Annual performance reviews of the Iowa Iowa Department of Inspections and Appeals indicate long-running problems in the timely investigation of complaints against hospitals and nursing homes. (Photo by Clark Kauffman / Iowa Capital Dispatch)
In the past two years, the state of Iowa has failed to conduct timely investigations into more than 1,200 complaints against nursing homes, according to federal officials.
The state has also failed to conduct timely investigations into complaints about hospitals — in some cases taking four months to investigate matters that should have been handled within five days.
The findings are among those included in two previously undisclosed annual performance reviews of the Iowa Department of Inspections and Appeals. The reviews were conducted by the federal Centers for Medicare and Medicaid Services, which periodically measures states’ efforts to enforce federal regulations at health care facilities.
The records show that in 2018, after DIA failed to handle 62% of nursing home complaints in a timely fashion, CMS instructed the state agency to develop an “action plan” detailing its efforts to address the issue. Despite that, the problem grew worse, and in 2019, 65% of the complaints were not handled on a timely basis.
In both years, the complaints at issue involved allegations of resident harm that required a “rapid response” within 10 days.
DIA officials say they are now taking an “all-hands-on-deck approach” to the problem. In a written statement, agency officials said the department “has worked diligently to fill several vacant positions, use overtime, and utilize temporary employees” to address complaints. Prior to the COVID-19 pandemic, the agency said, it had “markedly improved its timing” on inspections.
Dean Lerner, who headed the agency under former Gov. Chet Culver, a Democrat, faulted Republican Gov. Kim Reynolds for the deficiencies noted in the reports.
Lerner said the findings are a “disgrace” and reflect “a total failure of leadership,” adding that front-line workers and inspectors depend on DIA leadership appointed and directed by the governor.
“Reynolds and her Republican House and Senate have done as promised,” Lerner said. “They have systematically disassembled regulations meant to protect the most vulnerable among us.”
John Hale, a consultant and advocate for older Iowans, said the performance reviews “paint a picture of an organization that’s failing Iowans — failing to timely respond to the complaints of nursing home residents, failing to timely conduct routine inspections, and failing to use taxpayer dollars in an effective manner.”
Hale singled out state lawmakers for what he called their lack of oversight.
“The Legislature seems to be perfectly content to allocate millions of taxpayer dollars to agencies like DIA, and to be indifferent to how those dollars are used,” he said. “The House and the Senate each has a Government Oversight Committee. They should be routinely asking tough questions, and holding agencies accountable.”
The performance reviews, which typically are not made public, were first requested of DIA by the Iowa Capital Dispatch in February. After DIA refused the request, the Capital Dispatch asked for all DIA emails related to the reviews or to the news organization’s request for access to the reviews.
When DIA failed to provide the emails, the Capital Dispatch filed a formal complaint with the Iowa Public Information Board seeking access to all of the requested documents.
DIA has since provided the Capitol Dispatch with partial copies of the two performance reviews and redacted versions of the emails.
The performance reviews show that between September 2018 and September 2019, DIA fielded 971 nursing home complaints — “complaints” include self-reported incidents that emanate from the homes themselves — that residents’ mental, physical or psycho-social status were being harmed. The cases were considered serious enough that a “rapid response” by DIA was required, which meant that an on-site visit was to be made by state inspectors within 10 days.
The agency failed to meet that standard in 631 cases, or 65% of the time. In fact, 41 of those homes still hadn’t been visited by an inspector at the time of the CMS performance review, which was concluded in March of this year.
The previous year, DIA fielded 1,041 nursing home complaints that alleged harm and required a rapid response. In 646 of those cases, or 62% of the time, the agency failed to conduct an inspection within the 10-day time frame. In fact, six complaints — including two against the Rolling Green Village Care Center in Nevada — languished for more than 130 days with no inspection taking place.
Rolling Green is owned by ABCM Corp., a nursing home chain run by Richard Allbee of Hampton. Allbee is a major political donor who has contributed more than $20,000 to various candidates and political action committees in Iowa since January 2019.
Toby Edelman, an attorney with the Center for Medicare Advocacy and a nationally recognized expert on long-term care, said it’s important that complaints against nursing homes are handled by state inspectors on a timely basis.
“Many of the most significant quality of care and quality of life problems in nursing facilities are identified through complaint investigations,” she said. “When the state fails to conduct timely complaint investigations, witnesses and evidence are lost and serious problems are not cited, corrected and appropriately sanctioned.”
The performance reviews show that in 2017-18, CMS reviewers also cited DIA for failing to conduct timely investigations in response to complaints involving hospitals.
In 16 instances that year, CMS authorized DIA to conduct an investigation, within five days, into a complaint against an Iowa hospital. In six of those 16 cases, the investigations took 51 days to 131 days.
The six cases involved complaints against Davenport’s Genesis Medical Center; Des Moines’ Iowa Methodist Medical Center; Cedar Rapids’ Mercy Medical Center; Iowa City’s University of Iowa Hospitals and Clinics; and Cedar Rapids’ St. Luke’s Hospital, where two separate complaint investigations exceeded the 45-day time frame.
Among the other issues identified in the two performance reviews:
- During the 2018-19 fiscal year, DIA failed to inspect the required number of dialysis centers for patients with end-stage renal disease, a life-threatening condition. Iowa has 68 such centers and is required to inspect each of them at least once every three and a half years. For 19 of the 68 facilities, or 29% of the total, DIA failed to meet that standard.
- In the 2017-18 fiscal year, DIA was cited for failing to inspect seven outpatient therapy clinics within the required time frame of once every seven years. Three clinics had gone more than 11 years without an inspection, including Davenport’s Quad-City Physical Therapy & Spine, which had not been inspected since September 2006. In addition, 15 dialysis centers hadn’t been inspected within the required 3.5 years, and 14 hospitals weren’t inspected within the required four-year time frame. Six of those hospitals had gone more than five years without an inspection.
- During 2018-19, DIA failed to adequately follow up on nursing homes where violations, if left uncorrected, could have triggered the denial of Medicare payments for new admissions. In five cases, DIA failed to either take enforcement action or confirm the homes were back in compliance with regulations. The five nursing homes that weren’t held to that standard of enforcement were the Pearl Valley Rehabilitation & Nursing Center of Lake Park; the Mississippi Valley Healthcare & Rehabilitation Center in Keokuk; the Hillcrest Health Care Center of Hawarden; Wellington Place of Decorah; and Southridge Specialty Care of Marshalltown.
- In both the 2017-18 and the 2018-19 reports, DIA was cited for failing to conduct routine, non-complaint inspections at all nursing homes on a timely basis. Federal regulations state that the average interval between inspections must be no greater than 12.9 months, and all homes should be expected within 15.9 months. In 2018-19, the average interval was 14.7 months, and 11 homes were not inspected within the 15.9-month time frame.
- In fiscal year 2017-2018, DIA failed to inspect six hospitals within the required five-year time frame for non-complaint investigations: Regional Health Services of Howard County; Decatur County Hospital; Community Memorial Hospital and Medical Center in Sumner; Madison County Memorial Hospital; Hancock County Health System; and Spencer Municipal Hospital.
Lerner and Hale say the governor and state lawmakers have also failed to address long-standing problems at the Iowa Long-Term Care Ombudsman’s Office — an agency that is supposed to be an independent advocate for seniors and a watchdog over entities like DIA.
“I and other advocates for nursing home residents have expressed displeasure with the operations of the Long-Term Care Ombudsman for well over a year,” Hale said. “Here’s the great frustration: Our Legislature, the body that is supposed to provide oversight of how precious taxpayer dollars are being used, doesn’t seem to care.”
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