Where is the outrage?

Twenty-seven years ago, the Quad City Times published a six-part series on neglect and abuse in nursing homes. The articles told the stories of residents whose physical and mental health needs were not met, who were subjected to verbal or physical abuse by staff or other residents, and had been injured or had died.

The stories were tragedies. And sadly, tragic stories are still regularly appearing in the Iowa Capital Dispatch, and often republished in The Gazette, written by Clark Kauffman — the same journalist who authored the Quad City Times stories in 1996.

For over 27 years, horrific stories of neglect and abuse have stemmed from far too many nursing facilities that have employed too few workers; failed to adequately compensate, train, and respect workers; routinely accepted exceptionally high levels of employee turnover; lobbied elected officials to increase annual appropriations of tax dollars but to also minimize oversight of their efforts; avoided criminal prosecution for their misdeeds; and have put the desire for profit ahead of the needs of the Iowans they exist to serve.

In 27 years, little has changed. At too many facilities, neglect, abuse and dehumanization of older Iowans continue.

And we ask — “Where is the outrage?”

Where is the outrage among state and federal legislators, from the governor, from local and state and federal prosecutors, from leaders of state government departments, from the higher quality nursing homes who are tarred by the bad apples among them, and from the public?

Shame on all for the casual acceptance of neglect and abuse, the willingness to turn a blind eye to what’s going on, and the capability to view older Iowans as both invisible and expendable.

Consider the reaction when stories are told of neglect, abuse or death of children in day care or foster care, of horses on farms, or dogs in kennels.

When it’s abuse or neglect of other than older human beings, outrage is common. Charges are filed. Owners and operators are taken to court. Licenses to operate are revoked. Tax dollars that might have been a revenue stream are stopped.

But with nursing homes? If charges are filed, (which is rare), they are typically against the lowest person on the totem pole — the front line nursing aide; not a supervisor or administrator, not the management company, and not the owner or investors who are ultimately responsible.

And for these nursing homes that disserve older Iowans on either a frequent or regular basis, tax dollars — yours and ours — that pay the bulk of the cost of care just keep flowing to them year after year. This is not a small amount of money — millions of dollars annually go to individual facilities that enable them to keep providing more unsatisfactory care.

To us, this is acceptance of what should be unacceptable is appalling.

A handful of state legislators seem to agree, and are beginning to express concerns and ask questions.

Unfortunately, they are in the Democratic minority at the Iowa Capitol. They currently have little power.

But they have a voice, and we urge them to use it constantly and loudly. Maybe they can’t create change right away, but they can certainly raise a ruckus. They can hold news conferences, conduct hearings and draft legislation. They can force their fellow legislators to listen, and pressure them to either display their disinterest, or to join them in taking action.

It’s time for outrage to be expressed, and for elected leaders to lead. The needs of vulnerable older Iowans in the twilight of life should not continue to be ignored or dismissed. Each deserves to live a life of dignity; each deserves respect, concern, and most importantly, they deserve action.

The question is — who will express the outrage, and who will provide the leadership? We, and hopefully all Iowans, will be watching and waiting — and remembering in 2024 as election time rolls around.

John and Terri Hale own The Hale Group, an Ankeny-based advocacy firm focused on older Iowans They’ve identified twelve steps to improve the quality of care in Iowa nursing homes. For details, go to The Hale Group Facebook page or contact them at terriandjohnhale@gmail.com

12 Steps to fix the quality-of-care crisis in Iowa’s nursing homes

1. Create a broad-based strike force to address the persistent crisis in attracting and retaining sufficient front line workers. The strike force will review well-known solutions, prioritize recommendations, and develop a plan for expedited action.

2. Adopt minimum staffing standards to ensure an adequate number of front line staff per nursing home resident, like what Iowa requires for child-to-staff ratios in child care centers.

3. Revise nursing home cost reports to ensure more detail and greater transparency in how the industry spends $800 million in appropriations each year.

4. Require strict oversight and investigation to identify where tax dollars are being misused or wasted.

5. Incentivize quality care with a pay-for-performance program. Provide incentives for high quality performance, assist facilities who are performing poorly, and sanction those that continue to fail.

6. Change laws, regulations, and practices so that local, state, and federal prosecutors can hold owners and managers responsible for neglect or abuse of residents.

7. Allow Iowans to age in place. Budget more dollars to build and sustain a vibrant system of long-term care providers that serve people in their homes and communities.

8. Give one state agency the authority and resources to ensure nursing homes provide consistent high-quality care. Currently, multiple entities of state government are involved but no one is ultimately accountable.

9. Don’t waste a good crisis: turn it into an opportunity to inspire innovation and experimentation in how nursing homes are designed, operated, and staffed.

10. Prioritize the needs and voices of residents, families, and advocates over those of the nursing home industry. Proactively seek input from these non-industry groups on how to continually improve quality-of-care.

11. Approve legislation that allows the installation of cameras in rooms when residents request them.

12. Ensure the Department of Inspections, Appeals and Licensing and the Office of the Long-Term Care Ombudsman have adequate resources and procedures to quickly and effectively conduct routine inspections and respond to resident complaints.

For an expanded version, contact The Hale Group, an Ankeny-based firm advocating for older Iowans.

terriandjohnhale@gmail.com or https://www.facebook.com/advocacyforabetteriowa