Florida's Efforts to Improve Quality of Nursing Home Care Through Nurse Staffing Standards,Regulation, and Medicaid Reimbursement |
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| Authors: | Kathryn Hyer PhD MPP April Temple PhD NHA Christopher E Johnson PhD |
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| Institution: | 1. Associate Professor, School of Aging Studies , University of South Florida , Tampa, Florida, USA khyer@bcs.usf.edu;3. Assistant Professor, Department of Health Sciences , James Madison University , Harrisonburg, Virginia, USA;4. Associate Professor and Director MHA Program, Department of Health Policy and Management, School of Rural Public Health , Texas A&5. M University System Health Sciences Center , College Station, Texas, USA |
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| Abstract: | Between 1999 and 2007, Florida implemented two initiatives combining legislative, regulatory, and reimbursement strategies to increase nurse staffing levels in nursing homes to improve quality of care. Despite a $40 million incentive package allocated for direct-care staffing, per-resident-day staffing increased only after legislative requirements mandated minimum nursing hours per resident day. Total Medicaid expenditures grew by $1.1 billion over the 8 years; per diem rates increased 65% to reimburse providers' costs. Registered nurses' hours decreased, while licensed nurses' and paraprofessionals' hours increased. This article describes the impact of staffing policy changes, includes stakeholders' views about approaches to achieve quality outcomes, and documents state policy implementation efforts. Seven lessons from the implementation of state nurse staffing standards to improve quality of care outcomes are also presented. |
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| Keywords: | direct-care workers policy reform nurse staffing nursing homes policy implementation |
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