Mary Weaver writes a regular column for the Jefferson Herald and Greene County News online, where this commentary first appeared. She is a former registered nurse and former public health nurse administrator, who currently chairs the Iowa Democratic Party’s Women’s Caucus. Mary resides on a farm near Rippey.

I am saddened, as well as shocked by the horror stories erupting statewide about the deplorable, life-threatening situations occurring in Iowa nursing homes. Stories of gangrene resulting in amputations, a story of a person choking in their own saliva, a story of a person freezing in the winter of 2023 when the alarm door triggered was never given a response.

In complete transparency regarding this subject, in part of my former work life, I was a surveyor for the Iowa Department of Inspections and Appeals. That involved inspecting State Certified Home Care agencies as well as nursing homes.

The long-term care or nursing home survey team consisted of three or four people, and the team was usually in a facility for three or four days. Policies were reviewed, charts were audited, comparing orders written to implementation, interviews with residents were conducted, the ombudsman assigned to the facility was visited, staffing ratios for Registered Nurses and Certified Nurses Aids were reviewed using established formulas. Temperature checks of food served were done at mealtime.

It took one day for the team to write the report of the findings, usually a Friday, and the following Monday we were sent to the next facility. Facilities were visited once each year, but unannounced, and if a complaint was received regarding a facility, it was immediately visited.

We were not particularly liked by the administrators or the staff, as we were disruptive to the usual routine and activities. As surveyors we observed, remained neutral, and wrote our reports in an objective manner. Accountability was paramount. Caring was practiced.

U.S. Senate Special Committee on Aging, based on fiscal year 2022 data, found that Iowa ranks 49th in the nation in terms of its ratio of inspectors to care facilities. The report also noted the use of contractors is expensive as well as risky. In 2022, Iowa had 46 state inspectors overseeing 414 nursing homes. Some states with a comparable number of homes had twice that many inspectors on staff. Michigan, for example, had 93 inspectors for 433 homes, and North Carolina had 96 inspectors for 424 homes.

Clark Kauffman reported for Iowa Capital Dispatch that the pay range for a registered-nurse inspector working for the state of Iowa is $66,600 to $93,800. But the state has paid a private nationwide company, CertiSurv, $33,300 per inspection for each facility with 96 to 174 beds. In addition, the company charged the state $40,950 for a single inspection of any nursing homes with 175 or more beds.

My former nursing colleague and friend, residing in a facility in the eastern part of the state, pays $10,000 per month. She did not receive her bath last Friday because there were not enough nurse aides working. She needs assistance to ambulate to the bathroom, and on a recent day her call light was not answered for 90 minutes, resulting in incontinence, or lying in her own urine for a length of time. The facility houses 35 residents, and one aide is on duty during the nighttime shift.

The facility where my friend resides has been purchased along with four other facilities in eastern Iowa by a firm from New Jersey.

According to a recent report issued by the Iowa Health Care Association, 387 of the 404 nursing homes in Iowa (96 percent of facilities) will fail to meet staffing benchmarks recommended by the federal staffing guidelines.

The Centers for Medicare and Medicaid Services recently added four Iowa nursing homes to the federal list of the nation’s worst care facilities. They join six other Iowa care facilities already deemed eligible for inclusion. Typically, all the homes on the special-focus designation have about twice the average number of violations cited by state inspectors; they have more serious problems than most other nursing homes, including harm or injury to residents, and they have established a pattern of serious problems that has persisted over a long period of time.

Westwood Specialty Care of Sioux City was one recently added to this listing. It is owned and managed by Iowa’s largest nursing home chain, the tax-exempt nonprofit of Care Initiatives, based in West Des Moines. According to tax records, CEO Michael Beal collected a total of $608,638 in compensation from Care Initiatives and its affiliates in 2021.

In a study done by CMS reflects a trend towards private equity firms and other large corporate owners purchasing nursing homes and slashing levels of staff as a way to maximize profits.

Sue Dinsdale of the Iowa Citizens Action Network reports that $800 million Iowa taxpayer dollars are going to Medicaid to care for people with disabilities and the elderly. The reimbursement for the services paid for Medicaid patients has now been contracted to private entities by the state of Iowa.

Brent Willett, the CEO of the Iowa Health Care Association, has said that for every $1 spent to care for an Iowa Medicaid resident, the system currently reimburses providers 80 cents. In simple terms, these private contracted companies need to show a profit to their owners, and frequently do not allow the payment, or delay the payment making the facility reapply and make repeated requests for reimbursement.

Under a recent recommendation from the Biden administration the Centers for Medicare & Medicaid Services is proposing a rule to establish a federal floor for staffing levels, so that nursing homeowners could not slash staffing to unsafe levels. If finalized, the proposal would require every facility to have a registered nurse on site 24/7, to have a certain minimum number of registered nurses and nurse aides to help provide routine care, and to staff according to resident needs based on an assessment of the facility’s residents.

CMS, in partnership with the Health Resources and Services Administration, has announced a national nursing career pathways campaign. The campaign will help recruit, train, retain, and transition workers into nursing home careers as nursing staff. This plan will invest over $75 million in scholarships and tuition reimbursement. This plan will be implemented during the coming three to five years.

But on November 1, Governor Kim Reynolds was among fourteen Republican governors who opposed the regulations in a letter to federal officials. The governors assert the Biden administration’s proposed requirements would result in facilities having to close because of staffing shortages.

This is a crisis.

The elderly in our society deserve basic human dignity and care in the later years of their lives.

It is time to voice concerns to those who represent us in the Iowa legislature: State Senator Jesse Green and State Representative Phil Thompson.

• Encourage using part of Iowa’s $1.83 billion surplus to provide aid to keep long term care facilities open. Workforce shortages are more severe in rural Iowa.
• Provide funds for the training both R.N.’s and Certified Nurses Aides, which would expand the labor force.
• Evaluate the taxpayer funds going to the facility owners to assure dollars are being used to care for residents and not for excess profits to the owners.
• Hold recently privatized contractors accountable for adequate reimbursement of facilities.
• Accept the requirements and funds being put forth by the Biden administration to improve the care being provided to our elders in Iowa.

---

Editor’s note from Laura Belin: Clark Kauffman regularly reports for Iowa Capital Dispatch about horrific conditions in nursing homes. You can find all of his coverage here; most recently, he reported on December 8, “An Iowa nursing home resident was evicted and dumped at a homeless shelter after complaining that an employee of the home raped her, according to state records.”

Top photo of Mary Weaver provided by the author and published with permission.