How Florida's long-term care facilities are managing the COVID-19 virus
Florida’s long-term care industry includes more than 3,000 assisted living facilities and nearly 700 nursing homes. More than two-thirds of nursing homes in the state are for-profit entities, according to 2017 data from the Kaiser Family Foundation. It’s a fragmented market, with a number of chains such as Maitland-based Consulate Health Care — which operates approximately 10% of the state’s long-term care facilities — and many mom-and-pop operators. Over the past decade, the industry has seen increased competition from home health care companies as more seniors seek to age in place, and some have branched into that business area as well.
Along with Consulate, some notable players in Florida include:
HCR ManorCare: The nation’s second-largest nursing home chain, based out of Toledo, Ohio, operates 26 Florida facilities, concentrated primarily in Tampa Bay, Southwest Florida and South Florida. Following a 2018 bankruptcy, the chain was purchased by Ohio-based non-profit health system ProMedica and the real estate investment firm Welltower. Under the joint venture, Welltower owns the actual properties and ProMedica leases the properties and operates the facilities. HCR ManorCare also restructured as a non-profit entity. In a report to bondholders, ProMedica reported more than $2.3 billion in combined operating revenue for its skilled nursing and assisted living facilities in 2019.
Greystone Health: The Tampa-based company provides a range of services — including rehab, Alzheimer’s care, dialysis and hospice — at its 30 Florida care centers. It also operates 12 facilities in Missouri and one in Illinois and offers home health services. In 2016, the company's total operating revenue was $248.2 million, according to Provider magazine, which is published by the American Health Care Association and National Center for Assisted Living, the largest trade associations for the industry.
Life Care Centers of America: Headquartered in Cleveland, Tenn., Life Care Centers of America operates 21 nursing home and rehab facilities in Florida and owns or operates more than 200 skilled nursing, rehabilitation, Alzheimer’s and senior living campuses in 28 states. The company’s Kirkland, Wash., facility was the first in the nation to make headlines in March for a COVID-19 outbreak. The chain ranks fourth nationally by size, according to Provider magazine, and Forbes pegged the company’s annual revenue at $3 billion in 2018.
Signature HealthCARE: Signature relocated its headquarters from Palm Beach Gardens to Louisville, Ky., in 2010 but still operates 20 long-term care facilities and offers home care services in 11 locations. Signature had $982 million in total operating revenue in 2016, according to Provider magazine.
Palm Healthcare Management: The Sarasota-based LLC operates 15 centers throughout Florida that offer a range of services, including skilled nursing, rehab, memory care and more. The for-profit company had an estimated $203 million in operating revenue in 2016, according to Provider magazine.
Avante Group: The private Orlando- based company manages 12 skilled nursing facilities and two assisted living facilities around the state and recently started assisting in the managing of the Miami Care Center, a COVID-only isolation facility at the former Pan American Hospital in Miami. In 2016, Provider magazine estimated Avante had $202 million in total operating revenue.
Minimum Daily Requirements
Nursing Home Staffing: Two decades ago, Florida nursing homes were required to provide each resident with at least 1.7 hours of CNA care and 36 minutes of care from an RN or LPN during a 24-hour period. In 2001, the Legislature passed a sweeping nursing home package that increased the requirement for CNA care to 2.3 hours per resident per day and boosted direct nursing care to a full hour. Staffing levels are slightly higher today. CNAs must provide at least 2.5 hours of direct care per resident per day, and a facility can’t staff below one resident CNA per 20 residents. Nursing staff are still required to provide an hour of care per day, with a minimum of one nurse per 40 residents — and facilities must provide each resident with a combined minimum of 3.9 hours of direct care per day provided by licensed nurses, respiratory therapists, respiratory care practitioners and CNAs. “Medically fragile” residents require a combined minimum of five hours of direct care each day.
Assisted Living Staffing Requirements
While some states have no minimum staffing requirements for assisted living facilities, Florida does. ALFs are not required to have a worker on staff 24 hours a day who is awake unless the facility has more than 16 residents.