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Proposed Federal Nursing Home Mandates Undermine Progress in Florida, Exacerbate Workforce Shortage According to New Study

Unfunded federal mandates will cost Florida an additional $188 million, despite existing state staffing requirements.

Tallahassee, Fla. – A new analysis reveals the harmful and costly impacts the Biden administration’s recently announced federal staffing mandates will have on Florida nursing centers and their residents. According to the study by professional services firm CLA (CliftonLarsenAllen, LLP), the federal Centers for Medicare and Medicaid Services (CMS) proposed staffing mandate will cost Florida nursing centers an additional $188 million, despite Florida already having comprehensive staffing standards. In many categories, Florida standards already exceed what is required by the federal mandate.

Florida’s staffing standards recognize the different needs of each resident and provide flexibility for centers to staff according to those unique needs. Along with required nursing hours, Florida’s standards also recognize the important role of social workers, activity staff, and therapists in delivering quality care. The CMS proposed rule would require 2.45 nurse aide hours per resident per day (HPRD) and 0.55 registered nurse (RN) HPRD compared to Florida’s current requirement of 2.0 certified nursing assistant (CNA) hours, an additional .6 hour of direct care provided by specialty staff (may include a CNA) and 1 hour of licensed nursing services that are provided by a combined use of RNs and Licensed Practical Nurses (LPN). Under the CMS proposal, Florida centers would need to hire an additional 3,487 full time employees to meet the mandate.

“Florida is a proud leader when it comes to high-quality long-term care. We recognize the importance of minimum staffing requirements, which is why Florida nursing centers already abide by a stringent set of standards to ensure residents receive the highest quality of care,” said Emmett Reed, CEO of the Florida Health Care Association (FHCA). “At a time where Florida’s long-term care profession is facing workforce shortage challenges, these arbitrary and unfunded mandates will make it harder to recruit, train and retain long-term care workers.”

The federal staffing mandate undermines the Florida staffing standards already in place, in particular the licensed nursing services that Florida residents receive. Moreover, the CMS proposal offers no place for Licensed Practical Nurses (LPNs) to be counted in the care for residents. LPNs, which is the next stage in the career ladder for certified nursing assistants, currently make up over 61% of the workforce that is helping to meet the licensed nursing requirement in Florida nursing centers.

“Out-of-touch federal mandates undercut the progress we are making in Florida and eliminate a career path for many of our frontline caregivers,” said Deborah Franklin, FHCA Senior Director of Quality Improvement. “More of our nursing center residents are living with complex chronic conditions and need skilled nursing care. With an aging population that is seeking more specialized and person-centered services, what we need are common sense solutions to help attract, advance, and retain caregivers who can meet the needs of our residents, not more red tape.”

In Florida and across the nation, nursing centers are grappling with workforce shortages, which presents a serious challenge in the profession. Despite a recent surge in health care jobs, long-term care lags behind. A recent study found that while nursing and residential care had the highest wage growth across healthcare settings, employment in those fields is still 5.7% below pre-pandemic levels.

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October 10, 2023

Kristen Knapp, APR
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