Iowa Republicans and Democrats offer competing solutions to provide nursing home oversight

Iowa Capital Dispatch

Democratic state lawmakers are pushing legislation to increase state oversight of nursing homes while Republican legislators are advancing a bill that could reduce such oversight.

Both initiatives are being advanced now due to a spate of deaths and serious injuries tied to regulatory violations in Iowa nursing homes. Republican lawmakers say the situation calls for a more “collaborative” approach to enforcement, while Democrats argue the state isn’t being tough enough on violators.

On Tuesday, the House Subcommittee on Health and Human Services reviewed a GOP-backed bill, House Study Bill 691, that would revise the state law that requires the Iowa Department of Inspections, Appeals and Licensing to make a preliminary review of a nursing home complaint and, unless DIAL concludes the complaint is intended to harass a facility, make an on-site inspection.

The bill would add new exceptions to the requirement for on-site inspections, allowing DIAL to forgo an on-site visit if the agency concludes the complaint involves an issue that was already the subject of a complaint or a self-report from the facility itself within the previous 90 days. So, for example, if a facility self-reported an incident tied to insufficient staffing or a failure to monitor residents, it might not face another on-site inspection if a resident complained of the same issue two months later.

Another element of the bill would allow DIAL to forgo an on-site complaint inspection if the agency believes the matter can be investigated by phone or through an exchange of documents.

HSB 691 would also require DIAL to provide semiannual “joint training sessions” in which both state inspectors and industry officials would review the most frequently cited violations in Iowa during the previous year. As part of that process, the state agency would identify for the industry any regional patterns of violations.

In addition, DIAL would be required to establish a new process whereby every citation issued to a care facility for substandard quality of care or for residents’ being placed in immediate jeopardy would first be “reviewed” with representatives of the nursing home so they could provide additional “context and evidence” before top officials at DIAL decide whether to issue the citations.

GOP backers of the bill say the changes would help foster a more “collaborative” relationship between the care facilities and the state agency that’s tasked with enforcing federal laws and regulations that are intended to ensure quality care.

At Tuesday’s subcommittee meeting, the three-member panel’s lone Democrat, Rep. Timi Brown-Powers, voiced support for the bill.

“You want to make sure our nursing homes feel like we’re supporting this,” she said. “Right now, Iowa nursing homes are making headlines — and not in a great way, and so anything that we can do (needs) to make that a more positive transition.”

After the meeting, Brown-Peters said she has concerns with the bill, including the provision that could result in fewer on-site inspections. “But at the end of the day, I’m not sure this bill is going to do anything,” she said. “I’m still concerned we’re not going to have people out there investigating.”

John Hale, a consultant and advocate for Iowa seniors, said Tuesday he is “particularly alarmed by the broad language in the bill that would allow DIAL to dismiss resident complaints if they thought they were unreasonable or if they were seen to be harassing. I’ve worked with dozens of residents or their family members over the years who are seen as irritants by facility management. The reality is that sometimes you have to be annoying to get any attention or action. DIAL should not be able to simply dismiss the complainants because they continue to complain about issues that are seen as unresolved.”

Hale also said he’s concerned by the provision that would allow DIAL to forgo an on-site inspection if the same issue was the subject of a prior complaint or self-report. “It seems to me that repeat complaints should be seen as a great concern rather than a nuisance,” he said.

Another bill, Senate File 2063, that has the backing of some Republican lawmakers would require DIAL to launch, at taxpayer expense, a pilot “training program” in which the state would pay a portion of privately employed nursing home administrators’ salaries while those individuals undergo training.

That bill has drawn objections from the former head of the state inspections agency, Dean Lerner.

“This presents a conflict on its face,” Lerner said. “It should be obvious to everyone that DIAL, the nursing home regulator, should have nothing to do with the establishment of, or payment for, a program for trainees who would themselves … be under the regulatory oversight of DIAL.”

Democrats call for a different approach

Also on Tuesday, Senate Democrats announced they were backing several newly filed pieces of legislation to address what they called the “resident safety crisis” in Iowa’s nursing homes.

Sen. Claire Celsi, a West Des Moines Democrat, said the news media has reported “dozens of tragic situations and the Legislature can no longer ignore this… The system that we have is clearly broken and it’s time to fix it.”

Celsi said the legislation she and her Democratic colleagues are proposing is necessary partly because Republican lawmakers have refused to hold any Government Oversight Committee hearings on Iowa’s nursing homes and their oversight.

Among the proposals:

Senate File 2304 would establish a Long-Term Care Facility Safety Council that would add citizen review and input into DIAL’s oversight of nursing homes and would establish stiffer penalties for violations. The bill would also result in Iowa hiring 30 additional nursing home inspectors and assisted living monitors, at a cost of roughly $2.4 million annually, to ensure that inspections are done on a more timely basis.Senate File 2305 would establish a new minimum wage of $15 for front-line caregivers, with that minimum gradually rising to $20 an hour. The pay increase would be contingent on Medicaid increasing payments to nursing homes to offset the added expense.Senate File 2303 would increase, from $50 to $85, the Medicaid-funded personal needs allowance that care facility residents receive each month to pay for such things as cell phone bills, favorite snacks or shampoos, and other sundries. It has been 21 years since the Iowa Legislature last raised the personal needs allowance for nursing home residents.Senate File 2306 is intended to support alternatives to institutional long-term care, such as home health care, adult day care, and dementia care specialists whose work can enable Iowa seniors to age at home.

In a written statement responding to the Senate Democrats’ assertions, Iowa Health Care Association President and CEO Brent Willett said Iowa’s nursing home industry is “committed to work alongside policymakers to ensure Iowa’s long-term health care facilities are equipped to provide access to high-quality care across our state.”

He said federal data shows that Iowa nursing home providers “outperform the nation” in terms of the federal government’s five-star quality ratings for overall performance.

“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.”

“The stories we’ve been hearing about understaffing, abuse, neglect and an overall lack of accountability in Iowa nursing homes are devastating – and unacceptable,” Celsi said. “Our state’s current approach to long-term care is fundamentally broken and failing to protect Iowans. Today, we’re offering a comprehensive approach that will protect seniors and give Iowa families confidence in their long-term care decisions.”

“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. “Senate Democrats are introducing this comprehensive package of legislation to provide seniors with the safeguards, options, and accountability, no matter what kind of care they choose.”

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