Iowa isn’t meeting federal mandates on how often it tests nursing homes certified to receive Medicare or Medicaid benefits, and it has high employee turnover, according to a report released Monday by state Auditor Rob Sand.
The report found the state is inspecting licensed nursing homes at a slower pace than neighboring states: Iowa inspects its facilities on average every 17.1 months, four months longer than the federal mandate that requires inspections of licensed nursing homes be done on average every 12.9 months.
The Centers for Medicare and Medicaid Services directs states to inspect each nursing home at least once every 15.9 months. Sand’s report found that 85.4% of Iowa’s 403 licensed nursing homes failed to meet that standard in at least one of the last three inspections. Neighboring states inspected them an average of once every 16.5 months.
The report determined the frequency of testing taking into account the nationwide suspension of testing in care homes during the COVID-19 pandemic.
Iowa ranks 46th in the nation for the number of qualified nursing staff per resident, according to the report. Roughly 45 percent of Iowa nursing homes that reported staffing information do not meet federal standards for total nursing staff numbers.
The state has the 17th highest nursing staff turnover rate, with nearly 11 in 20 nurses (54 percent) who worked in licensed nursing homes last year leaving the facility, the report said.
Auditor Rob Sand said Iowa’s labor shortage and low wages for nursing home staff are the main reasons for the state’s poor national ratings and high turnover.
“I believe part of this situation is that Iowa has a workforce shortage and that the Legislature and the Governor are spending so much energy on other things, like the culture wars, rather than bringing more talent into the state to actually do the jobs that Iowans need to do,” Sund said at a press conference Monday.
Sund said providing additional funding for testing should be a legislative priority.
Iowa Senate Democrats introduced a bill last session to address the issue.
The Iowa Senate Democrats’ legislative package includes four bills aimed at improving and expanding care options for Iowa seniors and assisted living facilities.
Leading the pack is Senate File 2304The bill would increase oversight of long-term care facilities and implement new transparency and accountability standards. The bill requires regular inspections of facilities, increases penalties for violations, and provides for the hiring of 30 additional nursing home inspectors.
The bill would also increase oversight by establishing a safety council and adding public review and input into oversight of Iowa’s lowest performing nursing homes.
Sen. Claire Celsi, D-West Des Moines, said in a news release Monday that Senate File 2304 alone would go a long way to correcting the flaws identified in Monday’s report, but Republicans have failed to join Democrats’ push for nursing home reform.
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The bill also includes wage increases for direct care workers, increased personal needs allowances for nursing home residents and expanded alternatives to nursing home care for Iowa’s elderly.
Additional invoices in the package include:
Senate File 2306conducts advocate-led research into alternatives to institutional long-term care and invests in alternatives to institutional care, including home care, adult day care and dementia care specialists.
Senate File 2305The bill would set a minimum hourly wage of $15 for direct care workers, raising it to $20, and is supported by higher Medicaid reimbursement rates.
Senate File 2303This would increase the Medicaid personal needs allowance from the current $50 per month to $85.
“The audit report released today confirms with cold hard data what we have known for months: Governor Reynolds’ administration is failing to protect Iowa’s seniors in nursing homes,” Selsi said in a news release Monday. “Iowa is lagging behind its neighbors and the nation as a whole on key indicators of the care and safety of nursing home residents. In a state where abuse, neglect and unnecessary deaths are frequently reported, the consequences of these failures are clear.”
Sen. Janice Weiner, D-Iowa City, said in a news release Monday that the data revealed in the report is unacceptable and that the plan proposed by Senate Democrats would ensure safety, support and accountability for Iowa’s nursing homes.
“Iowa’s seniors are looking out for us, and it’s time for us to look out for them,” Weiner said.
