Bills propose boosting pay, training of Iowa nursing home staff

DES MOINES — Iowa House Republicans and Iowa Senate Democrats introduced their respective legislative proposals Tuesday to ensure safety, support and accountability in nursing homes and long-term care facilities.

Iowa is responsible for 3 percent of the nation’s nursing facility citations, and 4.1 percent of the nation’s immediate jeopardy and life-threatening situations — despite accounting for just 1 percent of the nation’s 65-plus population, according to federal data.

A report by the U.S. Senate Special Committee on Aging suggests Iowa has one of the nation's worst ratios of nursing home inspectors to care facilities, and that the state's use of private contractors to inspect homes is extraordinarily costly to taxpayers.

Under a bill advancing in the House, Iowa's nursing home staff would undergo new training. House Study Bill 691 would require the Department of Inspections, Appeals and Licensing to conduct training twice a year with inspectors and nursing homes to cover at least three of the 10 most frequent complaints found a year earlier.

The department also would be tasked with collecting data and identifying patterns of complaints against nursing facilities.

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"We want to make sure that both entities are on the same page — the nursing homes and the inspectors," Rep. Ann Meyer, R-Fort Dodge, who chairs the House Health and Human Services Committee, told reporters. "So we want to identify the top 10 complaints in the Iowa nursing homes and we want to make sure that those are addressed in training."

Senate Democrats released a package of legislation hoping to spur conversations with Republicans and find common ground to improve the care and oversight of Iowa’s nursing homes and protect seniors from neglect and abuse.

The bills would impose more frequent inspections and stricter penalties; study alternatives to institutional long-term care; raise the minimum wage for nursing home workers; and increase the monthly allowance for long-term care residents on Medicaid.

“Iowa’s journalists have put a spotlight on dozens of tragic situations and the Legislature can no longer ignore this,” Sen. Claire Celsi, D-West Des Moines, told reporters. “These are stories that have gripped everyone in the state of Iowa who has read them and sickened them, to be honest with you. The system that we have is clearly broken, and it’s time to fix it.”

She added: “There are many good facilities and we applaud them for the hard work they do every day, but there are simply some facilities and some situations that just beyond the pale that we need to fix.”

Democrats introduced the following bills:

"Iowans deserve safe, high-quality care that allows them to live their best lives and age with dignity in our long-term care facilities, but also at home and in their communities,“ said Sen. Janice Weiner, D-Iowa City.

Nursing home officials have said challenges including worker staff turnover rates and shortages fueled by low wages have impacted patient care. Industry officials say they also have felt financial strain from low Medicaid reimbursement that has not kept up with rising costs, making it harder to offer competitive wages.

According to state data, the average pay for direct care workers in nursing homes was $13 an hour in 2022.

Over two dozen of Iowa’s more than 400 nursing homes have closed since last June, with nursing home officials citing difficulties recruiting and keeping staff.

“Through our research and conversations, it quickly became clear that inadequate direct care staffing levels often led to resident harm documented in most tragic cases,” Celsi said.

House Republicans say they’re concerned that agencies supplying temporary employees to nursing homes are exploiting recently boosted state funding for nursing home care.

HF 2199 would cap what temporary staffing agencies can charge Iowa’s medical providers for nursing services. The bill is intended to provide financial relief for nursing homes, hospitals and other health care facilities that have heavily relied on contract nurses and contract nursing agencies, where the pay is substantially higher, to address workforce shortages.

Republicans, who are in the majority in both chambers, are not expected to take up Democrats' bills in committee before a Friday legislative deadline. But the proposals could be introduced during Senate debate and worked into spending bills later in the session.

"I don't know about moving legislation this session, but I do know that many of our colleagues, both in the House and in the Senate, have expressed an interest in this issue and getting something done," Celsi told reporters. “This issue should not be partisan. All of us are going to get old. All of us are going to need care someday to some extent, and we all have family members that need care.”

Senate Republicans earlier this year rejected a request by Democrats for a state oversight meeting to investigate nursing home care in the wake of recent reports of deaths, abuse and neglect.

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Brent Willett, chief executive officer of the Iowa Health Care Association, which represents long-term care facilities, said the group is committed to working with lawmakers to ensure long-term health care facilities are equipped to provide high-quality care.

“Delivering quality care is a continuous process, and there is always more we can do, which is why IHCA continues to advocate for common-sense policies designed to attract, train, equip and retain more permanent direct care workers in Iowa communities to meet the growing demand for long-term care services and supports,” Willett said in a statement.

John Hale, an advocate for older Iowans, praised Senate Democrats' proposals and urged lawmakers “to set party politics aside and work together to identify and pass portions of the bills they can agree on.”

“ … The bottom line is that older Iowans and adults with disabilities who reside in nursing homes are some of Iowa's most vulnerable citizens,” he said in a statement. “They deserve to have their needs addressed. Their needs are worth fighting for."

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