of 2.9 hours of care per resident per day by certified nursing assistants to 2.5 hours of care.
This shortens the minimum amount of time caregivers spend with each resident by 18 minutes per day. As a result, there can be delayed responses if a resident falls, less time to attend to bedsores, delayed bathing and grooming, less time to help a resident get to the bathroom, and less time to simply have a friendly, stimulating conversation.
But nursing homes like Avanté are not required to roll back safe staffing, and can make the moral choice to provide a higher standard of care than the state requires, as Avanté has done.
“It could be your mom or my mom that’s not being cared for properly because of staffing cut,” said Holm. “These are all of our loved ones. I’m very glad that residents will get much better care with our contract’s safe staffing protections in place.”
Miami, FL – With a new state law taking effect today that rolls back a landmark safe staffing law for nursing homes, caregivers from across the state announced the launch of a new campaign to protect Florida’s elderly and disabled. The top priorities of the campaign: provide quality care guidelines to residents and family members on how to report to the Agency for Healthcare Administration incidents of diminished care due to staffing cuts and inform elected officials that a nursing home in their district is sacrificing care, hold out-of-touch Tallahassee politicians and nursing home companies accountable, and overturn the Florida legislature’s roll-back of safe staffing levels.
Continue readingBy Stacey Singer and Toni-Ann Miller
July 1, 2011
Starting this month, Florida’s 70,000 nursing home residents could find fewer nurses at their bedside after the Florida Legislature voted to lower the homes’ minimum staffing standard by about 8 percent to help them absorb another round of Medicaid budget cuts.
The change means that nursing home patients will be assured an average of just 3.6 hours a day of contact with either a registered nurse, licensed practical nurse or certified nursing assistant, a reduction of about 18 minutes per patient per day.
An estimated 3,000 to 3,500 nurses could lose their jobs statewide as nursing homes shed staff, according to some estimates.
Three out of four seniors in long-term nursing home care have dementia or Alzheimer’s disease and need help with basic needs such as eating and drinking.
Jack McRay, advocacy manager for AARP Florida, predicted that malnutrition, dehydration, falls, bedsores and life-threatening blood infections in nursing homes will increase as nurses become tougher to find.
“You don’t take the nursing out of nursing homes,” McRay said. “We think it was very shortsighted on the part of the legislature.”
The major policy change was inserted into an eleventh-hour budget conforming bill, apparently to mute public input, he said.
“It was published the night before the legislature was adjourned, so it was an up-or-down vote and there was no hearing on this standard,” McRay said.
Medicaid budget cuts are trimming 6.5 percent from nursing homes’ already below-cost reimbursement rates, nursing home representatives said.
In Palm Beach County, 51 nursing homes will lose a combined $13 million because of the cuts, according to the Florida Health Care Association, the long-term care industry’s trade group in Tallahassee.
The Morse Geriatric Center has more than 60 percent of its residents on Medicaid and stands to lose more than $850,000 from the state budget cuts in 2011-2012, the trade group reported.
The suburban West Palm Beach center is a nonprofit that receives some community donations. It will seek savings in food service, vendor contracts and possibly employee raises before cutting staff, CEO Keith Myers said.
“I refuse to cut our front line staff,” Myers said.
The Palm Beach County Health Care District’s public nursing home, the Edward J. Healey Rehabilitation and Nursing Center, has about 70 percent of its residents on Medicaid, said agency spokeswoman Robin Kish. The Healey Center will lose about $460,000 in reimbursements this fiscal year, she said. Because it’s taxpayer-supported, it won’t cut staff, either.
But that won’t be an option in most places.
Statewide, an estimated 40 percent of Florida nursing homes would have operated at a loss in 2011-2012 without the flexibility to cut professional staff, the Florida Health Care Association warned.
The association tried throughout the legislative session to prevent another year of drastic budget cuts to Medicaid’s nursing home rates, said reimbursement director Tony Marshall. Ultimately, the state chose to balance its budget by taking $187 million from Medicaid’s nursing homes, Marshall said.
“We agree that better staffing leads to better care,” Marshall said. “You can’t staff if you don’t have the adequate funding.”
He said the 3.6-hour standard was determined with the help of a state-commissioned University of South Florida study in 2009. The study found that better staffing requirements passed in 2002 had significantly reduced problems at nursing homes, including lawsuits. The standard rose through the years to 3.9 hours minimum, but most of the benefits had been achieved by the time the standard had reached 3.6 hours, Marshall said.
The state average by 2007 exceeded four hours of nurse care per patient per day, above the national average. But those averages are far below what several studies have said is necessary.
Most studies have shown that patients do better in homes with a greater mix of registered nurses. The Institute of Medicine and the Centers for Medicare and Medicaid Services have said the ideal level of care in nursing homes is 45 minutes of registered nurse staffing per resident per day.
In 2007, Florida nursing home patients’ contact with registered nurses averaged 16.2 minutes a day. Here, staffers were more likely to be nurse assistants, whose pay averaged $11.73 an hour in 2007, compared with $26.19 an hour for registered nurses.
AARP is encouraging nursing home caregivers to sign its petition insisting that the homes commit to maintaining their nurse staffing. About 3,000 caregivers have signed it so far, McRay said.
Marshall said the average state nursing home is surviving on a profit margin of just 4 percent to 6 percent, making AARP’s demands unrealistic.
“It’s unfortunate that this is the route that had to be chosen” to reduce Florida’s budget deficit, Marshall said. “We will be back to the legislature to try to close that gap next year.”
By Brittany Davis
July 1, 2011
Nursing home residents may have less face time with their caregivers after a law takes effect today that revises minimum staffing levels.
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.
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.
Sen. Joe 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.
June 29, 2011
MIAMI — Advocates for nursing home patients and the workers who care for them are calling on facilities to maintain their current staffing levels even though more lax standards go into law Friday.
The new staff-to-resident ratio requirements reduce the average amount of direct care provided residents by 18 minutes a day.
AARP and the United Healthcare Workers are both issuing calls not to reduce staffing.
AARP says relaxing the standards “could put tens of thousands of very frail, vulnerable Floridians at risk.”