Des Moines, Iowa (Iowa Capital Dispatch) – 14 bills related to nursing home monitoring were introduced in the Iowa Senate this week, but it is not expected to win approval.
In early 2025, Senate Speaker Amy Sinclair, a Republican from Allerton, told Iowa Public Radio that she had no anticipated any action on nursing home regulation, and told the state was already doing a good job overseeing the industry.
Before the session, Sen. Claire Celsi, a Polk County Democrat, called for more stringent surveillance and increased enforcement of nursing home regulations. On Wednesday, she introduced 14 separate bills dealing with nursing homes just before the deadline for approval of this week's unavailable bill.
Celsi said that as the GOP manages both the House and Senate, he is ready to pursue the issue, not to mention voting, not to mention discussing this session.
“We're not going to remove this issue,” she said. “Even though it's a tough fight, this is something that still needs to be dealt with and we'll be embarrassed about people's hell until they start. It may take eternity, but we're not going to give up.”
One of the 14 bills, Senate File 532, is a broad law that increases penalties imposed on certain regulatory violations, and would prohibit Iowa's Medicaid-certified home from requiring residents or their families to agree to arbitration if they seek claims for negligence care. Dozens of cases filed against nursing homes in recent years have been thrown from Iowa courts through arbitration agreements signed by the resident or his guardian upon admission.
The bill also constitutes a serious violation of the facility's regulations in which it will file a quality of care complaint with the state or work with state investigators to retaliate against employees or residents.
Senate File 532 will also provide a $600,000 increase in state funding, generate additional federal funds, pay 30 nursing capacity inspectors, and visit living centers and skilled nursing facilities.
Iowa Senior consultant and advocate John Hale said the bill introduced Wednesday “shows the opportunity for Iowans to do what they are asking elected officials to do, and presents the opportunity to discuss bills that actually help people and pass.
One of the bills, Senate File 527, establishes minimum staffing levels at Iowa Nursing Facilities. These levels coincide with those set under current federal rules approved by the Biden administration, which the Trump administration is widely expected to exclude.
Data from the Centers for Medicare and Medicaid Services found that 14% of Iowa's 422 nursing facilities were cited in 2023 due to inadequate staffing. This was more than twice the national average, at 5.9%. Only five other states, Hawaii, Michigan, Montana, New Mexico and Oregon, had poor records of compliance with sufficient personnel requirements.
Dean Lerner, who headed the state testing division under Democratic government's Chet Culver, said the bill was needed to protect seniors from staffing shortages given the potential rollbacks of federal regulations.
“Republican Gov. Kim Reynolds and Attorney General Brenna Byrd went out of the way to kill the recent federal minimum personnel standard rules for nursing homes,” Lerner said. “Congressional Republicans are also trying to kill the rules. Almost every residents of every nursing home share their daily struggles with having caring staff well trained and to help them. Democrats care about these residents, and Republicans are interested in contributing to the industry's campaign.”
Regarding the outlook for the 14 new bill, Hale said, “If legislators really care and are on the side of the residents, the bill will move forward. If they don't really care and fall on the side of the nursing home operator and owner, the bill will die. All Iowa needs to see what happens with these bills and judge lawmakers accordingly.”
Of the 14 bills introduced on Wednesday, Celsi:
New Levels of Surveillance: Senate File 539 creates a Safety Council for Long-Term Care Facilities to establish standards for nursing homes and verify licenses for facilities that have been repeatedly cited for serious violations.
Taxpayer Recovery: Senate File 538 establishes a working group to study the potential recovery of Medicaid payments after care facilities are closed or sold.
Room Camera: Senate File 537 prohibits facilities that prohibit residents or their guardians from installing video cameras in the rooms of residents of nursing homes. This is similar to the House File 664, which has not progressed in the House since it was introduced on February 28th. Laws in line with these policies have been vehemently opposed by the industry for the past few years.
More Ombudsman: Senate File 536 calls for increased number of long-term care ombudsmen in the area working in the state and prioritize onsite visits to nursing homes that have recently changed ownership or have been handed over by private equity companies.
Change of Ownership: Senate file 535 requires a more detailed state review of Nursing Home Change of Ownership Application, and includes a review of new owner compliance with state and federal regulations in other jurisdictions. It also increases the amount the new owner needs for escrow to ensure that there is sufficient cash on hand to continue serving its residents.
Ownership of Private Equity: Senate File 533 prohibits the state from approving changes in ownership that result in the acquisition of nursing homes by private equity funds or real estate investment trusts.
Taxpayer Dollars for Lobbying: Senate File 531 prohibits care facilities from using Medicaid dollars to pay industry association fees and lobbying fees. “About $2.3 million in taxpayer dollars per year will be leaked through membership fees to the Iowa Healthcare Association,” Lerner said the head of the IHCA was paid $780,000 in 2023. Resident health, safety and welfare take back seats to fund and accountability. ”
Caregiver Minimum Wage: Senate File 530 will increase by 2031 by $1 a year to establish a new $15 wage for direct care workers of $1 per year.
Individual Needs Allowance: Senate 528 increases the personal needs allowance collected monthly by nursing home Medicaid beneficiaries from $50 to $85. A similar bill introduced earlier this year would increase allowances to $65. Iowa lawmakers have not increased the personal needs allowances for nursing home residents since 2001.
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