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Florida nursing home regulators curtsey to providers



In a small meeting room in Tallahassee yesterday, it was revealed how the powerful nursing home lobby is now self-regulating and the muzzling of residents’ voices continues unabated in lieu of politics and big money.

Yesterday, I had the opportunity to attend a rule development workshop at the Agency for Health Care Administration (AHCA). The workshop was to review the proposed implementation of the payment methodology for nursing home services and to provide an opportunity for the public to discuss technical changes to the rule. This follows on the heels of Governor Rick Scott’s and the Florida Legislature’s decision to cut Medicaid reimbursement rates a crisp $187 million and reduce staffing hours.

As an attendee at several types of these meetings in the past, I looked forward to the roundtable discussion about how rules could be improved to help nursing home residents.

However, nothing prepared me for what I experienced.

Walking up to the building, I noticed a gentleman standing out front who had this nervous appearance about him, that starry-eyed kind of look one has when waiting for an IRS agent to arrive in preparation of a personal tax audit.

He was an AHCA employee who courteously welcomed me inside and informed me where the meeting was located. He said the meeting was running behind schedule as “we are awaiting someone’s arrival.”

I eventually made my way to a small, relatively empty meeting room. There were only a handful people inside with most of them sitting at one end of a long conference room table. I decided to sit at the other end to help the conversation to flow around the room.

A few moments later, the nervous AHCA employee walked in and took his seat, immediately thereafter—the guest of honor—Tony Marshall, an employee of the Florida Health Care Association, bolted into the room out of breath. He commented about his tardiness, sloughing it off as being slowed down by the long walk from the parking lot.

Finally, the meeting was to start.

I awaited the usual humdrum introductions where everyone goes around the table and introduces who they are and what organization they represent, but that wasn’t about to happen.

Instead, everyone shifted their attention and posture toward Mr. Marshall, whereupon the nervous AHCA employee nodded and stated, “Mr. Marshall, the meeting is yours.”

Mr. Marshall proceeded to spout off a litany of his association’s concerns, eloquently articulating every point in thorough detail.

Much to my surprise—no discussion, no rebuttal, no workshopping of ideas, we just sat there; watched and absorbed his presentation. I noticed the other folks in the room were glued to his every word. At one point, Mr. Marshall said he wanted something documented in the record, tapping the table with his index finger (although it did not pertain to the immediacy of the proposed rule). I watched and listened as the AHCA employees searched for pen and paper and heard the simultaneous “click” of pens prepared to transcribe his thoughts.

As the meeting progressed, I realized the other attendees were either AHCA employees or provider representatives. No other consumer representation outside of Families for Better Care. No ombudsmen, no residents and no families in attendance.

Mr. Marshall unpacked all his issues and laced his comments with the occasional name drop of legislators and a brief mention of the Agency’s Secretary by first name, which he quickly recovered and said “Secretary Dudek.” Every concern, every question, the Agency documented with a puppy-dog stare.

The meeting was over when Mr. Marshall was finished.

This much was certain, whatever the Florida Health Care Association beckoned the Agency planned to accommodate.

I left the meeting frustrated and confused.

The Agency for Health Care Administration is the licensing and regulatory agency for hundreds of nursing homes across the state, of which, about 80 percent of those facilities are members of the Florida Health Care Association.

I understand it is necessary to work together as “provider” and “regulator” in hopes of finding common ground and positive solutions for the benefit of the residents. But this meeting was anything but that, rather, it was as if Mr. Marshall was a conquering general who came to dictate the Agency’s terms of surrender.

It is true that government does not work effectively if regulators are too heavy-handed and unmerciful to those entities that attempt to abide by the laws that govern their business. But in Florida’s long-term care industry, the pendulum has swung the other direction, as providers are telling the government what to do without hesitation or fear of repercussion. The old adage comes to mind, “fox guarding the hen house.”

The only way to correct this problem is for residents, families and consumers to become more actively engaged in the public dialogue. Find out when these workshops are taking place and attending or submitting comments and by asking questions. Call your legislators and share your long-term care experience from a consumer’s perspective and how the system can be improved to safeguard residents.

Families for Better Care will be happy to help you in that effort. You can either visit our website at http://familiesforbettercare.com or shoot me an email at [email protected] for more information.