Iowa Auditor, inspections agency at odds over nursing home inspection frequency

DES MOINES — Iowa State Auditor Rob Sand claims the state is failing to meet federal requirements for nursing home inspections, an allegation the director of the state’s inspections agency disputes.

Federal regulations dictate nursing homes be inspected at least once every 15.9 months. Sand, a Democrat, issued a report Monday that says 85 percent of Iowa’s 403 certified nursing homes recently went more than 15.9 months between inspections.

Sand’s report says the state is failing to meet those federal requirements and that Iowa lags behind neighbor states in nursing home inspection frequency and licensed staff levels at nursing homes.

Sand said he used publicly available data from the federal Centers for Medicare and Medicaid Services to compile the report.

A spokesperson for the Iowa Department of Inspections, Appeals and Licensing responded to The Gazette with a statement that claims Sand’s report uses “outdated and/or incorrect data and inaccurate performance measurements.” The DIAL statement says the state “is conducting timely nursing home inspections and will meet the federal requirements.”

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.

According to Sand’s report, the averages for the most recent two gaps between inspections at Iowa nursing homes — even when taking into account the federally ordered relaxing of rules during the COVID-19 pandemic — is 17.1 months, well above a federally required average gap of 12.9 months.

Sand’s report also said 85 percent of Iowa nursing homes had a recent inspection gap of more than the federally required 15.9 months.

“This is just an issue that has been the subject of lots of questions, been the subject of lots of coverage, and we thought that this information would be hopefully useful to policymakers as they decide whether or not they want to do something about the crisis in Iowa’s nursing homes,” Sand said Monday during a virtual news conference.

The statement from DIAL, which is led by Director Larry Johnson, disputed Sand’s claims, saying the state will meet the federal mandate for nursing home inspections in the federal fiscal year that ends at the end of this month. The agency’s statement said as of Monday, 99 percent of Iowa nursing homes are within the federally required 15.9-month inspection interval and that the remaining 1 percent will be completed before the end of the month.

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DIAL’s statement said the statewide average inspection gap is 12.75 months — not the 17.1 months that Sand reported and under the federal requirements — and that the figure will continue to improve.

The DIAL statement also described Sand’s report as “a waste of taxpayer dollars” since the federal Centers for Medicare and Medicaid Services will publish its own findings at the end of the month.

“Had the auditor contacted our department and worked with us, as he had done in the past, we would have provided his office with the accurate federal performance measurements and current inspection data,” the DIAL statement said. “Due to the dedication and hard work of the State’s surveyors (nursing home inspectors), the State has reduced the backlog caused by the pandemic and is conducting nursing home inspections in a timely manner.”

Democratic state lawmakers introduced legislation during the 2024 session of the Iowa Legislature that would have funded the hiring of 30 additional state nursing home inspectors and required more regular facility inspections. The legislation did not pass in the Republican-majority Legislature.

“The data revealed by the state auditor (Monday) is simply unacceptable,” Iowa Sen. Janice Weiner, a Democrat from Iowa City, said in a statement. “We must do better as a state, which is why Senate Democrats have put forward a comprehensive plan to ensure safety, support, and accountability in Iowa nursing homes. Iowa’s seniors cared for us, and it is past time for us to care for them.”

Iowa nursing home staffing levels low

Sand’s report also highlighted a shortage of licensed nurses in Iowa’s nursing homes, a topic on which there is broader agreement and concern among professionals, advocates and policymakers.

According to Sand’s report, Iowa ranks 46th in the nation in the ratio of licensed nursing staff per resident, and the state has the 17th-highest turnover ratio among nursing home staff.

According to Centers for Medicare and Medicaid Services data, 14 percent of Iowa’s 422 nursing facilities were cited for insufficient staffing in the 2023 federal budget year. Only five other states had a worse record of complying with federal law that requires all nursing homes provide sufficient nurse services to safely care for and meet their residents’ needs.

And more than 43 percent of Iowa nursing homes do not meet upcoming federal staffing level mandates, according to a recent national report.

Tom Barton contributed.

Comments: (515) 355-1300, erin.murphy@thegazette.com

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