Dean Lerner served Iowa as an Assistant Attorney General for sixteen years, Chief Deputy Secretary of State for four years, and about ten years as Deputy Director, then Director of the Department of Inspections & Appeals. He then worked for the CMS Director of the Division of Nursing Homes, and the United States Attorney for the Northern District of Iowa. He is a graduate of Grinnell College and Drake University Law School.

Iowa’s 2025 legislative session has only just begun, and nursing home residents have already been informed the Republican-controlled legislature has nothing more to do for them, since the industry is supposedly over-regulated already. 

Here’s what you should know.

Shortly before the 2024 legislative session, Democratic State Senators Claire Celsi and Pam Jochum held a press conference to highlight Senate Democrats’ request for the Government Oversight Committee to meet to discuss nursing home care in Iowa. In particular, they were alarmed by the number and frequency of documented tragic instances of abuse, harms, and deaths occurring in Iowa’s more than 400 nursing homes, mostly for-profit facilities funded by billions of taxpayer dollars.  

Their concern stemmed from reports showing that the Iowa Department of Inspections, Appeals, & Licensing (DIAL) was failing in its critical oversight responsibilities, such as conducting annual inspections of nursing homes. In addition, federal data revealed that nursing home staffing in Iowa was among the worst in the nation.

The Senate Democrats were simply asking for an opportunity to meet and discuss how to protect and better care for some of Iowa’s most vulnerable citizens. Iowa Senate President Amy Sinclair, who also chaired the Senate Government Oversight Committee at the time, immediately rejected the request for a meeting. A spokesperson for Governor Kim Reynolds also dismissed calls for more nursing home oversight and criticized proposed federal rules on minimum staffing for nursing homes.

On January 13, the first day of this year’s legislative session, Iowa Public Radio interviewed Sinclair and Iowa House Speaker Pro Tempore John Wills. I posed the following written question to them, which the interviewer asked them on the air: “Last session, you refused to even hold oversight discussions regarding poor nursing home care in Iowa, and lack of DIAL oversight. Will you refuse again this year?”

Needless to say, their chorus of refusal was unequivocal, immediate, and accompanied by fabricated claims of no responsibility for such oversight, along with other absurdities. Sinclair even stated, “sure, bad things are going to happen.” Since when did protecting the health, safety, welfare and rights of vulnerable Iowans not become the highest priority of every elected official?

It would be reasonable to connect the dots between this irrational, thoughtless, immoral, and harmful disregard and the pay-to-play politics of nursing home care in our state, as Clark Kauffman has reported for Iowa Capital Dispatch. Iowans can expect that this legislative session will offer more of the same Republican neglect.  

At the very least, the minority party should reintroduce all of the bills Democrats offered last session to improve nursing home care. (Republicans didn’t allow any of them to advance.) Among other things, the bills would have:

• established a Long-Term Care Facility Safety Council;
• prohibited mandatory arbitration clauses in admissions contracts;
• increased penalties for certain safety violations;
• prohibited interference by legislators in DIAL’s oversight;
• added more DIAL Surveyors, with an accompanying appropriation;
• expanded the Long-Term Care Ombudsman’s Office;
• provided alternatives to institutional care and enhancements for adult day care providers, dementia care specialists, and direct care worker wages; and
• increased the personal needs allowance.

Republicans should be forced to explain—without misleading or incomprehensible excuses—why they won’t even schedule an oversight meeting to discuss the shameful, serious problems that plague nursing home residents.

This session, it is important to add enhanced protections for Iowans. One step would be to end taxpayer funding (currently more than $2 million annually) of the Iowa Health Care Association, the membership association representing for-profit nursing homes. That association’s CEO collected salary and benefits exceeding $788,000 in 2022. 

Last year, the state approved the $85 million dollar sale of 29 Iowa nursing home facilities to a poor performing profit-driven private equity group. In light of that decision, the state should establish standards and transparency for any such future transactions when Iowans’ lives are at stake, as they are here. 

Like Governor Reynolds, Iowa Attorney General Brenna Bird opposed the Biden Administration’s minimum staffing standards rule. She even led a multi-state lawsuit challenging the rule, using arguments that mirrored the industry’s scare tactics. Researchers have estimated that the nursing home staffing standards would save about 13,000 lives a year across the country. Iowa’s elected officials should not seek to eliminate a life-saving rule. Instead, they should enact staffing standards of our own, which are essential and decades overdue.  

Here’s the best question to ask Iowans about these, and other nursing home care measures: “When I grow old and need care, I want to….”

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Top photo was first published on Iowa Senate President Amy Sinclair’s Facebook page on January 13.