SNF Staffing Shortages ‘Not Relieved as Expected’ Following Florida’s Expansion of Minimum Staffing Criteria

Legislative efforts to expand the types of positions that count toward Florida’s minimum staffing ratio seem to have backfired somewhat, as overall staffing levels in the state’s 700 nursing homes have declined within the past two years.

That’s according to a report published by AARP Florida, which found that staffing levels dropped from 4.74 hours per resident per day in April 2021 to 4.36 hours per resident per day by October 2022.

The AARP report, part of an ongoing study, is one of the first to look into staffing levels and quality of care following the state decision to allow non-nursing workers to count toward the state’s minimum staffing ratio. It’s timely as the industry awaits the looming proposed federal staffing mandate.

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Findings indicate the “significant decline” in nursing hours was not met with a matching increase in other types of staff, according to a statement issued by AARP.

Staffing hours specifically for certified nursing assistants (CNAs) in Florida nursing homes decreased 2.3 hours in this same time span. This equates to about 154 fewer hours of hands-on care for a week, if a facility had 100 residents, the report found. Put another way, that’s a loss of nearly four full-time CNAs working 40-hour-a-week shifts.

The AARP report linked these declines to two state laws passed in April 2021 and 2022. The first piece of legislation created a new nursing home position called the personal care assistant; this individual can do the job of the CNA without training, learning on the job.

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A followup bill was proposed to provide an annual report on the success of the personal care attendant program to the governor and legislature, but it did not pass. AARP Florida State Director Jeff Johnson told the South Florida Sun Sentinel that it has been difficult to measure the success of the program, or even know how many personal care attendants there are in the state.

“There is an urgent need to better understand staffing in nursing homes and how to increase the time devoted to resident care. Nearly two years after the creation of the [personal care assistant] program, it appears that staffing shortages have not been relieved as expected,” the organization said in a statement.

The second law allows non-nurse employees, including physical therapists, speech pathologists and activity directors, to count toward the state’s minimum staffing requirements.

Notably, average time spent with these other staff members – the people that were supposed to make up the difference in staffing requirements – decreased as well by about 4 minutes per resident per day, between April 2021 and October 2022.

What’s more, the quality of care changes when you supplement CNA care with an activity director or physical therapist.

“We have not seen an uptick in the time spent at nursing homes by virtually any other profession since that law went into effect, except maybe activities directors who are wonderful but will not change diapers,” Johnson said in the Sentinel article.

Another report from AARP Florida in March reviewed the state’s direct care requirements for the last decade.

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