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Sarasota Herold-Tribune

Nursing home bill opens rift

Nursing home bill opens rift

Friday, March 13, 2009

By KEVIN L. McQUAID

Florida lawmakers are considering a bill that critics say would significantly weaken state nursing home oversight and dilute the rights of the elderly.

Introduced by Sen. Mike Bennett, R-Bradenton, Senate Bill 1562 would strip the Agency for Health Care Administration, the state entity primarily responsible for nursing home regulation, of the authority to penalize or fine violators of Florida law.

The bill also would eliminate state Department of Health and Fire Marshal inspections of nursing homes, if they are inspected once every 15 months by AHCA.

Bennett said the bill is intended to avoid duplication among state and federal agencies that monitor nursing homes. "Nursing homes are literally overinspected," he said.

The bill is similar in scope to legislation Bennett introduced last year, which would have altered definitions and reporting requirements for "adverse incidents" that hurt or kill nursing home residents, and allowed nursing homes to develop independent training programs for nurse aides.

That bill unanimously passed both the state House of Representatives and the Senate before being vetoed by Gov. Charlie Crist in June.

Critics of Bennett's latest nursing home bill see the new proposal as a more ominous push to help an industry many view as beset by a lack of oversight.

"This bill feels to me like we're moving back to the dark ages," said Anna Spinella, chairman of Advocates Committed to Improving Our Nursing Homes, a Tampa group. "It would destroy oversight."

The legislation also would eliminate annual assessments of most long-term care centers by state ombudsman, and effectively cripple a state nursing home watch list that AHCA maintains because information would no longer be collected. The proposal also would cut a "gold seal" program relied on by many consumers that recognizes quality operators.

The ombudsman program, which advocates on behalf of residents, was created in 1965 as part of the federal Older Americans Act. The gold seal -- awarded to just 17 of 680 nursing homes statewide, including the nonprofit Sunnyside Village in Sarasota -- and watch list programs date to 1999.

Under Bennett's bill, AHCA fines for four classes of deficiencies would be eliminated and replaced with language that identifies "immediate jeopardy," and "actual harm that is not immediate jeopardy."

Class I violations, the most serious -- involving death, brain or spinal injury, permanent disfigurement, bone fractures or exploitation -- carry fines of $10,000 to $15,000 per count, under the current law.

Bennett says that the intent of his bill is not to decrease care for seniors, but to eliminate what has grown into a huge bureaucratic process.

"There's a huge duplication of paperwork," Bennett said. "The same form gets repeated, repeated repeated. It's insane."

Bennett said the plan would likely save Florida millions of dollars, though a formal fiscal analysis has yet to be developed.

He acknowledged that the ombudsman provision has little fiscal impact because assessments are conducted by volunteers.

"I'm not sure why that's in there," he said.

The senate bill comes as more and more aging Floridians will become eligible for long-term care, in both nursing homes and assisted-living centers, in coming years. From 2010 to 2030, the population of Florida residents aged 65 and older is slated to rise by more than 4.3 million, U.S. Census projections show.

But the proposed legislation also comes amid broad budget-tightening and revenue reductions as the Sunshine State contends with a deep economic downturn brought on by the decline in the real estate market.

Supporters said Bennett's bill -- a similar version, House Bill 1387, has been introduced by state Rep. Ken Roberson, R-Port Charlotte -- would only streamline processes.

"This wouldn't weaken anything," said Kristin Knapp, a spokeswoman for the Florida Health Care Association, a trade group that represents nursing homes. "It would only eliminate duplicative inspections."

Opponents remain unconvinced.

"We fought for years to get the watch list information for the consumer," said Norma Atteberry, a resident of Milton, near Pensacola, and president of the National Consumer Voice for Quality Long-Term Care, a Washington, D.C.-based group. "You have to have something that tells the nursing home industry it's imperative to provide good care, and I don't know how to do that without state regulation."

Officials from AHCA and AARP, formerly the American Association of Retired Persons, said they are reviewing the bill.

State Department of Elder Affairs Secretary E. Douglas Beach, who oversees the ombudsman program, could not be reached for comment, and representatives from State Fire Marshal Alex Sink and other state senators did not return calls.

Marilyn Dos Santos, an ombudsman and member of the group's statewide executive committee, said the proposed bills would limit ombudsman visits to both nursing homes and assisted-living centers to complaint response.

"It would take away our ability to help residents," Dos Santos said.

"People are sometimes afraid to make a complaint. We're not a duplication of AHCA, we're an enhancement. AHCA is concerned with facilities, we're concerned with residents."

During the state's 2007-08 fiscal year, the ombudsman program's 415 volunteers completed 3,932 assessments of long-term care centers, and investigated more than 7,750 complaints, state records show. The program saved the state $1.7 million, according to ombudsman data.

Brian Lee, the state's long-term care ombudsman, said the decreased oversight stemming from the proposed legislative changes could lead to higher state Medicaid spending, resulting from a greater number of hospitalizations and illnesses among nursing home residents.

If adopted, the new law would take effect July 1.


This story appeared in print on page A1