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Meeting staff ratios a challenge for homes

For nursing homes facing rules increasing the amount of care from nurses and CNAs, the answer is sometimes to leave some beds empty.

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


It hasn't been easy complying with new state regulations. But so far, so good.

So say the people who operate Citrus County's nine nursing homes. Their jobs became a bit more difficult Jan. 1, when the state's new rules governing staff ratios kicked in.

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 certified nursing assistant (CNA). The rules increased the required time for nursing care from 0.6 hours to 1 hour per day per patient.

The new standards have required some facilities statewide to hire more staff. Other homes have voluntarily halted admissions until they could beef up staff and meet the new requirements.

And some homes statewide, and in Citrus, have been frustrated by bureaucratic mixups.

"It's been tough but we haven't fallen below yet. We're having to cover with a lot of overtime," said Joanne Smith, executive director at Life Care Center of Citrus County, a 120-bed nursing home in Lecanto. Smith said the biggest problem is finding CNAs, who are in short supply. Life Care continues to partner with Central Florida Community College in offering a training class.

"It's been a real challenge," said Nancy Hall, administrator at Woodland Terrace of Citrus County, which opened in May and is the county's newest nursing home.

Woodland had 101 residents last week. Hall said she would have no problem filling all 120 beds, but she must proceed slowly to make certain staffing ratios are in line.

If those ratios aren't correct, the penalty can be severe: According to state guidelines, any facility that falls short of the allowable staffing ratios for two consecutive days, even if the shortage is only for a few minutes, faces a six-day admissions moratorium.

The result: Homes simply are reducing the number of beds they make available to patients, according to Ed Towey, spokesman for the Florida Health Care Association.

Indeed, "Census decisions are being mandated more than ever by the available staff you can get in," said Eric Bell, administrator at Cypress Cove Care Center in Crystal River.

Towey said that, statewide, nursing homes seem to be having more trouble finding nurses than CNAs.

That sentiment rang true with Diane Wesch, administrator at the Surrey Place nursing home in Lecanto.

Wesch said she wasn't having too much trouble finding CNAs. Securing enough nurses, on the other hand, was "a little bit more difficult."

The search remains critical, though, especially since the new regulations say homes must have one nurse per 40 residents on the overnight shift. Thus Surrey, which has 120 beds, now must have three nurses work the late shift instead of two, as it previously did.

Surrey recently updated its pay schedules, increasing wages for CNAs and nurses. Meanwhile, staffers are handling double shifts and overtime and managers are trying to create flexible schedules.

"It's a constant juggling act," Wesch said.

"It's definitely been a struggle. We have to spend a lot of time on staffing," said Pat Chevalier, administrator at Avante of Inverness. "But we're able to do it."

"We have to be very proactive," said David Hunt, administrator at Mariner Health of Inverness. A nursing home's census might be stable at noon, then increase significantly by evening if the hospital discharges some patients or a few other admissions arrive earlier than expected.

Striking that balance "has been very difficult," he said.

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