Infection-control violations were the No. 1 issue in Iowa nursing homes last year

The Iowa Department of Inspections and Appeals is the state agency tasked with inspecting Iowa's long-term care facilities. (Photo by Iowa Department of Inspections and Appeals)

The most frequently cited health care violations in Iowa nursing homes last year were related to infection control, according to state officials.

The infection-control violations were cited in the eight months leading up to COVID-19’s first appearance in Iowa and during the initial four months of the pandemic. During that same 12-month period, Iowa regulators saw a significant increase in complaints aimed at nursing homes while the number of investigations launched as a result of complaints declined sharply.

The numbers reflect data collected in state fiscal year 2020, which ran from July 1, 2019, through June 30, 2020.

Infection-control violations topped the list of nursing home violations for which state inspectors issued citations in fiscal year 2020. (Source: Iowa Department of Inspections and Appeals)

The 237 citations for infection control violations recorded during that time is double the number of the next most frequently cited violation, which was for failure to keep the facility free of accident hazards. The previous year, infection control violations were second to those related to accident hazards.

One reason infection-control citations outpaced all other types of violations: In March 2020, when the COVID-19 pandemic began to spread, the federal Centers for Medicare and Medicaid Services tasked all of the state agencies that inspect nursing homes with quickly conducting at least one inspection of every nursing home, focusing specifically on infection control.

The Iowa Department of Inspections and Appeals’ Complaint and Intake Bureau fielded 7,444 complaints last fiscal year, representing a 9% increase from 2019. According to the department, the bureau conducted 1,099 investigations related to those complaints, which represented a 28% decrease from the 1,526 investigations conducted the previous year.

In DIA’s annual report of its activities, Director Larry Johnson Jr. said 2020 was a year of incredible challenges for the department.

“As the regulator of health facilities and food establishments, a global pandemic and derecho event drastically affected and changed the operations of these industries and the work of the department,” Johnson said. “As we continue to navigate the constant change during this pandemic, DIA remains committed to protecting the health and safety of Iowa’s most vulnerable citizens.”

Complaints against, and self-reported incidents at, Iowa’s nursing homes increased significantly last fiscal year over 2019. (Source: Iowa Department of Inspections and Appeals)

To date, the pandemic has killed 2,304 residents of Iowa nursing homes, according to the Iowa Department of Public Health.

In addition to the decline in investigations, the number of inspections at restaurants, assisted living centers and other types of facilities also dropped in 2020.

For example:

  • RESTAURANTS: DIA’s Food and Consumer Safety Bureau completed 6,860 food inspections last year — a 27% reduction from 9,395 inspections completed the year before. According to DIA, in addition to continuing some on-site food inspections, the agency offered a “virtual inspection” option for restaurants and other food vendors, wherein DIA assessed compliance with food safety regulations through mobile audio and video technology. Together, the bureau and the locally contracted health departments that handle many restaurant inspections in Iowa conducted 2,200 COVID-19 compliance surveys at Iowa food establishments and responded to 926 COVID-19 complaints.
  • ASSISTED LIVING: DIA conducted 25% fewer inspections of assisted living centers last year than it did in 2018. In accordance with federal guidelines, DIA’s inspection activity from March through August of last year was tied to complaints, self-reported incidents and infection-control issues. During the 2020 fiscal year, the agency completed 313 inspections and investigations in assisted living centers, compared to 418 in 2018, and 374 in 2019.
  • CARE FACILITIES: Inspections at the residential care facilities that provide congregate housing for Iowans who need assistance with daily living dropped almost 13% from the previous year. A total of 174 inspections and investigations were conducted at residential care facilities last year, compared to 225 in 2018, and 199 in 2019.
  • DISABLED IOWANS: Facilities for people with intellectual disabilities also saw 20% fewer inspections last year than in 2018. A total of 360 inspections and investigations were completed at those facilities last year, compared to 451 in 2018, and 442 in 2019.
  • ABUSE & MEDICAID FRAUD: At the end of the 2020 fiscal year, the agency’s Medicaid Fraud Control Unit maintained 303 open investigations, consisting of 270 fraud cases and 33 cases of alleged criminal abuse or neglect. The unit recovered more than $3 million as a result of its work. In 2019, the unit maintained 317 open cases and recovered almost $3.6 million.