Health and Safety Violations Are Rapidly Increasing in Florida Facilities
Since 2019, The Agency for Health Care Administration (AHCA) has recorded staggering numbers of serious health and safety violations in Florida nursing homes.
Historically, AHCA has regularly cited neglectful facilities for health and safety violations. This has been going on well before 2019. However, AHCA has seen a significant jump in violations over the past five years.
Our Florida nursing home abuse attorneys have also seen an uptick in nursing home complaints. While the exact cause for the rise in violations remains unclear, it could potentially be linked to the loosening of regulation in the nursing home industry, new nursing home owners buying up Florida facilities, or the understaffing crisis that emerged during the Covid-19 pandemic.
Understaffing Leads to Increased Violations
Historically, Florida’s nursing homes have been understaffed. Florida’s state minimum staffing levels are flat across the board. They do not take into account the residents’ acuity level in the facility.
Further, paying fulltime staff members is expensive. Since staff is the largest line item on the budget, if a facility can reduce staff numbers, this increases their profit margin. Understaffed nursing homes became a particular glaring problem during the Covid-19 pandemic. The nursing home industry faced a never-seen-before staffing shortage. This nationwide understaffing issue led to countless difficulties in providing quality resident care. Medical staff were stretched thin and are often paid little for their efforts.
Certainly, the lack of caretakers in Florida’s nursing homes may have contributed to the increase in violations over recent years. However, this is a problem with an easy solution. Hire more staff and pay them livable wages.
New Laws May Contribute to Increasingly Bad Florida Nursing Home Care
In the summer of 2021, Florida Gov. Ron DeSantis signed into law HB 485, which allowed nursing homes to hire less qualified staff to care for residents. These staff, called “personal care attendants,” only require 16 hours of training before being allowed to care for nursing home patients. These vulnerable patients commonly suffer from memory issues, mobility issues, and complicated health issues.
While personal care attendants are meant to be temporary solutions to staffing shortages at nursing homes and are required to take a certified nursing assistant (CNA) exam if they wish to continue working at the facility after four months, elder care advocates are concerned about the quality-of-care residents receive. In an interview with Tampa Bay Times, Zayne Smith, the advocacy director of AARP Florida said, “I think people are going to die. I think we can expect the worst. I really do.”
Occurring in 2022 in Tampa Bay, a personal care attendant expressed to state investigators that she felt “set up for failure” by the nursing home after her involvement in a resident’s fall. The personal care attendant described how she had been assigned to care for 15 residents and in order to help out her fellow employees, she had attempted to turn a resident in bed by herself. The resident ended up falling out of bed, which resulted in a paralyzing spinal cord and neck injury. When state investigators spoke with the nursing home’s director of nursing, or DON, she confirmed that the fall would likely not have occurred if the resident had been turned by two staff members instead of one.
In March of 2022, Gov. DeSantis signed into law SB 804. This law reduced the long-standing requirement of certified nursing assistants spending 2.5 hours with residents each day to just 2 hours. The law also allows non-nursing staff to sub in for these hours. That means that staff such as social workers, physical therapists, and activities staff can be counted in state-mandated staffing reports.
Jeff Johnson, the state director of AARP Florida stated, “The last couple of legislative sessions have weakened staffing standards. It certainly makes sense that there’s going to be a correlation between less-trained staff and more violations.” AARP Florida, along with the state’s largest nursing home worker’s union warned that the way Florida is changing the nursing home industry’s rules will harm residents.
Now, despite the recent loosening of nursing home regulations and an objective increase in serious care violations across the state, Florida’s nursing home industry is pushing legislation which would immunize them in most wrongful death lawsuits. This bill, which has been called a ‘License to Kill‘ for Florida’s nursing home industry, would remove what little accountability and scrutiny is left over these facilities.
Same Facilities, New Owners
Many Florida nursing homes were purchased by New York-based private equity groups or out-of-state owner/operators during the pandemic. More than 200 nursing homes changed ownership during this time. While the facility’s outwardly appear the same, under new management, some of these acquired facility’s suffered an increase in health violations.
“Private equity and other private investment firms have purchased SNFs; in some cases, new owners have sold the real estate assets to another entity under their control, and then released the building back to the original facility with substantial management fees,” HHS analysts wrote. Skilled nursing facility watchdogs argue that this ‘exorbitant rent’ trend causes nursing homes to cut back on staffing, resident care, and overall quality.
Increasing Deficiencies in Florida Nursing Homes Since 2019
Health and safety violations in Florida nursing homes have almost doubled since 2019. In 2022 alone, there were 83 class 1 deficiencies cited by state investigators during inspections inside facilities. Class 1 deficiencies require immediate corrective action as they put residents in imminent danger which could include serious physical harm or even death. While class 1 deficiencies are only a relatively small portion of violations found inside Florida facilities, they can allow us to think about what else is most likely going wrong; like staffing issues, supervision issues, training issues, cleanliness issues, etc.
Destin Healthcare and Rehabilitation Center recently lost its funding from Medicare and Medicaid after receiving the most class 1 deficiencies in all of Florida in 2022. The Centers for Medicare & Medicaid Services (CMS) stated that it was necessary step to take as a last resort after trying to remedy the facility’s numerous health and safety violations.
Between the years 2012 and 2018, the number of class 1 deficiencies in Florida remained stable with an average of 32 per year. Beginning in 2019, this number jumped to 81. As of 2023, the average remains the same.
More Complaint-Based Nursing Home Investigations
Federal data shows that Florida has conducted more complaint inspections in recent years. Complaint inspections occur when residents or their loved ones file a formal complaint against the nursing home. Inspectors then conduct investigations if they determine it is needed.
Florida conducted approximately 1,900 complaint inspections in 2018, compared to 2,200 complaint inspections in 2022. While not all complaints are substantiated, research shows a significant link between the number of violations discovered within nursing homes and the number of complaints called in. Clearly, resident complaints have increased over the past few years, indicating a subjective perception that care levels had decreased.
What Florida Nursing Home Violations and Citations Mean
While most citations nursing homes receive are not life-threatening class 1 deficiencies, they are important to resident care. Citations can range from paint chipping on a bathroom wall to a resident suffering from a urinary tract infection (UTI). When state inspectors enter nursing homes for health inspections, they are trained to keep their eyes peeled for any type of abnormality. A band-aid on the floor of a shower stall will be written down. Food not being stored properly in the kitchen will be noted.
Inspectors will conduct interviews with residents and their family members. If a resident mentions that an aide has verbally abused them in the past, the inspector will note that and interview staff members about the incident and if the incident had been properly reported at the time it occurred. If a state inspector sees a resident with a bedsore, they will ask to see the resident’s medical records and interview staff about the wound and what type of wound care the resident receives to determine if the facility has failed in any way to provide proper care to the resident.
In essence, nursing homes can receive health and safety citations for many different types of deficiencies. They can also receive citations if they are understaffed. In 2022, there were 53 instances of nursing homes being cited for understaffing and insufficient training across Florida.
Florida nursing home’s health and safety citations are available to view on either Medicare’s Care Compare Tool or on the Agency for Health Care Administration’s (AHCA) Florida Health Finder.
Conclusion
Care in Florida’s nursing homes is objectively getting worse. Despite this objective data, Florida’s for-profit nursing home lobby group is pushing a lawsuit reform bill which would essentially immunize a nursing home if they kill a resident that is not married. Instead of deregulation and immunity for killing residents, we should increase scrutiny and accountability in Florida’s nursing homes.
More frequent inspections, better staffing ratios, and transparency of ownership would all go a long way in protecting Florida’s most vulnerable.
