Iowa fails to meet the federal mandate on the frequency of inspections on nursing homes certified to accept Medicare or Medicaid and experiences high employee turnover rates, according to a report released Monday by State Auditor Rob Sand.
The report revealed the state inspects certified nursing homes more slowly than neighboring states. Iowa conducts inspections every 17.1 months on average, which is four months longer than the federal mandate requiring certified nursing homes to be inspected, on average, every 12.9 months.
The Centers for Medicare & Medicaid Services instructs states to inspect individual nursing homes at least once every 15.9 months. Sand’s report found that 85.4 percent of Iowa’s 403 certified nursing homes did not meet this expectation on at least one of the past three inspections. Bordering states averaged inspections every 16.5 months.
The report took into account the national pause on inspections on nursing homes during the COVID-19 pandemic to determine the frequency.
Iowa ranks 46th nationally in the amount of licensed nursing staff per resident, according to the report. Roughly 45 percent of Iowa’s nursing homes that reported staffing information do not meet the federal standard of total nursing staff levels.
The state has the 17th-highest turnover rate among nursing staff; nearly 11 out of 20 — or 54 percent — nurses who worked at a certified nursing home in the previous year are no longer employed at the facility, according to the report.
Auditor Rob Sand pointed to Iowa’s workforce crisis and poor pay for nursing home workers as the main reasons for Iowa’s lackluster national rating and high turnover rate.
“I think a piece of this absolutely is the fact that Iowa has a workforce crisis, and that we’ve seen the legislature putting a lot of effort and the governor putting in a lot of effort into other things, like culture wars, as opposed to bringing more people into the state of Iowa to actually do the work that Iowans need to have done,” Sand said in a press conference Monday.
Sand said providing additional funds for inspections should be a legislative priority.
Iowa Senate Democrats introduced bills to address issues last session
Iowa Senate Democrats’ legislative package includes four bills to improve and expand care options for Iowa seniors and support facilities.
Spearheading the package is Senate File 2304, which would increase oversight and enforce new transparency and accountability standards for long-term care facilities. The bill would require regular facility inspections, enforce stiffer penalties for violations, and hire an additional 30 nursing home inspectors.
The bill would also increase oversight by creating a safety council and adding citizen review and input into oversight of Iowa’s lowest-performing care facilities.
Sen. Claire Celsi, D-West Des Moines, said in a news release Monday, Senate File 2304 alone would go a long way toward correcting the failures revealed in Monday’s report. However, Republicans have failed to join the Democratic push for nursing home reforms.
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The legislative package also includes increasing pay for direct care workers, increasing the personal needs allowance for care facility residents, and expanding alternatives to nursing home care for Iowa seniors.
Additional bills within the package include:
- Senate File 2306, which creates a study of alternatives to institutional long-term care led by advocates, and invests in alternatives to institutional care, including home health care, adult day care, and dementia care specialists.
- Senate File 2305, which establishes a $15 per hour minimum wage for direct care workers that will rise to $20 per hour and is supported by Medicaid reimbursement rate increases.
- Senate File 2303, which increases Medicaid personal needs allowance to $85/month from current $50 per month.
“The auditor’s report released today validates with cold, hard data what we’ve known for months: Gov. Reynolds’ administration is failing to protect seniors in Iowa nursing homes,” Celsi said in the news release Monday. “Iowa lags behind our neighbors and the country as a whole on key indicators of nursing home resident care and safety. In a state where reports of abuse, neglect, and unnecessary death are a regular occurrence, the consequences of these failures couldn’t be more obvious.”
Sen. Janice Weiner, D-Iowa City, said in a news release Monday that the data revealed by the report is unacceptable, and the plan put forward by Senate Democrats will ensure safety, support, and accountability in Iowa nursing homes.
“Iowa’s seniors care for us, and it is past time for us to care for them,” Weiner said.