- John and Terry Hill own The Hale Group, an Ankeny-based defense company focused on making Iowa a better place for everyone.
“My grandmother was a beautiful person and deserves better.”
What was missing from this grandmother’s experience as a resident of a Woodbine nursing home was a timely and effective investigation of her complaints about inadequate care. It’s one of many sad examples in a recent article by Clark Kaufman for Iowa Capital Dispatch.
Kaufman’s reporting focused on the Inspection and Appeals Service, a government agency tasked with conducting routine investigations of nursing facilities and responding to residents’ complaints. Kaufman documented lengthy delays in investigating complaints – with many waiting for more than a year. In some cases, investigations took place months after the death of a resident.
These delays represent the administration’s failure to serve Iowa residents effectively.
Unfortunately, we—and other advocates for nursing home residents—have heard plenty of stories about the inadequate response from the Inspection and Appeals Administration over the many years we have pushed for better home care.
The stories fell on deaf ears in the Iowa legislature, with many lawmakers defending the inaction by saying they were unaware of the problems. Others, who know the problems, do very little about them. Which is worse: ignorance or doing nothing?
more:Opinion: Died trying to improve the nursing home she lived in
Purposeful inaction. Both the Iowa Senate and the Iowa State House have legislative oversight committees designed to review the effectiveness of state programs and agencies. During the 2022 session earlier this year, while the effects of the pandemic were still having a major impact on the nursing home industry, its workforce and its residents, Republican-controlled committees chose not to meet to discuss these issues.
The Iowa legislature has also failed in its duty to Iowans.
Is the absence of government oversight and delayed investigations one of the biggest problems here?
no. The biggest problem is the poor quality of care in many of Iowa’s 400-plus nursing homes. Raising residents’ complaints that require investigations. If quality improves, residents’ quality of life will improve, and investigations can be reduced.
Each year, advocacy groups at the Capitol provide solutions to improve the quality of care. Every year ideas wither. We know because we’ve been there, in both public and private meetings where good ideas are delayed or killed. The nursing home industry prevents them, from not wanting to be, as they put it, under “further regulation”.
The strength of the industry is enormous. Lobbyists and officials in nursing home trade associations have an intimate relationship with elected leaders. They make large donations that fuel their re-election campaigns. They communicate with each other and become friends. They always ensure that legislators are recognized for their support in the media in their hometowns.
It is time to break the perennial legislative impasse. Quality of care issues exacerbated by COVID cannot be resolved by doing what has always been done.
Here is what we suggest:
- Credits for nursing homes (estimated at more than $700 million last year) must be tied to outcomes, in other words, quality care production. The state must set performance expectations for the quality of care that is measured, analyzed and reported to the public. Some facilities make millions of dollars annually, year after year, for providing woefully inadequate care. If they get paid for poor care, what incentive do they have to improve?
- A portion of the annual appropriations should be targeted to meet the workforce challenges that have plagued the industry and lead to lower quality of care. Nothing is more important than Direct Care employees who are well paid, benefit, trained and motivated to stay on the job. If additional appropriations are required to make this happen, the industry needs to sit down with consumer and worker advocates, determine what is required and prepare a joint application to the governor and legislature.
- The state should help the poorly performing utilities improve by providing technical assistance and requiring the adoption of best practices from other well performing utilities. If they don’t improve, the state should treat them like a failing bank – requiring a change of management or selling to an owner/operator with a proven track record of success.
- State agencies tasked with improving the quality of care in nursing homes need more oversight. These include the Department of Inspection and Appeals, the Office of the Long-Term Care Ombudsman, and managed medical care organizations. If legislative oversight committees are unable or refuse to do so, funding must be made available to other public or private entities to do so.
minimum? Like Woodbine’s grandmother, there are many beautiful humans in Iowa who deserve the best. All residents deserve high-quality care. No exceptions.
It’s time for our elected leaders, particularly those who hold power in State House, to be true to the people of Iowa. If they think the status quo in home hospice care is good, they should say so. If they do not believe the status quo is acceptable, they should pledge now – before the fall elections – to take long-overdue, meaningful action. Voters should pay attention and vote accordingly.
John and Terry Hill own The Hale Group, an Ankeny-based defense company focused on making Iowa a better place for everyone. Contact: [email protected]