Photo illustration via Canva; logo courtesy of the Iowa Department of Inspections, Appeals and Licensing The Iowa Department of Inspections, Appeals and Licensing took over responsibility for many of Iowa’s licensing boards in July 2023.

The state of Iowa isn’t meeting the federally mandated standards for nursing home oversight, with some care facilities waiting up to 41 months for an annual inspection.

Federal regulations require that no more than 15.9 months elapse between annual inspections at individual Medicaid-certified nursing homes. The regulations also require that, collectively, the state inspect all nursing homes on an average of 12.9 months, if not sooner.

However, state records and published industry reports indicate that between October of last year and September of this year, the state agency tasked with inspecting nursing homes hasn’t met either of those standards.

For example, the records show the Northcrest Community facility in Ames went 41 months between annual inspections before it was visited by state inspectors earlier this year. The Good Samaritan Home in Holstein went 34 months between annual inspections, and the nursing home that’s part of MercyOne Medical Center in Centerville went almost 28 months without an annual inspection.

Even the state-run Iowa Veterans Home in Marshalltown went 22 months between annual inspections, as did Genesis Senior Living in Des Moines, West Ridge Specialty Care in Knoxville, Garden View Care Center in Shenandoah and Aspire of Pleasant Valley.

In all, more than 150 care facilities waited 16 months or longer for their annual inspection. Between their delayed annual inspections, some of those same homes were the subject of numerous complaints that resulted in fines and citations from the Iowa Department of Inspections, Appeals and Licensing.

For example, 22 months passed between Genesis Senior Living’s annual inspections in December 2021, when it was cited for 45 violations, and September 2023. During that gap, 34 complaints triggered several investigations that led to an additional 32 violations being cited and $25,250 in fines being proposed.

The records also show that DIAL failed to meet the 12.9-month statewide average for nursing home inspections in each of the 12 months between October 2022 and September 2023. The delays appear to have peaked in late 2022 and early 2023 when the gap between annual inspections was, on average, close to 18 months.

The Iowa Capital Dispatch provided the Department of Inspections, Appeals and Licensing with a partial list of the facilities with long-delayed annual inspections and asked about the reason for the delays.

In response, DIAL spokeswoman Diane McCool noted that state agencies conduct their annual inspections — which are called re-certification surveys — at the behest of the federal Centers for Medicare and Medicaid Services. She said DIAL anticipates “all recertifications will be caught up” in the upcoming federal fiscal year, which begins in October 2024.

Asked whether the federal timeliness standards were in effect for Iowa during 2023 or whether they had been waived or suspended, McCool said, “We have nothing further at this time.”

DIAL Director Larry Johnson did not respond to follow-up calls and text messages.

In early 2020, before the pandemic resulted in the temporary suspension of certain inspection standards, DIAL was reported as having failed to meet the federal standard of a 12.9-month average inspection cycle every month since October 2017.

At that time, department officials said the bureaus responsible for inspecting nursing homes were close to being fully staffed and the department was utilizing contracted inspectors to catch up on some of the work.

GOP rejects calls for investigation

While some Senate Democrats in the Iowa Legislature have called for an investigation into the state’s oversight of the nursing home industry, Republican leaders rejected that idea earlier this week.

Sen. Amy Sinclair, R-Allerton, chair of the Senate’s Government Oversight Committee, said Thursday that hearings on the issue would “distract” DIAL’s employees from “performing their important work monitoring these facilities.”

Sinclair noted that in the previous 12 months the department had issued “over 2,800 citations” against Iowa care facilities, demonstrating how seriously the state takes the issue of elder care.

Sinclair and a spokesman for Republican Gov. Kim Reynolds noted that lawmakers have also increased funding for nursing home operators by nearly $75 million. Sinclair also cited “critical tort reforms to ensure nursing homes can continue to provide services in rural Iowa.”

Sinclair and the governor were responding to a request from Sen. Claire Celsi, D-West Des Moines, the committee’s ranking member, to hold hearings on the issue. Celsi cited a spate of recent media reports, such as those focusing on alleged deaths, abuse, neglect and rape in Iowa care facilities.

“The tragic nursing home stories published by journalists show that our state’s current nursing home system is fundamentally broken and is failing to protect Iowans,” Celsi said at a news conference Thursday.

John Hale, a consultant and advocate for older Iowans, said the issue isn’t legislators’ willingness to increase funding for nursing facilities, but the quality of care that’s delivered in return for that investment.

He said DIAL’s failure to meet federal standards in nursing home inspections is further evidence of the need for the oversight committee to meet.

“The department’s failure to conduct timely investigations is a failure to ensure adequate care for nursing home residents,” Hale said. “If the Senate Oversight Committee doesn’t care about that, then I suggest they should just say so and dissolve the committee. An important committee that refuses to meet is an embarrassment and an insult to Iowans.”

In recent years, Republican lawmakers have been reluctant to hold government-oversight meetings on any topic. Celsi said the last time the Senate Oversight Committee met was more than 1,500 days ago, in October 2019.

Dean Lerner, who served as the director of the state inspections agency under a Democratic administration, said he was dismayed, but not surprised, that Republicans are refusing to hold oversight meetings. “An oversight meeting, denied outright by Sen. Sinclair, might have at least considered Iowans’ best interests,” he said.

With regard to the state’s efforts to provide additional Medicaid funding for nursing home owners, he noted that participation in the Medicare and Medicaid programs is voluntary.

“If, as the industry claims, taxpayer dollars are insufficient to cover costs, all the home has to do is go private, cut their losses, and no longer be subject to government oversight. Instead, investors and equity interests flock to nursing homes because of the profits they can reap.”

Celsi has indicated Democrats might hold meetings on their own if Republicans refuse to participate.

“We can do one on our own,” she said. “It won’t be a formal Senate Oversight Committee meeting and it won’t be on the record as one. But we can certainly bring people together and call folks together and hear their stories.”

A U.S. Senate committee reported earlier this year that Iowa ranks 49th among the states in its ratio of inspectors to nursing homes. The report also noted that Iowa has tried to catch up on a backlog of inspections by using temporary contractors that are exceedingly expensive, costing as much as $41,000 per inspection.