Florida Fares Well in Nursing Home Staffing Study
A recent New York Times report revealed staffing levels at nursing homes across the country are often lower than previously reported to federal officials. The report originated with a Kaiser Health News analysis that found evidence of dramatic staffing fluctuations, with severe shortfalls on weekends.
Florida, however, fared well in the analysis, https://www.nytimes.com/2018/07/07/health/nursing-homes-staffing-medicare.html. Few facilities experienced the severe dips. Furthermore, most were ranked as maintaining above average staffing. There’s a reason for this. Kathryn Hyer, a professor in the School of Aging Studies and director of the Florida Policy Exchange Center on Aging credited Florida legislators for major legislation passed in 2001.
Current Florida standards require a minimum of 2.5 hours of direct care from a nursing assistant and 1 hour of direct care from a licensed nurse per resident, per day. Furthermore, nursing homes must stop accepting new patients if the staffing falls below the minimum levels for more than 48 hours.
Budget cuts have actually reduced Florida’s mandated staffing minimum from 2.9 hours per resident per day in 2007 to the 2.5 current level. However, unlike other state regulations, Florida requires providers to adhere to a daily minimum, thwarting wide fluctuations and low weekend coverage.
Hyer and her colleagues have tracked the quality improvements that followed state regulatory changes in 2001. They found, for instance, that with stronger staffing requirements fewer facilities were cited for deficiencies classified harmful to residents as well as dietary deficiencies. The percentage dropped from 21% in 2001 to less than 7% in 2006. Minimum staffing has also been shown to improve residents’ health and wellbeing by reducing pressure sores, improving residents’ ability to perform activities of daily living, and reduced restraint use.
Hyer was among a group of researchers at USF who began working with the Florida Health Care Association and Florida legislators nearly 20 years ago to increase both staffing requirements and Medicaid funding. The School of Aging Studies researchers continue to conduct research on how to improve nursing home quality, including extensive work on nursing home disaster preparedness.
- Hyer, K., Thomas, K., Mehra, S., Johnson, C. E., & Harman, J. S. (October 2009). Analyses on outcomes of increased nurse staffing policies in Florida nursing homes: Staffing levels, quality, and costs (2002-2007). [Report prepared for the Florida Legislature]. Retrieved from http://theconsumervoice.org/uploads/files/issues/Florida-staffing-study.pdf
- Hyer, K., Thomas,* K. S., Branch, L. G., Harman, J. S., Johnson, C. E., & Weech-Maldonado, R. (2011). The influence of nurse staffing levels on quality of care in nursing homes. The Gerontologist, 51(5), 610-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3218638/pdf/gnr050.pdf.
- Smith, K. M.*, Thomas, K., Johnson, S., Meng, H. & Hyer, K. Dietary Service Staffing Impact Nutritional Quality in Nursing Homes (2017) Journal of Applied Gerontology Published online January 26, 2017 DOI: http://journals.sagepub.com/doi/pdf/10.1177/0733464816688309
- Bowblis, J.R. & Hyer, K. (2013). Nursing home staffing requirements and Input substitution: Effects on Housekeeping, Food Service, and Activities Staff. Health Services Research, 48(4), 1539-1550. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725539/pdf/hesr0048-1539.pdf
- Hyer, K., Thomas,* K. S., Harman, J., Johnson, C. E. & Weech-Maldonado, R. (2013). Do Medicaid incentive payments boost quality? Florida’s direct care staffing adjustment program. Journal of Aging and Social Policy, 25(1), 65-82. https://www.tandfonline.com/doi/pdf/10.1080/08959420.2012.705629?needAccess=true