After shutdown, Iowa nursing home named one of nation’s worst

An Iowa nursing home that closed last month in the wake of an emergency court ruling that residents there were at risk has been added to a list of the nation’s worst care facilities.

The 125-bed Touchstone Healthcare Community in Sioux City was added July 27 to the Centers for Medicare and Medicaid Services’ list of care facilities eligible for designation as a Special-Focus Facility List. The addition of Touchstone to the list came six days after the home was shut down and the last of its residents was moved out.

Months before the shutdown, four different Touchstone vendors had sued the company for an alleged failure to pay more than half a million dollars in fees for management and patient-care services.

In March, the Iowa Capital Dispatch contacted the state agency that oversees nursing homes, the Iowa Department of Inspections and Appeals, after a reporter noticed the vendor lawsuits. The Capital Dispatch asked the department whether it was watching over the home and whether the owners had notified it of an inability to meet residents’ needs.

In response, the department indicated it had recently been at the home to investigate a complaint, had cited the home for 10 deficiencies and had returned to the facility to conduct the usual revisit to ensure problems had been corrected.

Three months later, on July 1, the owners of the home contacted the department to say they could not make the payroll that was due and owing that same day. Ten days later, department filed court papers seeking an emergency court order appointing a receiver. A judge issued the order that same day after concluding that conditions in the home presented “an imminent danger to the residents.”

Since January 2019, Touchstone has been cited for at least 116 regulatory violations and subjected to $195,000 in federal fines.

It had been on the list of Special-Focus Facilities for four years before dropping off the earlier list this year, and then being reinstated after it was closed down.

Also added to the list of Iowa homes eligible for Special-Focus Facility designation are Solon Nursing Care and Dunlap Specialty Care. Since January 2021, the Solon home has faced $154,823 in fines, while the Dunlap home has faced $300,000 in fines.

The Special-Focus Facility list is updated quarterly by the Centers for Medicare and Medicaid Services and includes homes deemed by the federal agency to have “a history of serious quality issues.”

Nationally, there are 88 nursing facilities on the list, with one or two slots filled by each state. Those homes are enrolled in a special program intended to stimulate improvements in their quality of care through increased regulatory oversight.

Because the number of Special-Focus Facilities is capped, new facilities — even those that have earned the federal government’s lowest ratings for quality — can’t be named a special-focus facility until other homes in that same state improve and “graduate” from the program.

That’s a process that can take four years or more. As a result, there are several homes in each state that are deemed eligible for special-focus status due to ongoing quality-of-care issues, but they are unable to benefit from actual enrollment in the program.

The two Iowa homes currently enrolled in the Special-Focus Facilities program are owned by the same Iowa-based company, QHC Facilities, which is now in bankruptcy. They are the QHC Villa Fort Dodge, which has been in the program for 10 months; and QHC Winterset North, which has been in the program for 19 months. According to the federal agency, the Fort Dodge home has shown some improvement in care, while the Winterset home has not.

The owner of the two homes is actively pursuing a sale of the chain, which consists of eight nursing homes and two assisted living facilities that provide care for up to 700 Iowans, including a facility in Marion.

In addition to the three Iowa homes recently deemed eligible for the list, seven other Iowa care facilities continue to be listed as “candidates” for special-focus designation due to quality-of-care issues: Arbor Court in Mount Pleasant, which has been a candidate for seven months; Aspire of Primghar, which has been a candidate for 11 months; Big Creek Nursing and Rehabilitation in Polk City, which has been a candidate for seven months; Genesis Senior Living in Des Moines, which has been a candidate for three months; The Ivy at Davenport, which has been a candidate for 18 months; Oakland Manor, which has been a candidate for two months; QHC Mitchellville, which has been a candidate for 27 months.

Typically, all of the homes that are deemed eligible for special-focus designation have about twice the average number of violations cited by state inspectors; they have more serious problems than most other nursing homes, including harm or injury to residents, and they have established a pattern of serious problems that has persisted over a long period of time.

This article first appeared in the Iowa Capital Dispatch.