New Report: Florida Nursing Homes Show Decline in Nursing Staffing

A new comprehensive report of staffing levels in Florida nursing homes found a significant decline in nursing professionals which correlates to changes in state law the Legislature made last year and worker shortages.

The result: nursing homes are operating with fewer trained nursing staff to care for high-need residents at a time when the facilities are dealing with more complex cases.

In the 18 months between April 2021 and October 2022, direct care staffing declined across Florida’s more than 700 nursing homes, the study found.

The new law, which took effect in April last year, reduced the required nursing care provided by Certified Nursing Assistants (CNAs) from 2.5 hours to 2 hours and created a new category of non-nursing direct care staff to fulfill part of the overall 3.6-hour minimum staffing requirement.

That may not sound significant at first glance, but the change translates to an average difference of roughly 30 fewer hours of nursing care per day in a nursing home with 100 residents. CNAs represent the greatest share of nursing home nursing staff.

Meanwhile, the decline in CNA staffing was not matched with an increase in other types of staff. Non-nursing direct-care staff include physical and occupational therapists, therapy assistants, speech-language pathologists, social service and mental health personnel, activities directors and assistants, dietitians, and feeding assistants. These new categories count toward the minimum staffing requirement under the law but the actual numbers of people available to care for residents has not increased for the most part. Only two categories of staff increased – activities and dietary/feeding, both up by less than a minute per resident per day.

“The reality is there is a loss in quality of care that occurs when you try to reduce nursing staff requirements,” AARP Florida State Director Jeff Johnson told The Orlando Sentinel. “The staffing standards are there for a reason. It’s pretty clear that nursing staffing levels have gone down, and no one has picked up the slack.”

The study found that overall nurse and non-nurse staffing in Florida nursing homes is on a downward trajectory because of legislative changes that cut staffing requirements and widespread post-pandemic burnout and economic shifts.

“We know that hands-on, personal attention from nursing staff is critical to the health and well-being of people who need care in nursing homes,” said University of South Florida Assistant Professor Lindsay Peterson, Ph.D.  “For decades, Florida has been a leader in ensuring a high level of staffing, compared to other states. Many nursing homes staffed at levels above Florida state minimum requirements, but this appears to be changing as minimum staffing requirements drop.”

The nursing home industry pushed for the changes in state law in response to the kind of worker shortage that plagued other sectors of the economy because of the pandemic. But that approach ignores other solutions that could help boost nursing home staffs.

The report says high quality research is needed to gain a greater understanding of the needs of nursing home workers and what attracts them to other companies and employment fields, and to find a solution to this shortage, lawmakers need to work with researchers and industry professionals.

The report includes a series of recommendations, including funding programs to prioritize educating health studies students on long-term care and exposing them to nursing homes during internships and clinical rotations and encouraging local organizations to apply for Health Profession Opportunities Grants to fund CNA education and training.