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Delays hinder homes' staffing

By JIM ROSS, Times Staff Writer
© St. Petersburg Times
published February 10, 2002

CRYSTAL RIVER -- Staffing a Florida nursing home is tough enough. But state government and its agents made the job a bit tougher in recent months.

Nursing homes were scrambling to hire certified nursing assistants (CNAs). But some people entering the field had trouble doing so. The reason: Scheduling problems with the mandatory state examination.

Separately, the Florida Board of Nursing was slow to approve new licenses and licensure requests from nurses who relocated from other states.

The timing for these obstacles couldn't have been worse.

They surfaced just as nursing homes were gearing up for Jan. 1, the day new staffing requirements took effect. And they hit an industry that already has trouble finding qualified CNAs and nurses to care for the state's ever-growing elderly population.

Citrus County nursing homes reported isolated problems, but they have been able to meet the new requirements.

The Department of Health says the problems are under control. But not everyone shares that sentiment.

The state Agency for Health Care Administration is responsible for inspecting Florida's nursing homes. Last week, that agency said the CNA mixup was so troublesome that it still isn't fully enforcing the staffing ratios law.

In other words, if a nursing home can prove the testing problem caused them to miss the legal mark on staff ratios, the home won't be cited for violating the law.

Meanwhile, if the Board of Nursing has gotten back up to speed with licensing requests, it would be news to Eric Bell.

Bell, the administrator at Cypress Cove Care Center, a 120-bed nursing home in Crystal River, is trying to hire three nurses who are licensed in other states. Two months have passed, and still the Board of Nursing hasn't approved these traditionally easy requests.

"It's just bad timing that both the problem with the nurses and the nursing aides happened just as these new regulations have taken effect," Bell said.

The rules, which emerged after a lengthy legislative battle in 2001, increased from 1.7 to 2.3 the number of hours each day that nursing home patients must receive care from a CNA. The new rules also call for the number of nursing hours to increase from 0.6 hours to 1 hour per day.

Bell wanted to hire five nurses who moved to this part of Florida. He didn't expect a problem, since reciprocity is common and fairly easy to handle.

But Bell has been able to hire only two of the five. The others are still waiting. Meanwhile, a newly trained nurse has been waiting to start at Cypress Cove but the state is taking a long time to handle her paperwork.

The Board of Nursing says the delays are happening because its staff recently moved from Jacksonville to Tallahassee.

"It (the delay problem) was something that was noted and has been addressed," said Bill Parizek, spokesman for the Department of Health. "We basically pulled people from other boards to assist and get applications done."

The CNA problem was much more complicated. Here's what happened:

Last year, a company called ASI Inc. administered the CNA test on the state's behalf, Parizek said. The Department of Health sought new bidders in May and wound up selecting a new vendor: Chauncey/Experior.

The new vendor was supposed to begin startup tasks Oct. 1 and be ready to begin testing Jan. 1. Meantime, the old vendor would serve out its contract through Dec. 31.

But there was a problem: The old vendor mounted a legal challenge, protesting the bid process. As a result, the state couldn't sign its contract with the new vendor until Dec. 7, after the legal battle was settled.

That didn't leave the new company nearly enough time to handle its preparation work and be ready for Jan. 1, Parizek said.

To make matters worse, ASI, the old contractor, was swamped with CNA candidates whom nursing homes had sponsored as they prepared for Jan. 1.

Candidates couldn't get a spot at testing tables throughout the state and ASI, keeping its traditional holiday schedule, didn't plan any testing dates after Dec. 20, according to the Florida Health Care Association, a trade group for nursing homes.

That changed quickly after the problem was recognized, the association noted, and some testing dates were set.

Still, ASI's contract expired at the end of the year and couldn't be extended. And the new vendor wasn't fully up to speed.

In January, the normally simple task of sitting for a CNA exam became difficult, as there were fewer sites than usual.

At Life Care Center of Citrus County, and other nursing homes statewide, administrators still await word on when and where their CNA candidates will be tested. One Citrus nursing home administrator said she heard a Florida nursing home, at the height of the CNA testing problems, had to send its CNA candidates to Georgia for testing.

Parizek said the system is much better now.

By law, the new test administrator must own and operate or lease and operate at least 20 testing sites. Last week, it had 14 sites approved and operating and eight more close.

Other sites are in the works.

Parizek said the new vendor, Chauncey/Experior, deserves a lot of credit: It typically takes five to six months to progress as far as it has progressed.

Still, Agency for Health Care Administration spokesman Pay Glynn said last week that his agency is not yet fully enforcing the law concerning staff ratios. If a home can prove it missed the mark because of the CNA testing problem, the home will not receive a citation.

David Hunt, administrator at the Mariner Health of Inverness nursing home, said the problems have not affected his scheduling of CNAs or nurses. And he noted that the law provides some relief: Nursing assistants who have completed a state-approved program may work up to 120 days as a CNA as they await their test date.

Still, some nursing home administrators are concerned.

"It's just now getting resolved. But it was a huge problem," said Ed Towey, spokesman for the Florida Health Care Association. "It could not have come at a worse time."

-- Jim Ross writes about medical issues in Citrus County. Reach him at 860-7302 or

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