Iowa County leads state in home-health violations

The Iowa County Public Health Department’s home-health agency has been cited for 37 violations over the past six months — far more violations than any other home-health provider in the state.

As a result of the state inspectors’ findings, Iowa County Public Health and its registered nurses have been barred from evaluating the skills and competency of the county’s home-health aides through November 2024, according to the Iowa Department of Inspections and Appeals.

Since mid-November 2022, 13 of Iowa’s home-health agencies have been cited by the state agency for violations, although most of the 13 were cited for three or fewer violations. Five of the 13 agencies that were cited for violations are run by county public health departments.

The Iowa County Public Health Department’s home-health agency was cited for 34 violations in November and three additional violations in December. Many of the violations were related to nursing assessments, medication reviews, incomplete care plans, competency evaluations, personnel qualifications, emergency preparedness and numerous organizational issues.

The organization’s 37 violations is roughly 10 times the average number of violations cited by state inspectors at other home-health agencies statewide.

According to state inspectors, Iowa County’s new public health administrator and the Iowa County Board of Health met in July 2022 and discussed the need to inform state and federal regulators of a change in management for the home-health agency, but then neglected to provide the regulators with that information.

A month later, in August 2022, the county was working with a consultant on a mock audit to help prepare for the anticipated state inspection. The state inspectors later noted that when they attempted to inform the administrator of the violations that were uncovered, the administrator indicated she didn’t expect to be surprised since the violations would likely be the same as those noted by the consultant and which had yet to be corrected.

The inspectors noted that the county had failed to conduct the required competency testing for aides to ensure they were capable of delivering adequate care, and that the county had initiated services for one patient a week late without notifying the patient’s doctor. The inspectors also found the county had failed to conduct the required review of patients’ medications in three of the seven cases that were reviewed; had failed to identify duplicate drug regimens for patients, and had failed to have in place accurate, timely care plans for patients that included all of their medications.

The county also had failed to update patients’ care plans with new physician orders; had failed to give one patient the prescribed skin-care treatment on 12 occasions in during a four-week period; and had failed to adequately assess or provide transfer summaries for patients who required hospitalization, according to inspectors.

The county was also cited for failing to give its home-health patients the name and contact information for either the administrator or the clinical manager so that any concerns pertaining to their care could be properly reported and addressed.

The agency’s administrator, Lorinda Sheeler, declined to comment on the matter, as did Dr. Steven Rippentrop, chair of the Iowa County Board of Health. They referred all questions about the county’s home-health operations to the sheriff and to the county attorney, each of whom also declined to comment.

This article first appeared in the Iowa Capital Dispatch.