State agency reports dramatic drop in advocacy for older Iowans

The Iowa agency tasked with advocating for nursing home residents has dramatically scaled back visits to those facilities. (Photo by Centers for Disease Control and Prevention)

The state agency tasked with advocating for Iowans in nursing homes dramatically scaled back visits to those facilities last year even before the COVID-19 pandemic, according to a new state report.

The newly released annual report of the Iowa Long-Term Care Ombudsman’s Office illustrates a sharp decline in nursing home visits, inspections, advocacy and training.

“The office is in a death spiral, doing less and having less impact at a time when the population it exists to serve grows larger and has more needs,” said John Hale, a consultant and advocate for older Iowans.

The report, which covers a 12-month period that ended last Sept. 30, contains very little data on the work performed by the office as compared to the annual reports filed in years past.

However, the numbers that are included point to a significant reduction in service in the year leading up to the pandemic that has so far claimed the lives of 387 Iowa nursing home residents.

For example:

  • Last year, the the office fielded 1,139 complaints — a slight decrease from the 1,171 complaints it handled in 2016. However, the number of nursing home visits the office made in response to complaints dropped during that same period from 636 to 163.
  • The number of nursing home residents the ombudsman visited with on non-complaint-related issues dropped dramatically as well, from 4,346 in 2016 to 1,602 last year.
  • The office also scaled back its participation in the periodic nursing home inspections that are handled by the Iowa Department of Inspections and Appeals. In 2016, the ombudsman’s office participated in 99 such inspections. Last year, that number fell to 46.
  • The number of training sessions provided to nursing home workers also fell, from 30 in 2016 to three in 2019.
Cynthia Pederson
Long-term care ombudsman Cynthia Pederson. Photo courtesy of Iowa Public Radio.

Iowa Long-Term Care Ombudsman Cynthia Pederson, who authored the report, could not be reached for comment Wednesday.

The Iowa Long-Term Care Ombudsman’s Office acts as an advocate for the elderly and responds to roughly 1,100 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 actively lobbying lawmakers on bills that have a direct effect on seniors and nursing homes.

The most recent 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%.

Hale said 2019 annual the report “paints a disturbing picture of an office that’s failing long-term care facility residents, as well as the taxpayers of Iowa who are funding it with over $1 million dollars annually.”

Hale noted that the report doesn’t mention a recent effort to outsource the functions of the office, or its decision to refrain from lobbying state lawmakers on issues that affect older Iowans.

He said those and other actions are what led to Senate File 2278, a bill that would have required the office to make unannounced visits to a minimum of 20% of Iowa’s long-term care facilities each year. It also would have required the staff to meet in person at least quarterly; reinstate the office’s access to state vehicles used for travel; and would have provided $173,000 in new funding for the hiring of two additional local ombudsmen.

Pederson herself registered as a lobbyist on the bill, indicating she was “undecided” on the legislation. The bill was backed by the Iowa Catholic Conference, Alzheimer’s Association, Iowa Alliance For Retired Americans, Disability Rights Iowa, the Iowa chapter of the National Association of Social Workers, and others. No lobbyists registered in opposition to the bill, but it failed to win the approval of state lawmakers.

Hale said it’s notable that the 2019 annual report makes no mention of the fact that the long-term care ombudsman’s office has “too few staff to identify and address the concerns of residents, and too few dollars provided to staff to make personal visits to facilities.”

Those are issues the office could have raised with the media, the Iowa Legislature or the governor’s office, but it has chosen not to, he said.

“The bottom line — the office is failing to do its job,” Hale said. “Too few Iowans are aware that the office exists, and too few use its services. Those who do use it are often poorly served because of staff reductions, a shortage of volunteers, and a policy to limit travel of staff. The office is invisible at the Statehouse and in the media.”

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.