Hundreds of Iowa nursing home complaints languish

In January 2020, Kimberly Jacob contacted the Iowa Department of Inspections and Appeals with a complaint about an Iowa nursing home: Her grandmother, Connie Roundy, lived at the Rose Vista Home in Woodbine and Jacob was concerned she wasn’t receiving adequate care.

The department acknowledged the complaint within days, but it wasn’t until March 25, 2021 — 14 months later — that it investigated. By that time, Roundy, a former schoolteacher, seamstress and farm wife, had been dead for six months.

The agency ruled Jacob’s complaint was substantiated and Rose Vista was cited for three regulatory violations, none of which appear directly related to Roundy’s care. No fines were imposed.

Jacob says she’s disappointed not only in the handling of the investigation, but in the length of time it took the agency to launch the investigation.

“DIA has a responsibility to execute investigations in a timely manner,” she said. “Failure to do so has serious consequences for our most vulnerable population. My grandma was a beautiful human being and she deserved better.”

According to newly disclosed statistics from the department, Jacob’s experience is not unique. As of last month, there were 410 complaints pending against Iowa nursing homes that were at least 30 days old. Of those, 201 complaints — almost half the total number — were more than 120 days old. In fact, 24 of the pending complaints against Iowa nursing homes are now more than one year old, according to the department.

“That’s a real problem,” said Toby Edelman, senior policy attorney at the national Center for Medicare Advocacy. “I mean, how can you investigate something that happened 120 days ago? Or a year ago? People are probably not around at that point — the staff, the residents or even the families.”

Department spokeswoman Stefanie Bond says that after Jacob filed her initial complaint in January 2020, she provided additional information to the agency in February. But four days later, Bond said, federal officials pulled state inspectors out of care facilities across the country due to COVID-19 and suspended most inspection activity.

It wasn’t until Jan. 4, 2021, Bond said, that the feds re-prioritized inspections for investigating complaints and recertifying homes. Three months later, she said, inspectors entered Rose Vista Home and investigated three pending complaints against the facility.

State records indicate that by the time Iowa’s nursing home inspectors resumed their investigations, they sometimes faced a significant backlog of previously uninvestigated complaints.

For example:

Ten complaints against Fort Dodge home: In August 2021, state inspectors visited the QHC Fort Dodge Villa and issued a 199-page inspection report detailing 19 regulatory violations. That inspection was preceded by 10 complaints against the home — every one of which were substantiated during the inspectors’ visit.

One death and four complaints in Exira: In April 2021, a resident of the Exira Care Center in Audubon County was found on the floor in a pool of blood with a head injury sustained in a fall. Two months later, the same woman was again found on the floor in a pool of blood, but this time she was dead. Inspectors didn’t visit the home and investigate either incident until May of this year, 11 months after the death. By that time, the inspectors had four separate complaints against the home to investigate. They cited the care center for 11 regulatory violations, substantiated three of the four complaints, and fined the home $18,000.

Eight complaints against Shenandoah home: In April 2021, state inspectors visited the Garden View Care Center in Shenandoah in response to eight complaints, seven of which were substantiated. A worker told inspectors she watched an aide pull a woman out of a room and drag her backward across the floor into another room. The inspectors cited the home for 16 regulatory violations. Federal officials imposed a fine of $316,140. Because the home didn’t appeal, the penalty was automatically reduced to $205,491.

‘Working through the backlog’

Bond says the pandemic, which hit Iowa about six weeks after Jacob filed her complaint, is largely to blame for the backlog.

She notes that after the federal Centers for Medicare and Medicaid Services suspended inspections at nursing homes, it developed a COVID-19 “focused infection control” process that directed state agencies to focus inspections on infection prevention.

As a result, Bond said, complaint investigations were temporarily limited to those involving infection issues and those involving allegations of immediate jeopardy to residents’ health and safety.

Currently, CMS is requiring state agencies to reduce their complaint backlogs by 60 percent and their recertification backlog by half. In Iowa, Bond said, inspectors are “working through the backlog,” and the agency has hired federally certified contractors to help.

Federal work-performance reviews of the department show that long before the pandemic hit, the state agency had difficulty meeting federal standards for investigating complaints.

Those reviews indicate that between September 2018 and September 2019, the agency fielded 971 nursing home complaints that residents’ mental, physical or psychosocial status were being harmed. “Complaints” include self-reported incidents that emanate from the homes themselves.

Those cases were considered serious enough that a “rapid response” by the agency was required, which meant that an on-site visit was to be made by state inspectors within 10 days.

The agency failed to meet that standard in 631 cases, or 65 percent of the time. In fact, 41 of those homes still hadn’t been visited by an inspector at the time of the federal performance review, which was concluded in March 2020.

The previous year, the agency fielded 1,041 nursing home complaints that alleged harm. In 646 of those cases, or 62 percent of the time, the agency failed to conduct an inspection within the 10-day time frame. Six complaints languished for more than 130 days with no inspection taking place.

System is ‘overwhelmed’

Iowa Long-Term Care Ombudsman Angela Van Pelt says she’s noticed that when state inspectors visit a care facility, they’re now handling multiple complaints, which in itself can slow down the investigation process. The longer it takes to make those visits, she said, the more likely it is that the number of complaints will grow.

And because the staff turnover in nursing homes appears to have reached an unprecedented level, with COVID-19 accelerating staff resignations and retirements, it can be hard for investigators to determine whether the complaints have merit, she said.

“I know our staff is talking consistently about administrative turnover — that in the 30 years they’ve been working, they’ve not seen this sort of shift, in terms of homes going through one administrator after another,” Van Pelt said. “This is just an overwhelmed system right now.”

This story has been condensed from a report that first appeared in the Iowa Capital Dispatch.