Care facility shuts down without 60 days’ notice to residents and the state

An Iowa nursing home was able to shut down operations and relocate all of its residents last month without giving families or regulators the 60-day notice outlined in state law.

The process used to close down Lyon County’s Rock Rapids Care Centre comes at a critical time for Iowa, with some industry officials predicting that Iowa could soon be hit by a wave of nursing home closures.

Advocates for seniors fear that other care facilities will follow Rock Rapids’ lead and shut down without giving regulators, residents and families 60 days’ notice to plan for safe, orderly transitions.

In cases of a planned closure, Iowa nursing homes are required to give 60 days’ notice to the state. That gives residents two months to consider their options and work with advocates on finding a new place to live.

In the case of Rock Rapids, the facility’s owners conducted an emergency evacuation of the home on 48 hours’ notice. At the time, the owners said the evacuation was necessitated by a lack of staff and that they planned to reopen the facility and move the residents back. A few weeks later, the owners announced Rock Rapids would not be reopening.

By that time, 13 of the 16 residents had been moved 19 miles away to the Pleasant Acres Care Center, which is owned and managed by the same company that ran Rock Rapids: Arboreta Healthcare of Florida.

Stefanie Bonds, spokeswoman for the Iowa Department of Inspections and Appeals, which regulates Iowa’s nursing homes, said the agency believes it was never the intention of Arboreta to shut down the home permanently.

“Closure of the home has never been the goal,” she said. “Facility management has been exploring several options to avoid closure of the Rock Rapids facility. They have been in close contact with DIA, with the priority being to ensure the residents’ safety as well as their ability to remain in their home. At this juncture, they believe this is no longer an option and they have provided a closure plan to DIA, effective Feb. 28, with a closure date of May 1.”

Arboreta Healthcare officials have not responded to requests for comment.

Bond said that at the time of the emergency evacuation, Rock Rapids residents “were given the opportunity to move to other facilities or to family members’ homes if they preferred.” She noted that three of the 16 residents opted to move to care facilities other than Pleasant Acres.

One of the nursing home industry’s professional associations and lobbyists, Leading Age Iowa, recently issued a report predicting that unless the government increases Medicaid payments to care facilities, Iowa will soon be hit by “an unprecedented wave” of nursing home closures.

Last year, at least two nursing home chains went through bankruptcy or receivership, and at least 17 nursing homes closed. In the past two months, five additional care facilities have indicated they are closing.

Asked whether DIA is advocating for a change in the law that would prevent nursing homes from conducting emergency evacuations as an end-run around the 60-day requirement, Bond declined to say.

In response to the question, she provided a written statement that said, “The state is revising its change-of-ownership application and procedures to include more robust financial information from prospective buyers of long-term care facilities, ensuring they have the financial stability to safely run a health care facility in accordance with state and federal regulations.

“The goal of these changes is to prevent receiverships such as the Blue Care six-facility chain receivership or emergency evacuations; so if a facility has to close, they can follow the proper closure proceedings to ensure resident safety and choice. Additionally, the state has made legislators aware of the recent issues and have been working with them on possible legislative changes as well.”

The emergency evacuation at Rock Rapids was attributed to a lack of staff at the care facility, a problem that was cited by DIA’s inspectors last November.  In December, however, DIA officials revisited the home and reported finding zero quality-of-care violations — suggesting that any staffing issues had been resolved.

The November inspection was triggered by 10 separate complaints against the home, all of which were substantiated by DIA. The state agency issued no citations, and no fines were imposed as a result of the inspectors’ findings.

At that time, inspectors reported the home had gone through four different administrators over the course of 10 months in 2022, had lost its long-distance service due to a failure to pay bills, and had been so short-staffed that the head of maintenance and other non-medical staff had been asked to work as nurses’ aides.

In January, the home was added to the federal government’s list of care facilities considered to be among the nation’s worst.

Rock Rapids Care Centre was a 44-bed facility and was operating with a one-star overall rating from the federal government. It was fined $216,869 in 2021. In addition, Medicare suspended payments to the home in January 2021 and August 2020.