Nursing home problems in Iowa require public investigation

Plenty is worth discussing about how Iowa’s 400-plus nursing homes are operated, staffed and regulated.

That can be true even if you don’t agree with every concern critics have raised over the years about workers and administrators and regulators. Iowa Senate Republican leadership and Gov. Kim Reynolds’ office, in other words, could have said “yes” to Democratic state Sen. Claire Celsi’s request this month for a Government Oversight Committee hearing on nursing homes without adopting her framing of the need.

Instead, Senate President Amy Sinclair chose a quick, nothing-to-see-here dismissal of Celsi’s letter. That didn’t serve any Iowans – not the people who depend on homes for day-to-day care, the families who expect competent care for their loved ones, or the workers who deserve the resources required to do their difficult jobs.

Formal legislative oversight should have been the starting point, and Sinclair, or Republican colleagues in the House, can still make that happen. Whatever the form, though – a task force ordered by Reynolds, perhaps – Iowa nursing homes’ problems deserve focused attention, and now.

Complaint about Biden staffing rule could have been part of a hearing

Among the biggest challenges for nursing homes is attracting and retaining qualified staff. Reynolds and colleagues have been vocal about this in the context of a proposed Biden administration rule requiring certain staffing ratios, saying that setting staffing standards in this labor environment is counterproductive.

Great. Talk about that. But more broadly, talk about what levers could be pressed in state government, at community colleges and in more local ways to help increase employment in caregiving.

Systemic issues and individual tragedies: Both should be unacceptable

Staffing is not, of course, the only thing. Celsi’s letter noted news reports documenting numerous alarming incidents throughout the state.

• Some nursing homes in recent years went as long as 41 months between inspections, which are supposed to be conducted annually, according to Iowa Capital Dispatch. The U.S. Senate Committee on Aging says that Iowa is 49th in the country for the number of nursing home inspectors per capita.

• Two winters ago, residents in Bondurant and Spirit Lake left their homes, both managed by the same company, and froze to death. One case led to a criminal conviction for a nursing assistant.

• State inspectors said a western Iowa facility responded to a resident’s accusation that a staff member sexually abused her by immediately evicting the woman and taking her to a homeless shelter.

Every incident like that one is independently alarming, and the accumulation of distressing stories makes it impossible to dismiss them as aberrations. Even the more “mundane” stories reflect unacceptable conditions: residents not receiving their medication, requests for assistance going unanswered for hours, routine medical care not being available on site.

The collaborative approach doesn’t seem to be working

As in other arenas involving interactions with vulnerable populations, especially medical care, small errors in nursing home care can have life-or-death consequences. Mistakes need not be malicious to have disastrous results. Frequent inspections to uphold strict standards are a sensible tool to manage mistakes and prevent recurrence.

Tens of thousands of dollars of campaign contributions connected to the nursing home industry go to the governor and legislators, Iowa Capital Dispatch has reported. Reynolds, Republican lawmakers and industry officials often deliver a party line that the best way to limit errors at homes is to foster a collaborative relationship between nursing homes and the government, focused on securing resources, rather than an adversarial regulatory relationship.

They seem to have achieved this goal in Iowa. Working collaboratively has evolved into looking the other way. The outcome is the conditions that prompted the Democrats’ oversight demand in the first place.

A series of oversight hearings could productively explore many critical issues regarding long-term care in Iowa. The COVID pandemic laid bare some of the risks involved with congregating large numbers of vulnerable Iowans in the same living quarters. And in survey after survey, older Americans say they would prefer to stay in their homes as they age rather than move into group care. Is Iowa doing enough to encourage and support at-home care?

But at minimum, the governor and legislative leaders must not ignore the drumbeat of reports of neglect and outright abuse of nursing home residents across our state.

They should order a public review of these incidents and the difficulties with nursing home care. They can focus on federal regulation and workforce struggles if they wish. But soberly considering cases where Iowans have suffered, and how to stop them from recurring, must be a prominent part of the discussion, too.

— Lucas Grundmeier, on behalf of the Register editorial board

This editorial is the opinion of the Des Moines Register's editorial board: Carol Hunter, executive editor; Lucas Grundmeier, opinion editor; Rachelle Chase, opinion columnist; and Richard Doak and Rox Laird, editorial board members.

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This article originally appeared on Des Moines Register: Nursing home problems in Iowa require public investigation