Five Iowa nursing homes have spent years on federal list of the nation’s worst care facilities

By: - June 4, 2021 1:42 pm

An Iowa nursing home recently hit with more than $300,000 in fines has been added to Medicare’s list of the nation’s worst care facilities. (Photo courtesy of the Iowa Department on Aging and Long-Term Care Ombudsman’s Office)

Five of the Iowa nursing homes deemed by the government to be among the worst in the nation have met those criteria for at least two years, and one has qualified for four years, according to federal records.

The list of the nation’s worst-performing nursing homes, compiled by the federal Centers for Medicare and Medicaid Services, is known as the special-focus facilities list, and is updated quarterly. The special-focus facilities are those deemed by CMS to have “a history of serious quality issues” and they are enrolled in a special program that is intended to stimulate improvements in their quality of care through increased oversight.

However, five of the 12 Iowa homes that are either currently designated special-focus facilities or are eligible for that designation based on their poor performance, have maintained that status for at least two years.

Nationally, the number of facilities on the list remains relatively constant: There are normally about 88 nursing facilities, with one or two slots to be filled by each state. The Iowa Department of Inspections and Appeals nominates the Iowa facilities for inclusion on the list, and CMS selects two from the state to be enrolled in the program.

In addition to Iowa’s two special-focus facilities, there are 10 Iowa homes that qualify for inclusion on the list based on their poor performance. In order for any of those 10 to be designated a special-focus facility and receive the added regulatory oversight that comes with it, one of the two currently designated homes first must graduate from the list.

Typically, homes that are eligible for the special-focus designation have about twice the average number of violations cited by state inspectors; they have more serious problems than most other nursing homes, including harm or injury to residents; and they have established a pattern of serious problems that has persisted over a long period of time.

The two Iowa homes currently designated as special-focus facilities are QHC Winterset North in Madison County, which has been the list for six months, and Touchstone Healthcare Community in Sioux City, which has been on the list for 44 months. Only two other nursing homes in the nation have been on the list longer than Touchstone.

Last November, the QHC Winterset North home was cited by state inspectors for failing to have enough staff on hand to prevent one resident from wandering away from the facility in 35-degree weather and to prevent a male resident’s unwanted sexual advances on female residents, which included placing his hand in the pants of a woman who was seen protesting and shouting, “No, don’t do that.” The state proposed a $9,000 fine against the home, but held the fine in suspension to let CMS impose its own penalty. According to CMS, no federal fines have been imposed against the facility since June 2020.

Last August, inspectors cited the Touchstone Healthcare Community for failing to ensure adequate staff assistance, resulting in major injuries to residents. One resident died days after falling and then undergoing surgery to repair a fractured vertebrae, while two others sustained broken bones after falling. Federal officials imposed a $50,122 fine against the home that same month.

The Iowa homes that are not currently considered special-focus facilities, but have qualified for the designation for at least one year,  are:

  • QHC Fort Dodge Villa in Webster County. The facility has qualified for inclusion on the list for 48 months.
  • The Carlisle Center for Wellness and Rehabilitation in Warren County. The facility has qualified for inclusion on the list for 24 months.
  • Cedar Falls Health Care Center in Black Hawk County. The facility has qualified for inclusion on the list for 25 months.
  • Crestview Acres in Linn County. The facility has qualified for inclusion on the list for 24 months.
  • Pleasant Acres Care Center in Sioux County. The facility has qualified for inclusion on the list for 16 months.
  • QHC Mitchellville in Polk County. The facility has qualified for inclusion on the list for 15 months.

Other Iowa homes that qualify for inclusion on the list are The Ivy at Davenport in Scott County; Pearl Valley Rehabilitation and Healthcare Center in Muscatine County; The Rehabilitation Center of Des Moines in Polk County; and The Rock Rapids Health Centre in Lyon County.

CMS’ special-focus facilities program has come under fire in recent years. In 2017, the New York Times reported that 52% of the 528 homes that successfully graduated from the program after showing what CMS called “significant improvements in quality of care,” were subsequently cited for causing serious harm or placing residents in immediate jeopardy.

In 2019, the Government Accountability Office noted that the number of nursing homes participating in the program and being subjected to greater regulatory oversight was cut by more than half in 2014 due to limited staff and financial resources at CMS.

Also in 2019, the Center for Medicare Advocacy found that of the 21 facilities to have graduated from the program in May 2019, six had been cited for one or more high-level resident-harm or immediate-jeopardy violations during the previous year.

Members of Congress have also been critical of the fact that dozens of nursing homes that qualify for the special-focus facility designation have mortgages insured against default by the U.S. Department of Housing and Urban Development. HUD’s inspector general has criticized the agency’s management of the program and called for enhanced oversight.

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Clark Kauffman
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.

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