Florida nursing homes would be allowed to operate apprenticeship programs and use participants’ on-the-job training to meet state minimum staffing requirements, under a bill approved Wednesday by a Senate health committee.
Sponsored by Sen. Aaron Bean, R-Fernandina Beach, the measure (SB 1132) was approved by the Senate Health Policy Committee in an 8-1 vote. It was opposed by the state’s top advocate for long-term care residents and a lobbyist for the state's largest health-care union, both of whom warned that nursing homes would hire less-qualified workers and pay them less without running afoul of staffing requirements.
“This is a road toward mediocrity, and mediocrity is not a virtue,” Florida Long-Term Care Ombudsman Mike Phillips told members of the committee.
The bill is supported by the nursing-home industry, which says the apprenticeship program is necessary to address a staffing shortage and to help build a future long-term care workforce
Florida law requires nursing homes to provide a minimum weekly average of 3.6 hours of direct care per resident per day. It requires a minimum of 2.5 hours a day provided by certified nursing assistants and one hour provided by licensed nursing staff.
The bill would make permanent what is now a temporary apprenticeship program for “personal care attendants.”
The state Agency for Health Care Administration approved the temporary program last year at the behest of the nursing home industry to help during the COVID-19 pandemic. The program allows people who complete an eight-hour course taught by registered nurses to work at nursing homes for four months as personal care attendants. The nursing homes can count the training time toward the state-mandated staffing hours.
The bill is needed to make the program permanent because current law doesn’t allow nursing homes to use non-nursing staff to meet the minimum requirements.
"Attracting and retaining front-line caregivers continues to be one of the biggest challenges for Florida’s nursing centers, and the pandemic only made things worse,” Deborah Franklin, senior director of quality affairs for the Florida Health Care Association industry group, said in a prepared statement Wednesday. “The personal care attendant program has been a tremendous help, and we hope it becomes a permanent part of our workforce."
Citing what he said were industry figures, Phillips told senators that 2,000 personal care attendants had worked in nursing homes under the temporary program approved last March. Roughly 500, Phillips said, ultimately went on to take the CNA exam, of whom about 85 percent passed.
“That’s a 20 percent success rate, which means you have an 80 percent failure rate,” Phillips said.
The nursing home industry said the program is not meant to replace CNAs, who, according to the Service Employees International Union, or SEIU, earn an average of $23,000 annually.
Instead, according to the industry, the goal is to recruit more people to work as certified nursing assistants and promote job growth.
Jacksonville resident Shontia Carter testified that the apprenticeship program helped her leave her “job” at a moving company and find a “career” at a nursing home. Carter said she has passed the clinical part of the CNA exam. She must still pass the written portion of the test.
“I made a promise to my children that I would give them the best life that they’d deserve. The personal care program is helping me do just that.” she told members of the Senate committee.
Before passing the bill, the committee made a change to increase the number of required course hours from eight to 16 before participants can start working at nursing homes.
SEIU lobbyist Tanya Jackson said the union supports creating additional pathways for certified nursing assistant licensure, which is a 120-hour program. But the union, which represents more than 26,000 health-care workers, doesn’t think the four months of on-the-job training should count toward the mandated CNA hours.
“That 2.5 hours of care is what increases the quality within these nursing homes,” she said, adding, “It’s the toughest job in a nursing home, and I don’t think anybody here would tell you that that’s not the case.”
The bill is moving forward as the nursing home industry pushes the Legislature to grant broad immunity from lawsuits related to COVID-19. The full Senate is slated Thursday to take up a bill that would limit lawsuits against nursing homes.
Senate Minority Leader Gary Farmer, D-Lighthouse Point, noted that the Legislature had agreed to increase Medicaid payment rates by $75 million before the pandemic. Additionally, nursing homes have gotten federal CARES Act dollars, and they are caring for fewer residents because of the pandemic.
“It’s just too much for me, and I know the intention,” said Farmer, the lone senator to oppose the bill. “It’s tempting to create new jobs. We always want to do that, and I applaud you for looking out for that aspect. I just think it goes too far in allowing the replacement and not the supplementing.”
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