Iowa’s elderly deserve better protection from state regulators

July 18, 2022 8:00 am

Iowa is taking months and sometimes years to investigate complaints against nursing homes. (Photo by Maskot/Getty Images)

My mom turns 80 in a couple of weeks. (Happy birthday, Mom!) Dad’s 80th birthday was in January. I am beyond grateful they both are active and relatively healthy. They’re still living independently in their own home in Ames.

Obviously, not everyone is so fortunate. I have an aunt and uncle – my dad’s older sister and her husband — who are convalescing from a stroke and a fall, respectively, in a skilled nursing facility in eastern Iowa. There were about 22,600 Iowans living in skilled nursing facilities in 2020, according to Kaiser Family Foundation data.

There are some excellent nursing homes in Iowa, despite enormous challenges brought on by the COVID-19 pandemic and staffing shortages that followed. But under the rating system established by the federal Centers for Medicare and Medicaid Services, only about a third of Iowa’s facilities rate “above average” on a five-star system. And as Iowa Capital Dispatch’s deputy editor, Clark Kauffman, has reported, that rating system has had some significant flaws.

Iowa also has some of the worst nursing homes in the country, and the state is not doing nearly enough to protect some of its most vulnerable residents.

Kauffman’s recent report about the state’s failure to investigate complaints about nursing homes in a timely manner should be a wake-up call to Iowans and their elected leaders. The Department of Inspections and Appeals, the agency responsible for nursing home regulation and oversight, had more than 400 complaints pending as of last month that were more than 30 days old. Of those, almost half were more than 120 days old. That’s four months.

One especially horrifying example that Kauffman reported happened in April 2021, when a resident of the Exira Care Center was found on the floor in a pool of blood with a head injury sustained in a fall. Two months later, Kauffman reported, the same woman was again found on the floor in a pool of blood, but this time, she was dead. DIA inspectors didn’t visit the home and investigate either incident until May of this year, 11 months after the death.

Imagine if that woman had been your grandmother. It’s beyond tragic.

A DIA spokesperson blamed the backlog on the pandemic, but the fact is the state was regularly failing to investigate even the most urgent complaints in a timely manner before 2020, according to CMS data.

Iowa can afford to do better, but it is not a priority for a majority of our elected officials.

The Legislature did approve an increase of nearly $320,000 for DIA to help clear the pandemic-related backlog of inspections. This was the required match to receive nearly $2.3 million of federal funds for the same purpose – but lawmakers did not add any staff positions to carry out inspections. Instead, the department is outsourcing the work. This suggests zero commitment to improving conditions beyond the short-term need to catch up from the pandemic.

The Iowa House this year approved an increase of $300,000 to address a chronic staff shortage in the Long-term Care Ombudsman’s office. This office in the Department of Aging investigates complaints about residents’ rights, building condition and residents’ safety. The extra money could have increased the number of regional ombudsmen from six to eight and added a staffer. It didn’t make it through the Senate.

Despite requests by Democrats, the Senate Government Oversight Committee held only one meeting during the legislative session. The GOP majority party did not want to hear any complaints about the Reynolds administration – instead, they reserved all of their scrutiny for political vendettas against public schools and state universities.

This isn’t a decision driven by a lack of money. The Republican-led Legislature voted this year to cut taxes amounting to nearly $2 billion a year from state revenues. While retirees will get a share of the savings, most of the money will go to people who can already afford top-of-the-line elder care. When budget cuts inevitably follow this dramatic emptying of the state treasury, nursing home residents will have even less protection.

It’s up to Iowans who care about the wellbeing of elderly loved ones to make better nursing home regulation a priority. They can do this through their communications with their lawmakers and their decisions in the voting booth. But they face significant competition.

The for-profit nursing home industry has invested significantly in the campaigns of Iowa lawmakers and the governor. The Iowa Health PAC, which represents the long-term care industry, contributed $20,000 to Gov. Kim Reynolds’ campaign in November. Contributions in 2021 also included $70,000 to GOP legislative leaders’ campaigns and $22,000 to Democratic leaders. The PAC made more than $200,000 in political contributions last year and it has been making similar investments in political contributions for many years. The industry is getting its money’s worth.

Meanwhile, it’s ordinary Iowans who suffer. One Iowan, Kimberly Jacob, said a complaint she filed in January 2020 about the Woodbine home where her grandmother resided wasn’t investigated for more than a year — six months after her grandmother’s death.

“My grandma was a beautiful human being and she deserved better.” Jacob told Kauffman.

All Iowans deserve better.

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Kathie Obradovich
Kathie Obradovich

Editor Kathie Obradovich has been covering Iowa government and politics for more than 30 years, most recently as political columnist and opinion editor for the Des Moines Register. She previously covered the Iowa Statehouse for 10 years for newspapers in Davenport, Waterloo, Sioux City, Mason City and Muscatine.