Key takeaways from new AARP Florida report show clear correlation between nursing home staffing and quality of care

Nursing homes are increasingly dealing with more complex cases requiring higher levels of care. But Florida, once a national leader, is eroding the minimum standards of care needed to protect the state’s most vulnerable residents. 

Those are the key findings of a new report commissioned by AARP Florida that offers the first comprehensive snapshot of the state of care in Florida nursing homes. 

A push by the nursing home industry for less stringent minimum care standards ignores the findings of dozens of peer-reviewed studies done over many years, according to the new report, written by University of South Florida Assistant Professor Lindsay Peterson, Ph.D., Interim Director of the Florida Policy Exchange Center on Aging.  

Those studies found a direct correlation between staffing levels and quality of care.  

Nursing homes respond to minimum requirements, the study found. When minimums increase, “the quality of care improves.” 

Twenty years ago, Florida set the standard nationally for nursing home care. “In 2001, driven by reports of inadequate patient care and complaints from the industry about lawsuits, the Florida Legislature set limits on negligence cases, increased minimum nursing staffing requirements, and raised Medicaid rates to help the nursing homes pay for the increase,” the report says. “It was a nationally groundbreaking move that included a commitment to increase minimum nurse staffing standards from a low of 2.3 hours per resident per day in 2000 to 3.9, including a minimum of 2.9 certified nurse aide hours.” 

But under pressure from the nursing home industry, those minimum standards have been slipping. In 2011, the Legislature reversed the progress it had made just 10 years earlier,  lowering the minimum daily staffing for certified nursing assistants to 2.5 hours per resident. And last year, the Legislature further reduced the minimum standards.   

The erosion of minimum care standards comes as nursing homes are dealing with patients requiring more intensive care.  

“One of the most significant trends in long-term care is the rising level of nursing home residents’ needs,” the study found. “People with low- to moderate-care needs, such as dressing and bathing, increasingly receive services at home or in assisted living settings, rather than in nursing homes. At the same time, hospitals are discharging patients to nursing homes “sicker and quicker.” Today’s nursing home residents require IV therapy, other skilled services, and care for dementia, severe mental illness, and other chronic health conditions such as diabetes, and heart failure. 

AARP Florida State Director Jeff Johnson hopes the comprehensive study serves as a resource to legislative decision-makers and elected officials. Peterson’s report includes a review of numerous peer-reviewed studies on the impact of state standards on quality care and offers a thorough look at the history, policy changes and the challenges going forward. 

“As we look toward meeting the complex needs of an increasing population of elders, it has never been more important to understand the history and development of Florida’s nursing home care standards,” Johnson says. “We are the voice of Florida’s most vulnerable older adults, and we know that there are many challenges facing nursing home residents – not the least of which is nursing staffing. We want to have a state-level conversation about how to address the rising needs of nursing home residents, and be a thought partner in helping solve the nursing home industry’s staffing crisis.” About 70,000 people are cared for in nearly 700 nursing homes across Florida. A severe staffing shortage driven partly by the COVID-19 pandemic, along with ongoing concerns about pay and working conditions, prompted the Legislature to reduce minimum care standards so that lesser trained and lesser paid staff take on more of the care than before. 

Nursing homes already were struggling. A Tampa Bay Times investigation published in February found that the number of serious violations of nursing home regulations nearly doubled between 2019 and 2022 compared to the previous six years. More than half of those violations involved staff shortages or insufficient training, the Times found.  

It is still too early to measure the impact of last year’s changes in minimum care standard. “The latest changes in Florida minimum staffing requirements present new opportunities to examine the role of staffing and its relationship to quality of care for tens of thousands of Floridians living in nursing homes,” the Peterson study found. “The next critical step is to assess whether quality of care changes as staffing changes.” 

Read the full report here.

Watch our Facebook Live event featuring Jeff Johnson and Dr. Lindsay Peterson.