‘Concerning’ Link Found Between Reduced Nursing Home Staffing Hours and Hospitalizations

There were more hospitalizations for residents in Florida nursing homes, following legislation which lowered the number of nursing hours per resident.

That’s according to a report from AARP Florida, the third report the advocacy group for older adults has released since staffing hours were changed in 2022. Between 2019 to 2020 and 2022 to 2023, the rate of re-hospitalizations among short-stay residents increased by 12%, the report found. For long-stay residents, AARP Florida said the number of unplanned hospitalizations increased by more than 20% in just one year.

That’s up to more than 2.1 hospitalizations for every 1,000 days residents spent in a nursing home between 2022 and 2023, compared to less than 1.8 between 2021 and 2022. 


Kristen Knapp, senior director of strategy and communications with the Florida Health Care Association, argued that the parallel trends of short and long-stay hospitalizations are not a result of Florida policy changes but rather a function of the post-Covid workforce environment across the country.

“Centers are still having to rely on contract labor to fill vacancies, and agency staff who are less familiar with residents’ day-to-day needs may result in the on-call physician making a hospital transfer order unnecessarily,” Knapp said in an email. “Nurse training and employee turnover may also be likely to correlate with readmission rates, as well as Florida’s litigation climate, with residents being returned to hospitals sooner to avoid potential lawsuits.”

Florida is one of about three dozen states that have implemented their own minimum staffing home requirements. Today, Florida’s law requires only 2 hours of certified nursing assistant (CNA) care daily per resident, at least one hour of care per resident provided by either registered nurses (RNs) or licensed practical nurses (LPNs).


“Multiple nursing home interest groups, from nursing home owners to resident advocates, are debating the potential harm or benefits posed by a federal staffing mandate – with some saying it requires too much in light of the present healthcare workforce shortage, and others arguing that it does not go far enough,” researchers said in the AARP report. “The evidence from Florida indicates that minimum staffing requirements do make a difference in staffing levels, as prior AARP reports have shown.”

Nursing staff in Florida, including aides and assistants provided an average of 3.86 hours of care per resident per day, a 30-minute reduction from 2021, with a 16-minute reduction following the enactment of new and reduced staffing standards, according to the AARP report.

The Centers for Medicare & Medicaid Services (CMS) proposed minimum staffing rule would require all qualifying nursing homes to provide a minimum of 2.45 hours, with 2 hours and 27 minutes of CNA care and a minimum of .55 hours, or 33 minutes, of RN care to each resident each day. An RN must also be on site seven days a week, 24 hours per day according to the CMS proposed rule.

More than one in four residents had to be readmitted to the hospital during their nursing home stay. There was also an increase in short-stay residents being transferred to the emergency department – nearly 10% of such residents in the state required the ED, a 28% increase since the worst of the pandemic.

“A year after the Florida Legislature passed major legislation cutting nursing home staffing requirements, federal data now shows a mixed record as to quality of nursing home care in Florida, particularly for shorter term nursing home residents who require rehabilitation and care after a hospital stay,” according to the report.

These findings are “concerning,” since operators have worked to admit more short-stay residents than ever before even as staffing standards decreased, the report found.

AARP’s 2023 Long-Term Services and Supports Scorecard ranked Florida in 49th place nationally for the frequency of long-stay hospitalizations occurring in a 6-month period. This indicates that the increasing rates of nursing home resident hospitalizations was already an issue prior to legislation to reduce nursing home staffing requirements – the state may score even worse in future scorecards, AARP said.

“The ongoing struggle of nursing homes to hire and retain sufficient numbers of nurses and nurse aides has driven much of the conversation about minimum staffing standards in Florida, to date,” the report stated. “However, the data that links the quality of care directly to the level of nurse staffing demonstrate that resident health and safety are also critical factors to that conversation.”

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