Florida’s Worst Nursing Homes Could Receive Fewer Inspections

By: Ryan Mills Naples Daily News

A patient at a Central Florida nursing home near The Villages died after being left out in the sun for three hours. Another was rushed to a Melbourne emergency room after staff administered

anti-psychotic medications at 80 times the prescribed dose. And at a nursing home between Gainesville and St. Augustine, one patient died after staff waited five minutes before starting cardiopulmonary resuscitation, and another nearly died after he was overdosed on morphine.

Over the last 3 years, Florida’s Agency for Health Care
Administration cited all three low-rated nursing homes with Class 1 violations
— the most severe violations the agency can levy. By state law, AHCA was
required to ramp up oversight, inspecting the homes every six months for two
years. But that oversight would be cut back under two bills making their way
through the Florida Legislature that would reduce inspections at problem
nursing homes. Advocates say it’s a threat to patient safety. ACHA leaders say
they’re already going into poor-performing homes frequently and need more
flexibility around inspections.

As part of the legislation, AHCA would be required to do only one additional inspection at
nursing homes after the agency cites them with a Class 1 or multiple Class 2
violations. The loosened mandate would apply to every nursing home in the
state, from the highest rated to the lowest. And with fewer inspections, AHCA’s
inspection fine would be cut in half from $6,000 to $3,000.

The nursing home provision is part of a larger legislative push by AHCA to give the agency more flexibility in how it deploys staff across the health care spectrum. Other parts of the legislation would give AHCA leeway
to extend inspection deadlines at highly rated assisted living facilities and
exempt “low-risk providers” — nurse registries, home medical equipment
providers and health care clinics — with excellent regulatory histories from
regular inspections.

The two bills — Senate Bill 1726 and House Bill 731 — have
received little pushback in Florida’s regulation-averse Legislature. AHCA
Secretary Mary Mayhew claims the purpose of the legislation is to give AHCA the
ability to spend less time in good health care facilities and more time
inspecting problem providers. The agency’s resources are increasingly strained
as the state’s population and the number of health care providers increase,
agency leaders said. “We wanted to make sure that as we look at our workload, we
are able to have a clear focus on higher-risk and poor performing providers,”
Mayhew said. But critics of the legislation worry about the ramifications of
cutting back on AHCA’s mandates. “In my opinion, oversight and inspections are
critical to ensuring quality care and that residents are safe,” state Rep.
Margaret Good, D-Sarasota, said during an early February health care committee
meeting. “I’m concerned that requiring fewer inspections could lead to worse
outcomes to those that are most vulnerable.”

The state’s nursing homes came under scrutiny in 2017 after 12 residents of the Rehabilitation
Center at Hollywood Hills died following a power outage caused by Hurricane
Irma. A 2018 investigation by The Fort Myers News-Press and the Naples Daily News
found dozens of Florida’s worst nursing homes have long records of failing to
meet state and federal standards and operate with little risk that regulators
will shut them down.

Sen. Aaron Bean, R-Jacksonville, who is sponsoring the legislation in the Senate, said he would
be open to amending the bill to continue requiring AHCA to inspect the state’s
worst nursing homes every six months for two years if they are cited with a
serious violation.

AHCA Deputy Secretary Molly McKinstry said a problem with the current regulations is
they treat nursing homes with good histories of compliance the same as providers with poor histories.
She said on occasion, a serious violation will occur at a highly rated nursing home, which
quickly corrects the problem. But the law gives AHCA no wiggle room to scale
back inspections at that nursing home, even if there is little reason to
believe that problems are persisting. AHCA would be required to “go back with a
full inspection team every six months for two years while we have other
facilities that have a more chronic history that we’re not spending as much
time in because they didn’t have a Class 1 (violation),” McKinstry said.

But the proposed legislation doesn’t just eliminate the stricter
inspection mandates for highly rated nursing homes. It would apply to all
nursing homes, including chronic poor performers. Fifty-nine nursing homes are
currently in the more intense two-year inspection cycle, according to AHCA. Of
those, 52 have below average ratings from the federal Centers for Medicare and
Medicaid Services, which ranks nursing homes on a five-star scale with one star
being the worst and five stars being the best. The average rating of the 59
nursing homes on AHCA’s list is 1.9 stars. There are 695 nursing homes in the state.

“Even if you take at face value what they say is true — AHCA
is overburdened, they’re overtasked, the Legislature wants to help to focus on
bad operators, concentrate your resources, take them away from the facilities
that are doing good and go after the bad guys – well, if you look at this bill,
it does exactly the opposite. That’s the said irony,” said Brian Lee, former
head of the state’s Long-Term Care Ombudsman program who now heads the
nonprofit Families for Better Care.