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.
These days, Iowans may wonder how our elected officials, who should prioritize protecting and caring for the most vulnerable, can live with themselves or even look at themselves in the mirror. More than 50,000 Iowans live in the state’s more than 400 nursing homes. Most of those facilities are for-profit enterprises, funded by tens of billions of taxpayer dollars. These residents, their families, those of us approaching our own long-term care needs—and frankly, all Iowans—should be able to count on responsible individuals of both political parties to fulfill their oaths.
Not in Iowa.
Republicans have had full control of state government (the Iowa House, Senate, and governor’s office) since 2017. In her recent Condition of the State address, Governor Kim Reynolds made it sound as if we were now living in the State of Nirvana, thanks to her and her party.
Just to mention a few minor issues, her address did acknowledge Iowa’s tragic cancer rate, among the highest in the nation and rising. Perhaps to avoid confronting the real horrors of this trend, which has happened under Republican rule, she didn’t mention the pure human suffering involved: pain, expense, emotional toll, and deaths.
To address Iowa’s cancer crisis, our state’s leader generously proposed devoting $1 million toward research—a ludicrous amount, hardly proportionate to the devastation. Regarding Iowa cancer research, Chris Jones, a retired University of Iowa water quality research engineer, has valuable information to share. Jones points to a plethora of established cancer research leading to the inevitable conclusion that, like neglected nursing home care, there’s no genuine political interest in doing something.
During her big speech to the legislature, Reynolds also didn’t discuss hungry kids, Iowa’s declining public education system, polluted lakes and rivers, gun terror in our schools, and other problems the GOP trifecta has failed to address. It’s fair to say “Iowa nice,” has been replaced with “Iowa Trump.”
Given these circumstances, it’s natural to ask a simple political question: are Iowans better off today than we were nine years ago? Nursing home residents and their families should have a ready answer to this question.
On the first day of the 2025 legislative session, Senate President Amy Sinclair and House Speaker Pro Tempore John Wills announced on Iowa Public Radio that although bad things are going to happen in Iowa’s nursing homes, the GOP House and Senate caucuses needn’t interfere with oversight of these already over-regulated facilities.
In reality, the crisis in our state’s long-term care system has reached epic proportion. Abuse, harms, and deaths have become commonplace. Iowa Capital Dispatch deputy editor Clark Kauffman exposes these tragedies on a regular basis. His investigative reporting on this topic is unsurpassed—grounded in decades-long research and expertise.
Recently, Kauffman wrote about Iowa’s uncontrolled nursing home staff turnover, one of the proven most significant causes of poor care. During the entire period of the Republican trifecta, the state has failed to fund a program that was supposed to address staff turnover rates.
Kauffman quoted Sinclair’s comments on Iowa Public Radio about why she is refusing, like last year, to even discuss nursing home caregiving. His article noted that the Senate president “…accepted $22,000 from the Iowa nursing home industry’s primary political action committee during the past 26 months….”
Kauffman didn’t need to research Sinclair’s other nursing home industry election contributions—he’s already exposed how pay-to-play nursing home politics works with the Republican Party.
Here’s one example, among myriad others, that flies in the face of Republicans’ claim that there’s too much oversight of nursing homes. Kauffman recently reported on “a former nursing home worker accused of sexual impropriety at three different Iowa care facilities.” Sinclair and Wills lauded the Iowa Department of Inspections, Appeals, & Licensing for its trusty nursing home assurances. Why wouldn’t the state’s regulator of nursing homes deserve Republican scrutiny when that department should have prevented this pattern of sexual misconduct?
The Biden administration proposed a new federal rule on nursing home minimum staffing standards. Its requirements are modest—many of the better performing homes would already be in compliance. The rule also provides for exceptions and will not be implemented until 2026. Yet Governor Reynolds and Iowa Attorney General Brenna Bird have actively opposed the staffing rule. Like Sinclair, they have parroted the nursing home industry’s talking points, adding some embellishments.
Reynolds led a group of fifteen Republican governors on a November 2023 letter to President Biden condemning the rule. Among the many multi-state lawsuits Bird has filed against the Biden administration, she led a group of 20 Republican attorneys general fighting the nursing home staffing rule. The lawsuit filed in the U.S. District Court for the Northern District of Iowa even sought a preliminary injunction to stop the rule from going into effect. (A federal judge recently denied the injunction.)
Reynolds and Bird both relied on the industry’s talking points. Who knows whether those claims coincided with the industry’s political donations, conferences, or awards to elected officials? Advocates for nursing home reforms have heard these same industry screeds forever.
Those who oppose the federal rule claim there aren’t enough available staff to meet the minimum staffing requirements. As Kauffman’s reporting on turnover reveals, there isn’t a shortage of available workers. The problem is employee retention (likely related to low pay and poor treatment or scapegoating). Like the son who murders his parents and then begs for mercy as an orphan, staffing shortfalls are self-inflicted. Irony abounds, industry utilizes its own conduct to argue against the federal rule, and Republicans go along.
Next, Iowa’s GOP leaders have claimed it would be prohibitively expensive to meet the minimal staffing requirements. Simply put, the nursing home industry is mostly for-profit. Tens of billions of taxpayer dollars flow to homes with little scrutiny or transparency, and next to zero accountability for safe and decent caregiving.
Related party transactions siphon profits away from care. Private equity prioritizes profits over care, and all manner of other industry legal gymnastics sacrifice resident health, safety, and welfare for the almighty dollar.
A July 2024 study by researchers at the University of Pennsylvania concluded that implementing and enforcing the Biden administration’s nursing home staffing rule would save around 13,000 lives annually across the country. According to the study, the rule our state’s esteemed Republican leaders condemn would save between 101 and 250 Iowa lives every year.
Iowans ought to ask Reynolds, Bird, and all those who cite industry falsehoods to oppose the life-saving Nursing Home Minimum Staffing Rule: How can you sleep at night?
Top photo of then candidate Brenna Bird with Governor Kim Reynolds was first published on Bird’s campaign Facebook page on August 4, 2022.