Nursing home residents’ cries are falling on deaf ears in the Capitol

Instead of hiring more inspectors, lawmakers are finding ways to reduce inspections

Iowa Capital Dispatch has been reporting for four years about nursing home residents dying due to neglect, as well as the state’s backlog of inspections and its lack of staff to complete them. It was bound to get lawmakers’ attention eventually.

Deputy Editor Clark Kauffman, who writes these stories, has been reporting on similar issues for more than two decades.

I was semi-hopeful before the start of the 2024 legislative session that this would be the year the Legislature actually did something meaningful about it. I should have known better.

This week, on the same day that Iowa Capital Dispatch reported that two patients died of injuries after falling repeatedly at an Iowa nursing home, the Iowa House passed a bill allowing the state agency that oversees nursing homes to skip certain on-site inspections after receiving a complaint about an issue that has been the subject of a previous complaint.

The bill, House File 2585, passed on a bipartisan vote despite some Democrats raising serious concerns about the provisions dealing with inspections.

Rep. Megan Srinivas, a Des Moines physician, explained why this is a terrible idea. She described one of her patients who, until a fall in her home, had been an active 78-year-old grandmother, living independently. After treatment for a hip injury, she had to go to a nursing home for recuperation and rehabilitation, with the expectation that she would be able to return home.

“Unfortunately, she ended up back in the emergency room to see me instead,” Srinivas said. “She would ring the bell at her nursing home, but she wouldn’t get help when she needed it. She would, because of the wait time — sometimes two, three hours — end up soiling herself and sitting in her stools or her urine for extended periods of time until the skin on her buttocks broke down. It formed a huge wound, an open wound that caused her to have a bloodstream infection and that’s why she came in to see me.”

Think this was an extreme situation that hardly ever happens? Think again. Iowa Capital Dispatch reported on a similar case last summer in which a nursing home resident’s pressure sores developed into huge, gaping wounds. That woman died.

Srinivas’ patient was treated with antibiotics and returned her to the nursing home with the expectation that after a few weeks, she would be back on the path toward going back home.

“Unfortunately, she ended up back in the hospital again just two months later, because that same issue happened yet again. She was left in her stool time after time to the point where that simple fall ended up with her having now an infection that’s on her heart valve,” Srinivas said.

Now, because surgery is not an option for her heart, she will likely never get to go back home, Srinivas said. “This is what happens when we don’t have sufficient oversight in our nursing homes. This is what happens when people are left without being accountable for those in their care.”

And this kind of legislation is what happens when an interest group is as far into lawmakers’ pockets as the nursing home industry. Elderly Iowans’ cries are falling on deaf ears in the Capitol just as surely as they are in understaffed nursing homes.

Srinivas proposed in an amendment to add 30 more nursing home inspectors at a cost of $2.4 million, after Republicans killed a separate bill. That amendment failed, and lawmakers are instead helping the nursing home industry find ways to reduce their exposure to inspections and allowing them in the door to talk their way out of being cited with violations.

Another bill that Democrats proposed would have increased the minimum wage for front-line caregivers to $15 an hour, with gradual increases to $20 an hour if Medicaid covers it. Instead, the House voted Tuesday to cap payments from health care facilities to employment agencies that provide temporary workers to cover for staff shortages that are primarily caused by low pay.

The lawmakers who are making these decisions must think they’re never going to need long-term skilled care. But they almost certainly will. Someday, many years from now, when they’re ringing a call button with no one to help while they’re rotting in their own excrement, maybe they’ll remember how, back in 2024, they could have done something to help.

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