Nurses say safe staffing is under attack at Florida’s nursing homes

Debra Williams, CNA with 1199 SEIU Florida

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Republican lawmakers have filed legislation that would weaken mandatory staffing requirements at Florida’s nearly 700 nursing homes, which care for tens of thousands of residents statewide. While supporters tout these changes as a way to address the industry’s staffing shortage, certified nursing assistants who provide essential care at those facilities are sounding the alarm.

Debra Williams, a certified nursing assistant from South Florida, spoke against the bill Tuesday in front of the House Finance & Facilities Subcommittee. “We’re unified against HB 1239, and any legislation that threatens the level of care in our nursing homes,” she said.

Williams spoke Tuesday on behalf of her union, the 1199 SEIU United Healthcare Workers East. That’s Florida’s largest healthcare union. They represent 10,000 nursing home workers at about 78 long-term care facilities in the state, including about a dozen in the Tampa Bay region.

Her union, as well as the AARP and other senior advocacy groups, oppose House Bill 1239 and a similar Senate version, SB 804. They warn the legislation, drafted with input by powerful long-term care lobbying interests, is dangerous, and could reduce the quality of care afforded to nursing home residents.

Studies show, safe staffing ratios can protect the health and safety of nursing home residents, of which Florida has plenty. But, as researchers of a 2020 study that examined staffing levels write, many U.S. nursing homes “keep staffing costs as low as possible to maximize profits.”

Reducing staffing requirements for Florida’s nursing homes

Florida’s staffing requirements for nursing home care have been in place for two decades. Under current law, Florida mandates a minimum 3.6 hours of direct care, daily, per nursing home resident. Of that, 2.5 hours can be provided by a certified nursing assistant (CNA), and residents must receive at least one hour of licensed nursing care. That’s less than what’s typically recommended by experts and researchers—but new bills proposed by Republican lawmakers could cut that down even further.

Under House Bill 1239, sponsored by Republican Rep. Lauren Melo, mandatory staffing standards would require just 2 hours of CNA care, down from 2.5 hours. A similar Senate version, SB 804, would cut staffing requirements to 2.5 hours of “direct care” services. That “direct care” category of workers encompasses a broad mix of facility staff, including respiratory and occupational therapists, mental health workers, podiatrists, dietary staff, and other specialty care providers.

Supporters say this would allow for holistic, personalized, and “patient-centered” care. CNAs, however, say that the hours required for nursing care shouldn’t be cut in order for that to happen. Elderly, sick residents may require additional specialty care, but that shouldn’t factor into required hours delivered directly by clinical staff. Will a specialty care provider be willing to change residents’ diapers, wash them, groom them, change soiled sheets, and lift wheelchair-bound residents out of their chairs?

“Ninety percent of nursing care is to be able to get you strong enough, get you dressed, fed, help you move, grooming, and bathe you,” Roxey Nelson, a Tampa Bay-based spokesperson for 1199 SEIU Florida told WMNF.

It’s important, but arduous work. Taking care of seniors in these facilities requires physical, as well as emotional labor. And many workers have been chronically underpaid. Some CNAs in long-term care facilities make as little as $12 an hour. And Williams, a CNA, says this crisis in care was a problem long before the pandemic.

“Caregivers like myself have long worked for low wages and little benefits,” Williams said. “Most of us, we really can’t even afford health care coverage for ourselves.”

Investing in nurses, not the industry’s pockets

Nurses say they have the skills, compassion, and dedication to their work that’s needed to truly take care of Florida’s ailing seniors, but they’re lacking in resources. While Florida’s nursing care industry receives millions of dollars in public funding each year, CNAs – who perform essential work to care for Floridians’ parents, grandparents, and other family members – may struggle just to get by.

“For decades, this industry has put profit over people and has done nothing to warrant our trust,” said Williams.

Supporters of the legislation, such as the Florida Health Care Association, argue the flexibility of the proposed staffing standards would ease nursing homes’ ongoing staffing shortages. But opponents – including actual workers at these facilities – say, this isn’t a solution: it weakens an already precarious staffing situation. And it will do nothing to demonstrate to CNAs their value as workers, nor protect the safety of residents.

According to Williams, a better, more permanent solution would be to protect, respect, and pay caregivers fairly. She said, “We look forward to legislation that will do that, and truly serve our seniors.”

House bill advances

But as labor journalist Alex Press puts it, where there’s crisis in healthcare, there’s opportunity for capital. Despite Williams’ impassioned speech Tuesday, the House Bill cleared its first hearing. Two Miami-Dade Democrats – Rep. Benjamin Christopher and Rep. Nicholas Duran – crossed party lines to vote in favor. Meanwhile, the Senate version, filed by Republican Sen. Ben Albritton, will have its first hearing with the Senate Health Policy Committee Thursday.