Iowa is slow to inspect its nursing homes, a new state audit shows
A new state audit says Iowa is failing to meet federal regulatory requirements on annual nursing home inspections ― a claim that state officials have said is “misleading.”
The Iowa state auditor’s office on Monday released a 10-page audit that found, on average, Iowa conducts inspections of its nursing homes every 17.1 months, which is four months longer than the federally mandated 12.9-month minimum.
In addition, about half of Iowa’s nursing homes reported a greater period between inspections than allowed by federal health regulators.
However, the Iowa Department of Inspections and Appeals, the agency that conducts nursing home inspections, called the auditor’s report misleading.
“The auditor’s report is inaccurate, incomplete, and confusing,” DIAL Communications Director Stefanie Bond said in a statement. “It is also a waste of taxpayer dollars as the Center for Medicare and Medicaid Services (CMS) will release their own findings of the state survey agencies after the federal fiscal year concludes, which is in two weeks.
“In short, DIAL is conducting timely nursing home inspections and will meet the federal requirements,” she said.
The new report from the state auditor’s office comes as Iowa’s nursing homes have faced greater scrutiny in recent years, particularly following the abrupt closure of two-dozen facilities since 2022.
“This is just an issue that has been the subject of lots of questions, has been the subject of lots of coverage, and we thought that this information would be hopefully useful to policymakers as they decide whether or not they want to do something about the crisis in Iowa’s nursing homes,” State Auditor Rob Sand said during a news conference Monday.
Iowa has 403 federally certified nursing homes as of June 1. Nearly 20,000 residents live in these facilities, according to the most recent average daily totals.
The U.S. Centers for Medicare and Medicaid Services rules mandate individual Medicaid-certified nursing homes must have an annual inspection at least once every 15.9 months.
In addition, federal regulation also require that state officials, as a whole, inspect all nursing homes on an average of at least 12.9 months.
As of June 1, on average, the period of time between inspections at Iowa’s nursing homes was 514 days, or 17.1 months, according to the state audit. Sand said that calculation accounted for the COVID-related stoppage in inspections.
The state audit found that 85% of nursing homes reported that, over their past three inspections, at least one period between inspections lasted longer than the federally mandated 15.9 months.
The time between inspections is longer on average in Iowa than its neighboring states, except for Missouri, according to the audit. In Missouri, 99% of nursing homes report a period of time between inspections that’s greater than 15.9 months.
The state will meet the federal mandate for nursing home inspections for fiscal year 2024, which ends in September, Bond said. Per the department’s data, as of Monday, 99% of Iowa nursing homes are within the required 15.9-month recurring inspection interval. The remaining 1% will be completed before the end of this month.
Per DIAL, the statewide average interval for all nursing homes is 12.75 months and “will continue to improve.”
“Due to the dedication and hard work of the State’s surveyors (nursing home inspectors) the State has reduced the backlog caused by the pandemic and is conducting nursing home inspections in a timely manner,” Bond said.
The Iowa Health Care Association, which represents Iowa’s nursing homes, pointed to federal data that shows only 28 Iowa nursing homes, or 6.8%, have not received a recertification survey to maintain federal certification status within the past 15 months.
Iowa Health Care Association President and CEO Brent Willett said the most recent available survey data shows that for surveys conducted in the month of July, the average duration between surveys was 12.2 months.
“We respect and appreciate the Auditor’s work on this important topic,” Willett said in a statement. “Nursing homes should be regularly and rigorously inspected per federal guidelines and in Iowa, that is what is happening. The report’s findings are not a contemporary reflection of nursing home recertification survey frequency today.”
Sand pointed to a number of challenges contributing to the issues within Iowa’s nursing homes, including a shortage of health care workers, low wages and poor insurance reimbursement rates.
Federal data shows Iowa ranks 46th nationally for the number of licensed staff per nursing home resident.
Forty-five percent of Iowa nursing homes report they do not meet federally mandated nursing staff levels. In addition, over the past 12 months, the average turnover rate among nursing staff at Iowa nursing homes was 54%.
Sand denounced Iowa Republicans and Gov. Kim Reynolds for not taking greater action to address these problems.
“A piece of this absolutely is the fact that Iowa has a workforce crisis, and that we’ve seen the legislature putting a lot of effort and the governor putting in a lot of effort into other things, like culture wars, as opposed to bringing more people into the state of Iowa to actually do the work that Iowans need to have done,” he said.
Last year, Republican leadership in Iowa’s GOP-majority Legislature rejected Democrats’ formal request for a state oversight meeting to investigate issues plaguing state nursing homes. At the time, Republican legislators pointed to previous work by the Iowa Department of Inspections and Appeals to show “how serious the state takes the issue of elder care.”
Iowa state Democrats echoed Sand’s criticisms following the audit’s release on Monday.
“The auditor’s report released today validates with cold, hard data what we’ve known for months: Gov. Reynolds’ administration is failing to protect seniors in Iowa nursing homes,” Sen. Claire Celsi, D-West Des Moines, said in a statement. “Iowa lags behind our neighbors and the country as a whole on key indicators of nursing home resident care and safety. In a state where reports of abuse, neglect, and unnecessary death are a regular occurrence, the consequences of these failures couldn’t be more obvious.”
Sen. Janice Weiner, D-Iowa City, said the data revealed in the state audit “is simply unacceptable.”
“We must do better as a state, which is why Senate Democrats have put forward a comprehensive plan to ensure safety, support, and accountability in Iowa nursing homes. Iowa’s seniors cared for us, and it is past time for us to care for them,” Weiner said in a statement.
Michaela Ramm covers health care for the Des Moines Register. She can be reached at [email protected], at (319) 339-7354 or on Twitter at @Michaela_Ramm.
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