Seven years ago, Florida lawmakers put in place tough staffing requirements for nursing homes in exchange for limits on lawsuits against the institutions.
That action in 2001 followed horror stories about nursing-home patients covered with bedsores or dying from ant bites led to multimillion-dollar jury verdicts against nursing homes.
Since then, nursing homes have had to report to the state the number of nurses and nursing assistants providing care to patients.
But now, House Republicans say nursing homes should have more ''flexibility'' in staffing decisions in order to cope with nearly $300 million worth of proposed budget cuts and a proposed two-year freeze on reimbursement rates paid by the state. A bill unveiled Thursday would prohibit the state from enforcing state laws on nursing-home patient care from June 30, 2008, to July 1, 2010.
''Right now, we don't have the money to pay them,'' said Rep. Aaron Bean, a Fernandina Beach Republican and chairman of the House Healthcare Council.
`THE DARK AGES'
But Kelley Rice-Schild, executive director of a 60-bed nursing home in Miami, said the combination of the cuts and elimination of staffing requirements ''is going back to the dark ages.'' She said that the higher staffing requirements -- and the state money to carry them out -- had improved the quality of care that nursing-home patients receive throughout the state.
She said the House's proposed budget cut would cost her $18 a day for each patient at the Floridean Nursing and Rehabilitation Center and may force layoffs.
''There's no fat to cut in the nursing homes anywhere,'' Rice-Schild said. ``People are our No. 1 expense -- that's the most obvious place.''
The staffing requirements have been increased gradually since 2001, and now Florida law requires that a certified nursing assistant spend at least 2.9 hours of direct care with each patient each day.
The Florida chapter of AARP, which also was deeply involved in the nursing-home fight seven years ago, on Thursday called the House proposal ``appalling.''
'SACRED' RULES
Sen. Durell Peaden, a Crestview Republican in charge of writing the Senate's healthcare budget, called the staffing requirements ''sacred'' and said they had worked in keeping ``malpractice down.''
Peaden said all the medical technology ''in the world'' cannot overcome the need for nurses.
''You can't substitute a nurse standing by that person's bedside,'' said Peaden, a retired doctor.
The House's proposal to eliminate the staffing requirements for nursing homes was included in a package of budget cuts that would slice more than $1.1 billion in healthcare spending across the state.
Besides cutting rates for nursing homes, the House also would eliminate dentures, hearing aids and eyeglasses for poor adults, close a state hospital in Lantana that serves tuberculosis patients, and reduce the money that all healthcare providers receive for treating Medicaid patients.
DENTURES AN ISSUE
In a moment of gallows humor, Rep. Rene Garcia, a Hialeah Republican, wondered why the House was keeping intact a meals-on-wheels program for the elderly yet slashing money for dentures for poor adults.
''I think it's a little bit hypocritical,'' Garcia told Rep. Bean on Thursday. ``We expect them to eat the food delivered to their houses, but we may have them to put it a blender so they can eat it.''
