LAKELAND

A promise made by the Florida Legislature in 2001 to raise basic care for nursing home residents to 2.9 hours per day finally is reality.

It was a major win for Florida's infirm elderly.

But when lawmakers finally made good on the promise last May, the issue drew scant attention.

That it happened at all amazes some tenacious advocates for the elderly, including state Sen. Nancy Argenziano, R-Dunnellon, who championed the legislation that led to the increased care.

Still, she criticizes fellow lawmakers for delaying the timetable of the original legislation to last week-the higher staffing level was to be reached in 2004.

The original version called for nursing homes to provide 2.9hours of certified nursing assistant care per day, but that's been changed to 2.9 hours averaged over a week.

Despite this concession and the delay, Argenziano and other advocates said they're glad to see progress.

But at how high a cost?

More than half of the state's nursing home residents are too poor to pay the freight, so their care is heavily subsidized by Medicaid. Yet the nursing home industry claims that the subsidy isn't enough to keep up with skyrocketing costs for medical care, insurance and other services.

As a result, some nursing homes are losing money and advocacy groups fear that quality of care ultimately will suffer, despite all the progress in staffing increases and other improvements such as stricter monitoring of homes by state investigators.

Argenziano said she doesn't have much sympathy for an industry that enjoys heavy public subsidization. She said the staffing levels should have been bumped to 2.9hours five years ago when Senate Bill 1202 became law.

"They should have done it immediately," Argenziano said.

At the time, nursing home providers were required to give only 1.7 hours per day of care from certified nursing assistants, who assist nursing home patients with feeding, bathing, personal hygiene and other daily tasks.

Senate Bill 1202 called for incremental spikes in CNA care, beginning with 2.3 hours per day and ending at 2.9 by 2004.

But it stayed at 2.6 until this year.

"Even at 2.9 (hours) it's what the feds call the minimum standard," Argenziano said.

She said she wants careful monitoring of nursing homes to ensure they comply with the state's directive for heightened care.

"We have to monitor it very closely," Argenziano said, "because the for-profit nursing homes still don't want to do the 2.9."

The extra 18 minutes (the difference between 2.6 hours of care and 2.9 hours) came with a hefty pricetag - approximately $21 million in state Medicaid funds, money that lawmakers hoping to control escalating costs for health services to the poor were reluctant to spend.

In delaying the staffing increase, lawmakers argued that injuries to residents of Florida's 656 nursing homes had dropped substantially, and that state inspectors were citing fewer problems overall.

This was substantiated by the state Agency for Health Care Administration in its 2005 report to legislators, showing that between July 1, 2001, and June 30, 2005, there was:

A 71 percent decline in the most serious nursing home deficiencies, things that may have resulted in death, fracture or dislocation of bones or joints, brain or spinal damage or any incident that resulted in abuse, neglect or a report to law enforcement.

A 50 percent annual decrease in complaints about the state's nursing homes.

A 24 percent annual decrease in lawsuits against nursing homes.

These statistics come from the nursing home providers and reflect data that is shielded from public view, making some advocates skeptical of the decreases reported.

"I'd like to think that care has gotten better, but I don't trust that (it has)," said Barbara Hengstebeck, director of the Coalition to Protect America's Elders.

"I'm not getting as many complaints (about nursing home abuses) as I used to," she said, "but it could be that AHCA doesn't have enough staff to go out and do as many inspections as they should. It could be anything."

Still, Hengstebeck said the bump in CNA care is "a huge victory" for Florida's infirm elders and their families.

That bump, which translates to just 18 minutes a day of additional care, may not sound like much, but it will definitely reduce injuries even further, said William Teague, who oversees the Long-Term Care Ombudsman Program in Polk.

Teague's office provides an additional layer of scrutiny for Polk's 23 nursing homes with bed space for up to 2,865 residents.

By far the overwhelming number of complaints are related to accidental injuries and falls caused by too few CNAs on staff at many nursing homes, he said. "From an advocate's point of view, the more hours the better."

The fight to win those 18 minutes was nearly defeated by Gov. Jeb Bush, who was determined to abolish the mandate to raise staffing to 2.9 hours, said Ed Towey, spokesman for the Florida Health Care Association, a nursing home trade organization.

Bush still managed to veto $91million in Medicaid funds. Much of that money, roughly $65.5million, would have eased the burden on nursing home providers who have seen government subsidies to help care for the elderly poor dwindle in recent years.

This rankled an industry forced to contend with skyrocketing costs and ultimately could lead nursing homes to shift the costs to private-pay residents.

That in turn will lead to fewer slots for Medicaid patients, "which will profoundly affect access to nursing home care by middle-class families everywhere in the state," said a lead article in FHCA's June/July newsletter.

Nursing home providers see the 2.9-hour mandate as just another costly burden, Towey said.

"It's getting much more expensive to operate (a nursing home), particularly in areas of utilities, fuel and insurance," he said.

Even in 2001, the government was shorting nursing homes for the cost of caring for Medicaid patients, Towey said. Back then, the average Medicaid reimbursement rate was $100 per day, or roughly $12 less than the actual costs, he said.

Today the average reimbursement is up to $161 per day, but nursing homes must make up a difference of $18 in actual costs.

More than half of all nursing home residents in the state are Medicaid patients, approximately 45,000 out of an estimated 71,000 residents, according to FHCA.

Eric Pera can be reached at eric.pera@theledger.com or 863-802-7528.