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FHCA Warns Proposed Federal Nursing Home Mandates Will Compound Operational Challenges, Workforce Crisis in Letter to CMS

Tallahassee, Fla. – The Florida Health Care Association (FHCA) has submitted comments to the Centers for Medicare & Medicaid Services (CMS) to warn of the unintended consequences of the proposed federal nursing home staffing mandates. In a letter submitted to CMS, FHCA’s Chief Executive Officer Emmett Reed cautions that these mandates will lead to reduced access and quality of care for residents. 

Despite Florida’s already robust staffing requirements, the proposed rule would have significant impact.

“We agree that improving and providing the highest quality of care should be the goal that everyone is working toward; however, a one size fits all staffing model is not the way to achieve that goal,” said Emmett Reed, CEO of FHCA. “Arbitrary and unfunded mandates such as proposed in this rule will only create access issues, because the staff required in this proposal do not exist, are not projected to exist, and the proposed requirements certainly cannot be met if CMS is unwilling to provide any additional funding for centers to hire the staff needed to comply.”

According to a recent analysis by CliftonLarsonAllen, to meet the requirements proposed by CMS:

  • Florida providers need to hire almost 3,500 additional staff, including 2,662 nurse aides and 885 additional registered nurses.
  • 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.
  • These additional staff would cost providers an estimated $188 million in additional costs annually for Florida alone with no suggested reimbursement increase included in the proposed rule.
  • Almost 12,000 of the state’s 70,000 long term care facility residents are at risk of losing their care if providers are unable to find the staff required.

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.

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.

In Florida and across the nation, nursing centers are grappling with workforce shortages, which presents a serious challenge in the profession. In 2012, a total of 5,090 Floridians passed the test to become a certified nursing assistant. In 2022, that number has been reduced by half to only 2,590 passing.

“This ongoing environment of unavailability of staff, in combination with funding at levels that are inadequate to compete with other professions, must be factored in as an unfortunate reality when considering staffing minimums,” continued Reed in the letter.

To read the full letter submitted by FHCA’s CEO Emmett Reed, click here.


November 6, 2023

Kristen Knapp, APR
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