Florida is a harbinger of national long-term care issues because of its proportion of residents in the 85+ age group. Florida ranks sixth nationally in nursing home beds, has the nation’s highest mandated nursing home staffing levels and Florida’s bed growth rate is ten times the national average of 2%. Competition from assisted living facilities for residents and staff is keen. From 1999-2007 Florida’s State Legislature implemented several initiatives designed to improve quality in nursing homes. Legislative innovations include financial incentives to increase nurse staffing, mandates to increase paraprofessional staffing over 5-years, improved Medicaid reimbursement, tort reform, enhanced monitoring and new reporting requirements.

This symposium presents the impact of staffing change on quality, turnover, and financial performance. In addition to comparing turnover and tenure by nursing levels, the relative importance of various staffing thresholds on quality of care are calculated. Nursing home data (Florida State reports, Medicare and Medicaid Cost Reports, Minimum Data Set (MDS), the On-line Survey Certification of Automated Records (OSCAR) file, and the Area Resource File (ARF)) is matched at the facility level to provide comprehensive understanding of how quality innovations and legislative mandates impact administrative tenure and turnover, staffing and financial performance, stability of workforce and quality outcomes in Florida’s long-term care facilities.

Benefits and Learning Objectives
To describe the impact of Florida legistlative and regulatory innovations on nursing home turnover, tenure, financial performance and quality of care.