I have been my family’s “designated caregiver” for more than 20 years, and from 1993 to 2001 was the primary caregiver for 3 family members at the same time, taking care of them in their home, in my home, in assisted living facilities, and in 9 different nursing homes in the bay area, only one of which provided adequate care.  

As a result of the things I saw, heard, felt, tasted and smelled during that time, I have become an indepenent advocate for nursing home residents.

       So I speak to you ...
on behalf of the approximately 70,000  citizens who live in Florida’s nursing homes,...
at a time when the GAO has established that 9 out of 10 nursing homes do not provide adequate care, primarily due to lack of staff,  and  ask you not to re-open  the issues settled by  SB 1202, enacted in the 2001 legislative session. 

In 2001, based on  loud cries from the NH  industry  that there was a crisis in insurance coverage, and  after a long arduous battle between that industry, the trial lawyers, the insurance industry, the AARP, and others, a very delicate balance was established to provide  quality of care provisions to benefit nursing home residents, in exchange for a substantial limitation on the right of nursing home residents to accountability for poor care ...
the very accountability threat which was all that kept the NH industry from further cutting of the 3 s’s – staff, services and supplies – after the loopholes which previously allowed the industry to make mega profits  were identified by the GAO and closed.

NH residents did not receive everything they needed in 1202 in terms of quality of care  – there is still a long shopping list -- but what they did receive was generally determined to be a delicate balance to what they gave up in terms of accountability.
 
Tort reform has already been enacted for nursing homes in Florida – it was  enacted in that bill. 

At that time 1202   was hailed by the NH industry as about the best thing since sliced bread, even though the insurance industry indicated it would be 2 or 3 years before the results of that legislation would bring down premiums.  

Subsequently the insurance  industry revised its estimate and pointed to a 3 to 5 year time frame.  Very recently it still points to a 3 to 5 year future time frame, and adds “if ever” or “maybe never”. 

Now, some 18 months later, before SB 1202 has even been fully implemented, and although $27 million dollars was given by the state to nursing homes toward their insurance premiums, and with the help of about $300 million new money basically to finance the staffing provisions of 1202, 
there are rumblings from here and there for further tort reform in this arena , perhaps through the back door of the medical malpractice tort reform that we hear about every day.

I receive calls from  caregivers and staff people every day – somehow my name is out there as someone to call about nursing home issues – from these calls, and my personal visits to nursing homes and family councils,  I can tell you first hand that 2 things are now happening :

Those nursing homes which  are trying hard are making some progress in quality of care.  
I hear that daily from residents and their families, and from staff, and they anticipate more improvement when the final staffing increment occurs at the beginning of next year.  

Other nursing homes, for whatever reason appear to be trying to circumvent the 1202 staffing provisions with a variety of methods, including reducing housekeeping and dietary staff and requiring cna’s to perform those tasks in addition to their normal hands on duties.

In addition,  requests being made to allow nursing homes to meet the 1202 statutory staffing requirements only some of the time, or on an average, or by counting staff on hand in independent living sections of life care facilities and also counting those same staff in the nursing home section, or other methods  which ignore the fact that nursing home residents live 24 hours a day, seven days a week  365 days a year. 

Nursing homes  are also more and more frequently, and successfully, using the threat of criminal trespass, adult protective services, or guardianship provisions against family members who raise quality of care questions.

The NH industry has been clearly identified by the Department  of Justice to be riddled with fraud. 
                              
Hardly a day passes when the newspapers do not carry a story of the comprised down amount of money fraudulently taken.  

I wonder if this could this be a Worldcom or Enron by another name.

The NH industry is apparently still profitable,despite cries to the contrary, since whenever a group of homes is sold, there is always a buyer ready to pay a pretty penny.—could this be part of the pattern which enables the industry to raise is reimbursement rate with each change of ownership?

The insurance industry truly is in crisis – make no mistake about that – but it is not a crisis that should be solved on the back  - or more clearly – on the backsides, of NH residents.  

It is an insurance crisis and requires an insurance solution.  

It is a crisis that was created by the insurance industry’s business practices, and not by NH residents.

The current population of our nursing homes primarily consists of people who have paid their dues to society – not unlike your parents and grandparents, and mine.

They survived  :

The First World War, 
The Great Depression,
WW 2 – the Big One,
The Korean War,
The Vietnam War,
The Cold War.

Many are veterans – many are purple heart veterans.

NH residents  deserve better than they have been receiving these last numbers of years. 

Under 1202 they will be getting better care --

The larger numbers of staff will allow staff to do their jobs better, and the improved numbers should result in improvement in obtaining and retaining good staff.

Please don’t reopen  1202 to solve an insurance problem.

Thank you.