by Robin Opsahl, Iowa Capital Dispatch
April 8, 2025
The Iowa Senate passed a bill clarifying some parts of the process for the state’s review of “immediate jeopardy” violations at Iowa nursing homes, but did not approve changes suggested by Democratic senators to increase oversight and regulation over care facilities in the state.
House File 309, passed 39-9 Tuesday, was described by the bill’s floor manager Sen. Kara Warme, R-Ames, as a small, technical correction to a law passed in 2024 on Iowa nursing home oversight. In 2024, the Legislature approved a measure requiring the Iowa Department of Inspections, Appeals and Licensing, the state entity charged with nursing home oversight, to allow nursing homes to review potential citations for substandard care and placing residents in immediate jeopardy of serious injury or death.
During the review process with DIAL, facilities would be able to provide additional “context and evidence” before the state agency would make a decision on issuing a citation. Under previous law, nursing homes were able to provide additional context after citations were issued.
The legislation sent to Gov. Kim Reynolds Tuesday would clarify that the review process would happen for each instance of a “deficient practice identified by the department for which a citation may be issued,” and that the review process only applies to nursing facilities and not all health facilities. However, advocates for Iowa seniors and other critics said the measure, within the larger discussion of the 2024 law, could conflict with federal law or lead to fewer citations for legitimate cases of substandard care.
While the measure is a relatively minor change to Iowa’s laws on nursing homes, the bill is also currently the only legislation dealing with nursing home regulation to survive past the second funnel deadline of the 2025 legislative session. Using the legislation as a vehicle for a larger discussion on nursing home inspections and care, Senate Democrats introduced four amendments they argued would help prevent resident abuse and neglect at Iowa care facilities.
Senate Minority Leader Janice Weiner introduced two amendments, both of which were ruled out of order, one of which would allocate $600,000 in funding for DIAL to hire 30 new inspectors, increase penalties for certain regulatory violations by facilities and give DIAL a shorter time frame to respond to complaints.
“The bill is currently written is lopsided in favor of those who run nursing homes, when those we should be protecting are our seniors,” Weiner said. “And this amendment balances and remedies that.”
The other amendment proposed a ban on private equity funds’ ability to acquire Iowa nursing homes. While speaking on the measures, Weiner referenced several Iowa Capital Dispatch reports on violations that occurred in care facilities, including a case in Keota, where a resident at a care facility died from complications resulting from a fall after being found lying with bleeding head wound but not being transferred to a hospital until 15 days later. She also cited a case in Wellman, where a nursing home worker found a woman lying on the floor with a “big goose egg” on the side of her head but was put to bed instead of being provided medical assistance.
“These are not just awful individual stories, they’re part of an incredibly problematic data set,” Weiner said. “According to a federal database, Iowa is one of the worst performing states for nursing home violations, with triple the violations of what would be expected for our state’s population.”
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Two other amendments, from Democratic Sens. Tony Bisignano of Des Moines and Molly Donahue of Marion, proposed stopping care facilities from being able to ban residents and their guardians from installing video cameras in residents’ rooms, and from allowing nursing home residents to also submit context and evidence to DIAL during the review process. These measures were also not accepted by the Republican-controlled Senate.
Three of the four amendments were bills introduced by Senate Democrats in early March as pieces of a 14-bill package on Iowa nursing homes. None of these measures survived the first funnel deadline. Sen. Zach Wahls, D-Coralville, criticized Republicans for rejecting the measures as non-germane or irrelevant to include in the legislation, as the majority party has previously passed “strike-all amendments” on the floor rewriting the entire content of bills.
“We were told that the Republican Party is sympathetic to the plight of Iowa seniors who are facing unbelievable horrors in these facilities — that their safety is a top priority,” Wahls said. “These amendments didn’t need to have their germaneness questioned. These amendments would have materially improved legislation and created important protections for Iowa seniors who live in these facilities and whose families count on these facilities to provide these services. … So I don’t want to hear it that these amendments weren’t logical, weren’t connected to the legislation. We had an opportunity to hear from the public on these bills, and the Republican majority decided not to give any of those three bills, those three amendments, a hearing.”
Warme said the bill was a technical fix of the established policy for addressing situations involving residents in immediate jeopardy, “with the goal of problem solving and improving care in our nursing facilities.” She thanked Sen. Sarah Trone Garriott, D-West Des Moines, for saying many facilities and workers are trying to do their best.
“I agree with that, and the way that others would describe their amendments, you’d think that these nursing facilities are staffed by monsters,” Warme said. “I appreciate the health care workers, nurses and CNAs, who are doing so much to care our elderly in these facilities.”
Iowa Capital Dispatch is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Iowa Capital Dispatch maintains editorial independence. Contact Editor Kathie Obradovich for questions: info@iowacapitaldispatch.com.
