Legislation on nursing home oversight fails to win support

In November, the Fleur Heights Care Center of Des Moines was cited by state inspectors for failing to immediately respond to resident abuse by one of its caregivers. The worker allegedly yanked a resident’s briefs off with enough force to tear the garment, told another resident to “shut up,” and placed her hand over a third resident’s mouth to stifle her screams. (Photo by Clark Kauffman/Iowa Capital Dispatch)

Legislation that would force Iowa’s long-term care ombudsman to play a more active role in protecting Iowa’s elderly appears to be dead for the 2020 session.

The Iowa Long-Term Care Ombudsman’s Office acts as an advocate for the elderly and responds to roughly 1,200 complaints annually from 55,000 Iowans now living in the state’s 860 care facilities. But in recent years, the office has been plagued by budget cuts, staff defections, volunteer resignations, cutbacks in care-facility visits and complaints that the office isn’t lobbying lawmakers on bills that have a direct effect on seniors and nursing homes.

Newly released data from the National Ombudsman Reporting System shows that of the nation’s 50 state long-term care ombudsmen, Iowa ranks last in on-site visits made to care facilities. In 2018, the Iowa office visited, at least quarterly, just 10% of all the state’s care facilities. The national average was 72%.

Currently, the Iowa office employs eight investigators — most of whom carry the title of “local ombudsman.” Last year, Long-Term Care Ombudsman Cynthia Pederson attempted to outsource the task of investigating complaints to another entity. That effort hit a roadblock in November when no one responded to the state’s formal request for proposals to take over the duties of the local ombudsmen.

Cynthia Pederson
Long-term care ombudsman Cynthia Pederson. Photo courtesy of Iowa Public Radio.

In the past seven weeks, Democrats in the Iowa House and Senate have proposed three different pieces of legislation intended to address those issues, but Sen. Tony Bisignano, D-Des Moines, a co-sponsor of the most comprehensive bill, says the chances of Republicans supporting any of them are “probably zero” this session.

“I don’t see the will here,” he said. “I think we have hit the bottom in terms of what we are doing for senior services here in Iowa with the ombudsman’s office. They don’t make unannounced visits to care facilities, they don’t have anything to provide the staff for transportation – and there really is no will here in the Legislature to protect seniors in these facilities. It’s really sad … We know that these facilities are under-staffed. We hear the horror stories – and they’re true. We neglect our elders in these care facilities.”

House File 2392 would require the ombudsman to make “in-person visits” to long-term care facilities. Currently, state law requires Iowa’s regional ombudsmen to “visit” care facilities — even when there’s no specific complaint to investigate — but the number of visits isn’t specified. The current law doesn’t explicitly require that the visits be “in person,” but it does say that while making these visits, the ombudsmen are to “observe daily routines, meals and activities.” Many investigations are now handled by phone and Pederson says two newly designated “mobile ombudsmen” make sporadic visits to care facilities.

Senate File 2278 would require the ombudsmen to make unannounced visits to a minimum of 20% of Iowa’s long-term care facilities each year. It also would require the staff to meet in person at least quarterly; would reinstate the office’s access to state vehicles used for travel; would provide $173,000 in new funding for the hiring of two additional local ombudsmen; and would prohibit additional attempts to outsource the work of the office unless all stakeholders are consulted.

House File 2081 would provide additional funding for the office to pay for on-site visits and the employment of 18 full-time workers.

Although two of the three bills would provide her office with more resources — which exempted them from last week’s funnel deadline — Pederson has not registered with the Iowa Legislature as being in favor or against any of three. The same is true of the Iowa Department on Aging, where the ombudsman’s office is housed.

Federal law requires Pederson to represent Iowa’s elderly in advocating for legislative remedies to the issues they face. But her staff has complained that Pederson hasn’t lobbied state legislators for, or against, any bills that were considered during the 2018 and 2019 sessions and hasn’t offered any legislative proposals in her annual reports.

Pederson did not respond to questions email to her office this week.

John Hale, a consultant and advocate for Iowa seniors, has long argued that the ombudsman’s office is failing to do its job.

“It’s an unacceptable situation that cries out for attention,” he says. “Iowans deserve a Long-Term Care Ombudsman’s Office that provides excellent service to facility residents and uses taxpayer dollars in an efficient and effective manner. It’s not happening now. Hopefully the legislature will see that it happens in the future.”







Clark Kauffman
Deputy Editor Clark Kauffman has worked during the past 30 years as both an investigative reporter and editorial writer at two of Iowa’s largest newspapers, the Des Moines Register and the Quad-City Times. He has won numerous state and national awards for reporting and editorial writing. His 2004 series on prosecutorial misconduct in Iowa was named a finalist for the Pulitzer Prize for Investigative Reporting. From October 2018 through November 2019, Kauffman was an assistant ombudsman for the Iowa Office of Ombudsman, an agency that investigates citizens’ complaints of wrongdoing within state and local government agencies.