Reimagining long-term care in Iowa

Like the rest of the country, Iowa is at a crossroads with the future of long-term care. The COVID-19 pandemic has been devastating and deadly for families and loved ones who reside in nursing homes. What we do next is up to us. The status quo is unacceptable. We must reform how, and equally importantly, where care is delivered.

Poor infection control, staffing shortages, and a high number of Iowans with “low-care needs” (defined as residents requiring no physical assistance for bed mobility, transferring, toileting and eating) admitted to skilled nursing homes were problems with the nursing home industry heading into the pandemic. AARP Iowa has long advocated for critical reforms to address staffing shortages and the imbalance Iowa taxpayers spend on nursing homes as opposed to home-based care. As COVID-19 spread through nursing homes like a prairie fire it became clear the time is now to accelerate long-term care reforms statewide.

Consider this: to date, 2,320 residents died from COVID-19 in Iowa nursing homes. How did this happen when we knew COVID-19 was coming and the methods needed to protect residents and staff? One answer may be in the number of citations issued related to not adhering to infection control standards. Iowa regulators issued 237 citations for infection control violations between July 1, 2019, and June 30, 2020.

Another contributing factor is staffing. According to AARP’s COVID-19 Nursing Home Dashboard throughout 2020, Iowa continually outpaced much of the nation in percentage of facilities with shortages of nurses and/or aides and that trend continues, with more than one-third of all facilities reporting a shortage. This is a striking statistic when you consider nursing homes in Iowa received at least $206 million directly from the federal government, and millions more from Iowa taxpayers to tackle this significant problem. Where is that money going?

This fact is clear: older Iowans want access to home-based care. Our most recent AARP statewide survey shows 86 percent of Iowans say it is “very” important to have long-term care services that would allow them to remain at home. Additionally, 89 percent of Iowans support increasing resources for in-home care. Home-based care is wildly popular, yet our state funding remains unbalanced and at odds with the wishes of Iowa consumers. Iowa currently directs 74 percent of its long-term care spending to institutional care, with only 26 percent going toward home-based care. Many states have set goals to improve consumer choice, with spending split equally between institutional and home-based care. Other states have implemented reforms to achieve that balance, leading to better outcomes, higher customer satisfaction, and, often, cost savings.

For those who choose to live independently in their own homes, we must find ways to better support them and their caregivers. Iowa has an estimated 317,000 unpaid family caregivers providing uncompensated care valued at nearly $3.9 billion annually. Iowa would be wise to expand and strengthen its home and community-based services, so people in need of care can stay in their homes and their family caregivers can work. We could also give our uncompensated family caregivers a break, both financially and with time, through expanding respite care resources and providing uncompensated caregivers tax credits for costs they incur while providing care.

Iowa ranks among the worst in the nation in the number of low-care needs nursing home residents who could be better served in their own homes. However, with COVID continuing to lurk, families are choosing to keep their loved ones out of these facilities and in their homes. We have a decision as a state: do we continue to use taxpayer dollars to prop up long-term facilities financially? Or, do we instead focus our tax dollars where they are needed most — home-based care and support for our caregivers.

Iowa is well-positioned to take advantage of the many reforms available and chart our own course as we pursue “top 10” status in elder care. Now is the time to have a frank and serious discussion on how we transition to a new care delivery model: one that recognizes the dignity and humanity of our loved ones and provides high quality and safe care in the manner and setting of their choice.

Brad Anderson is AARP Iowa state director.

AARP Iowa Advocacy Director Anthony Carroll will be on an Iowa Ideas panel about this topic. The session, Rethinking Long-Term Care Facilities, is within the Health Care track. The session is set for Thursday, Oct. 14, from 4:20-5:20 p.m.