title: Florida's efforts to improve quality of nursing home care through nurse staffing standards, regulation, and Medicaid reimbursement.
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.
authors.affiliation: School ofAging Studies, University of South Florida, Tampa, Florida, USA. khyer@bcs.usf.edu
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hyer
authors.forename: April
authors.initials: A
authors.lastname: Temple
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Johnson
mesh_terms: D000368:Aged; D005431:Florida; D018166:Health Care Reform; D006284:Health Plan Implementation; D006707:Homes for the Aged / Q000191:economics / Q000592:standards; D006801:Humans; D008484:Medicaid / Q000191:economics; D009735:Nursing Homes / Q000191:economics / Q000592:standards; D009740:Nursing Staff / Q000592:standards; D010043:Outcome and Process Assessment, Health Care; D010561:Personnel Staffing and Scheduling / Q000592:standards; D011785:Quality Assurance, Health Care / Q000379:methods*; D012052:Reimbursement, Incentive; D014481:United States; D000078329:Workforce