A New Vision for Long-Term Care in Florida

Florida’s system of providing long-term care for older people and those living with disability was struggling with longstanding problems even before 2020.  Then the coronavirus pandemic devastated long-term care residential facilities, exploiting its flaws to cruel effect.

Now AARP Florida is asking Florida lawmakers to embrace a new vision for long-term care in Florida, beginning in the upcoming 2021 state legislative session.

“In many ways, the pandemic has forced us to confront challenges in caring for older Floridians,” said Jeff Johnson, AARP Florida’s state director.  “It is clearly time for a better, more effective system that helps millions of older Floridians live as long as possible in their homes and communities, and then receive the care they deserve if residential facilities are the appropriate setting.”

The proof is in the hard facts.  Nearly 40 percent of the COVID-19 deaths in the state have started as infections in long-term care facilities, though residents and staff make up less than 2 percent of the state’s population.  The pandemic’s death toll just in long-term care facilities is two and a half times as large as the toll from the Sept. 11 terrorist attacks.

Consumer confidence in the system of large, residential long-term care facilities has collapsed.  Families are balking at placing their loved ones in facilities that have become Petri dishes for contagion, sending occupancy rates in nursing homes and assisted living facilities sharply down. 

Since January, according to the industry’s own data reported to federal officials, more than 93 percent of Florida elder-care facilities have had at least one coronavirus case.  Even in December, nearly a year later, one in seven Florida nursing homes reported they had less than a week’s worth of personal protective gear on hand for staff, residents and visitors.

AARP Florida believes basic reform of long-term care should be built on three principles:

• Help keep older Floridians at home whenever possible.  End the bias in the system to place frail Floridians in institutional residential care facilities.  Instead, put the emphasis on empowering and supporting our 2.9 million family caregivers to provide care for elders at home and in their communities whenever possible.  Successful models for care abound, but state budgets continue to prioritize funding for nursing-home care over helping families care for their own at home.
  
• Think small.  When frail Floridians must be cared for in facility settings, follow the “Greenhouse” or similar models, in which high-quality care is provided in smaller, more homelike settings.  Currently, most nursing homes and many assisted living facilities are laid out like hospital wards, with residents brought from their rooms for congregate meals and socializing in large groups. 
  

That is, and has been, a formula for contagion. Think about how easily the flu, MRSA, staph, and strep infections have infiltrated and spread in those environments.  Decentralizing residents and dedicated staff into smaller groups could limit exposure to infection and promote residents’ health. 

• Demand that taxpayers should not fund negligent long-term care.  Florida taxpayers have every right to demand sweeping change in long-term care.  After all, they’re paying for most of it. 
  

About 79 percent of the financing for nursing homes in Florida is public funding through Medicaid and Medicare programs, Johnson noted.  “Yet for years, state and federal governments have allowed longstanding problems to fester.  Taxpayers have a right to get what they’re paying for – a higher quality system that supports the growing need for long-term care.”
Johnson pointed out that Florida lawmakers are contemplating giving immunity from civil lawsuits, “blanket” or otherwise, to companies operating long-term care facilities.  AARP Florida strongly opposes this proposal, he said. 

“Florida law already makes it difficult for families to hold nursing-home operators accountable in court for negligent acts or omissions affecting their residents.  Immunity would give these companies impunity to shirk responsibility for providing the care that taxpayers and families have paid for,” he said.

More is at stake than the care provided to elders and their families, Johnson said.  “Since World War II, millions of older Americans have flocked to the Sunshine State, he said.  “They’ve built a Longevity Economy that fuels a majority of the state’s gross domestic product and provides millions of jobs.  Every month, they pump nearly $7 billion into the state’s economy through their Social Security benefits alone.”

“Older Floridians have earned a better long-term care system.  Taxpayers deserve it.  The case for lasting, fundamental reform is irrefutable and overwhelming.  Our leaders today should be judged by whether they rise to the occasion,” Johnson said.

AARP Florida will continue to share information about efforts to reform the Florida long-term care system.  For in-depth information about resources and information supporting the AARP long-term care introductory email, see the attached PDF document.