Iowa Senate Republicans reject request to investigate nursing homes, say regulators too busy

Iowa Republican legislators have turned down Democrats' formal request for a state oversight meeting to investigate Iowa's nursing home crisis, saying it would distract state regulators "from performing their important work monitoring these facilities.”

On Thursday, state Democratic lawmakers formally requested a Senate Oversight Committee to conduct an inquiry into challenges plaguing Iowa nursing homes, stating there needed to be a bipartisan effort to increase transparency and accountability in facilities across the state caring for older Iowans.

In a letter to the committee's chair Thursday, Sen. Claire Celsi, a ranking member of the committee, pointed to well-documented instances of abuse and neglect of residents in these facilities as the driver for the request.

"We have a critical responsibility to ensure state departments are carrying through their legislatively assigned functions," said Celsi, D-Des Moines, during a Thursday press conference at the Capitol. "The nursing home crisis is real, and the state has an obligation to investigate and provide workable solutions."

Later Thursday, Senate Oversight Committee Chair Sen. Amy Sinclair said in a statement to the Des Moines Register she would not be scheduling a meeting.

She pointed to 2,800 citations issued by the Iowa Department of Inspections and Appeals, the regulatory body responsible for inspecting the state's nursing homes, over the past 12 months, which Sinclair said "demonstrates how serious the state takes the issue of elder care."

Sinclair also touted other legislative efforts.

“To address workforce shortages in the industry, since 2017 the Senate has increased funding for nursing home care by nearly $75 million, increased incentives for high quality of care to over $111 million, and passed critical tort reforms to ensure nursing homes can continue to provide services in rural Iowa," she said in a statement.

The governor's office on Thursday raised concerns about calls for additional oversight, including a recent proposal from the Biden Administration to implement minimum staffing requirements in nursing homes. Gov. Kim Reynolds was one of 15 governors who issued a statement opposing the federal mandate.

"The additional government regulation could unravel the workforce progress in Iowa and lead to facilities being closed," Kollin Crompton, deputy communications director for the governor's office, said in a statement.

More: 'Call lights not being answered for hours': Iowa nursing homes can't find staff to stay open

Iowa among worst in country for nursing home inspectors per capita

Concern over the state of Iowa's nursing homes has been a critical issue in recent years, particularly has the state has grappled with the abrupt closure of more than two-dozen facilities since the beginning of last year. Iowa currently has more than 400 facilities across the state.

During Thursday's press conference, Celsi and other nursing home advocates pointed to alarming news reports from these investigations that detail cases of assault, sexual misconduct, abuse and neglect against nursing home residents in Iowa.

The DIA, which has seen a significant increase in complaints and citations in recent years, has been unable to adequately monitor Iowa's nursing homes, advocates said Thursday. According to data from the U.S. Senate Committee on Aging, Iowa is 49th in the country for the number of nursing home inspectors per capita.

Mary Weaver, a former DIA nursing home inspector, spoke at Thursday to share her friend's experience living in an Eastern Iowa nursing home. Weaver said her friend did not want to be named for fear of retribution.

According to Weaver, her friend waited about two hours for someone to answer her call light to help her to the bathroom because the facility only staffs one aide to care for 35 residents overnight. The next night, the friend tried to go to the bathroom by herself and fell.

"This is not the kind of treatment we want for our older Iowans. This is inhumane," Weaver said.

Nursing homes call for greater investment; lawmakers say there needs to be strings attached

Nursing home officials point to workforce challenges, including high turnover rates and direct care worker shortages, as the main driver of those issues within their facilities. Many industry experts have called for greater investment in these facilities, saying current reimbursement has not kept up with rising costs, making it harder for them to offer competitive wages.

Last legislative session, as part of the $8.5 billion state budget for fiscal year 2024, lawmakers did approve an additional $15 million allocation to nursing homes through Medicaid reimbursement.

More: Iowa nursing homes got more funding from lawmakers to stem rampant closures. Will it help?

“Gov. Reynolds has increased Medicaid funding every rebase year as Governor, leading to $163 million of new funding going to nursing facilities to increase quality of care for residents," Crompton said.

In addition, Crompton pointed to other efforts touted by Reynolds to alleviate stress on nursing homes. That includes additional funding into programs like the Rural Health Care Loan Repayment and Recruitment Program and creation of health care apprenticeship programs.

"Gov. Reynolds believes solving the health care workforce shortage and addressing funding is the path to improving long-term care for Iowa’s seniors. Her record proves it," Crompton said.

Between state reimbursement and federal funding, it's estimated nursing homes in Iowa receive as much as $800 million in taxpayer dollars based on figures from the Iowa Department of Health and Human Services, said John Hale, an advocate for nursing home reform.

Celsi opposed providing this funding without expectations of goals, saying "proverbially throwing money at the problem" has not resulted in improved outcomes. She said that despite the additional investment from the state budget, Iowans haven't seen an improvement in nursing homes' staffing crises or the quality of care to residents.

While Celsi said she's open to increasing funding to address particular issues, there must be accountability on how those state dollars are spent.

"(Nursing homes) have to come to the table and tell us what they need," Celsi said. "We can't just trust them that if we give them millions of dollars, they will use it for the right thing. This last raise we gave them, none of it went to (staff wage) raises."

Michaela Ramm covers health care for the Des Moines Register. She can be reached at mramm@registermedia.com, at (319) 339-7354 or on Twitter at @Michaela_Ramm

This article originally appeared on Des Moines Register: Iowa Republicans reject request for bipartisan inquiry of nursing homes