Tampa Tribune: Florida Legislative Session Leaves Advocates Fearing for the Elderly

As Florida Governor Rick Scott considers whether to sign or veto this year's crop of bills, the outcomes of Florida's 2011 Legislative Session are starting to register, particularly in regard to senior issues.  The Tampa Tribune reports below:


Session leaves advocates fearing for the elderlyTALLAHASSEE -- She had driven through the night from Tampa and signed up early to testify. But the state House committee hearing was ending, and still no one had called her. Nervously, Anna Spinella stood up and demanded to speak.

It was March 1999. The state Legislature was contemplating tougher standards for nursing homes. Spinella had traveled to tell lawmakers about her family members — such as Kenny, the brother-in-law whom nursing staff had so often left soaked in urine and the remains of his last meal. And Helen, the sister who suffered from a bad bedsore after staff sheared off a mole by mistake and then failed to treat it.

Spinella got her three minutes at the podium. Two years later, Gov. Jeb Bush signed a fiercely negotiated deal that combined new lawsuit protections for nursing homes with an increase in mandatory staffing. But while the legal reforms have stuck, the staffing levels are dropping as the state pares back Medicaid payments to nursing homes.

Faced with the worst budget year in recent history, Florida lawmakers chopped those Medicaid reimbursements this spring by 6.5 percent and scaled back staffing requirements below 2003 levels.

"Staffing is everything," said Spinella, now legally blind and hobbled with a bad leg. Unable to drive and being the primary caregiver for her frail, 79-year-old husband, Joe, she can't make it to Tallahassee anymore. "This is killing me."

The cutbacks are among the more controversial outcomes of the legislative session that will directly affect seniors. Others include privatizing Medicaid into a managed-care program — starting with seniors in long-term care, over objections from advocates for the elderly.

GOP lawmakers insist they were looking out for seniors. They point out that despite a nearly$4 billion shortfall, they funded more than 2,000 new slots in sought-after programs that enable seniors to age in their homes and communities instead of an institution.

Meanwhile, funding for the Department of Elder Affairs was left intact, said Rep. Matt Hudson, R-Naples, the House health care budget chairman. "In a tough budget year, seniors fared very well," he said. "When you make virtually no cuts to an entire agency in such a year, I call that miraculous."

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The 2001 nursing home reforms required a one-hour minimum of daily care by licensed nurses and phased in a minimum of 2.9 hours by certified nursing assistants. A University of South Florida study found in 2009 that with the added staffing, "deficiencies per facility have decreased," especially the serious violations.

But as budget pressures have intensified, lawmakers have loosened the requirements. This spring, they knocked the CNA mandate down to 2.5 hours, and a combined minimum weekly average of CNA and licensed nursing down from 3.9 to 3.6 hours.

Sen. Joe Negron, the Senate's health budget chief, said during floor debate that he didn't like reducing those minimums required of nursing homes. But "it's not fair to cut their reimbursements and then keep their fixed costs the same," he said.

The final reductions, Negron said, were a compromise with the House, which had proposed a 10 percent cut to preserve funding for mental health and substance abuse treatment.

Negron, R-Stuart, was also the Senate's main architect behind overhauling Medicaid into a manage-care system, which will likely be dominated by for-profit HMOs. Seniors in long-term care will feel the effects first, starting in 2012.

"We specifically advised that they should not put long-term care first," said Jack McCray, AARP advocacy manager. "… You've got health issues, financial issues, access issues, transportation for caregivers. Long-term care is a very complicated issue."

Negron said those in nursing homes will experience little change, since the state will continue to pay directly for the care they receive within the nursing home, without passing the money through a managed-care plan.

The main change will come for seniors who can remain at home with support services, he said. Managed care will make it easier to provide those services, which most seniors would prefer over a nursing home, Negron said. Over time, the state will save money from more people "aging in place."

Richard Polangin, government affairs director for the Florida Alliance of Retired Americans, worries about where the savings will come from if HMOs are in charge.

"HMOs have to make a profit; they have to reward investors," he said. "Where does that profit come from? From our perspective, and all the research we're familiar with, it comes from reducing services."

Few entities provide medical care on a not-for-profit basis, said Michael Garner, president and CEO of the Florida Association of Health Plans.

"I'm sorry; I'm not going to apologize for the fact that we need to keep our doors open, just like every hospital or physician. … The argument that profits will keep care from getting delivered is unsubstantiated."

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McCray said AARP is still waiting to see the effects of a bill that reduces reporting requirements for assisted-living facilities. It also stops requiring the Agency for Health Care Administration to develop and disseminate a list of such facilities sanctioned or fined for violations. AHCA currently posts the report on its website.

Hudson, the bill's sponsor, said it eliminates only outdated, arcane requirements for assisted-living facilities, and he argued that few people use the state report violations.

That wasn't enough reassurance for Michelle Rehwinkel-Vasilinda, one of three House Democrats who voted no.

"I just felt like we need more oversight of the ALFs, and this was removing oversight," the Tallahassee legislator said.

"When you're looking at facilities for children, or for elders who can't speak up for themselves, we need to be watching and making sure people are doing the right thing — especially when there's a profit motive involved."
cwhittenburg@tampatrib.com

(850) 222-8382


By CATHERINE WHITTENBURG | The Tampa Tribune
Published: May 18, 2011

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