(C) Iowa Capital Dispatch
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Advocates: Legislators must address nursing home complaint backlog [1]
['Clark Kauffman', 'More From Author', '- July']
Date: 2022-07-19
Iowa lawmakers aren’t addressing the state’s oversight of nursing homes, advocates for the elderly say, despite a backlog of hundreds of uninvestigated complaints.
“Elected officials should be shouting from the rooftops about their dissatisfaction with the current state of affairs,” said John Hale, a consultant and an advocate for Iowa seniors. “Yet they aren’t. Their silence means they are either entirely comfortable with the status quo, or they weren’t aware there was a problem. Either response is unsatisfactory.”
Dean Lerner, who headed the state agency that inspects Iowa nursing homes under Democratic Gov. Chet Culver, said Republican Gov. Kim Reynolds is partly to blame.
“It continues to baffle me how this governor, and her Republican House and Senate, continue to knowingly ignore critical responsibilities to Iowa’s most vulnerable citizens, witness the harms caused, and get re-elected,” Lerner said.
Two weeks ago, the Iowa Capital Dispatch reported that the Iowa Department of Inspections and Appeals had 410 complaints pending against Iowa nursing homes that were at least 30 days old. Of those, 201 complaints – almost half the total number — were more than 120 days old, and 24 unresolved complaints were at least a year old.
In January 2020, Kimberly Jacob complained to DIA about the care her grandmother, Connie Roundy, was receiving at a home in Woodbine. DIA investigated the matter in March 2021 — 14 months after the complaint was lodged and six months after Roundy had died.
Sen. Zach Wahls of Coralville, minority leader in the Senate, said he “was pretty stunned” at the number of unresolved complaints at DIA.
“The governor’s disastrous handling of our economy has compromised the ability of long-term care facilities to fully staff their buildings and made it harder for the Long-Term Care Ombudsman’s Office or DIA to conduct routine inspections,” he said. “Gov. Reynolds and Iowa Republicans have made this crisis worse, not better, by refusing to prioritize funds for DIA inspectors or the Long-Term Care Ombudsman’s office and by signing off on the discontinuation of on-site visits by long-term care ombudsmen.”
THE BACKLOG Here’s a look at the age of pending complaints before the Iowa Department of Inspections and Appeals, the state agency that oversees nursing homes, hospices, surgical centers, dialysis centers and other medical facilities in Iowa: Pending complaints against Iowa nursing homes: Filed 30-60 days ago: 80 cases Filed 60-90 days ago: 85 cases Filed 90-120 days ago: 44 cases Filed more than 120 days ago: 201 cases (24 of these are more than a year old) Total: 410 cases Pending complaints against other types of Iowa facilities: Filed 30-60 days ago: 24 cases Filed 60-90 days ago: 22 cases Filed 90-120 days ago: 23 cases Filed more than 120 days ago: 54 cases Total: 123 cases Source: Iowa Department of Inspections and Appeals data as of June 2022.
Rep. Holly Brink, an Oskaloosa Republican who served this year as chair of the House Government Oversight Committee, said Tuesday she was unaware of a complaint backlog or the Capital Dispatch news story, which was reprinted in the Des Moines Register, Cedar Rapids Gazette and Mason City Globe Gazette.
“No one has brought that to my attention,” she said, adding that she hasn’t looked at nursing home oversight in the past.
Brink said she couldn’t recall whether she supported this year’s legislation that would have awarded the Iowa Long-Term Care Ombudsman’s Office $300,000 to hire additional staff to investigate the nursing home complaints directed to that agency. The legislation won approval in the House, but as part of a much larger appropriations bill. It died in the Senate.
“Without seeing the exact legislation, I don’t think it’s fair for anyone to make a comment on that,” she said. “I just don’t think that’s fair for anyone to comment if they don’t remember every exact detail of it.”
House and Senate Republican leaders — including House Speaker Pat Grassley, House Majority Leader Matt Windschitl, Senate President Jake Chapman, Senate President Pro-Tem Brad Zaun and Senate Majority Leader Jack Whitver — could not be reached for comment Monday and Tuesday.
Siegrist: Backlog is ‘concerning’
Rep. Brent Siegrist, a Council Bluffs Republican and an assistant majority leader in the House, said the complaint backlog is “certainly concerning,” though he’s not sure what sort of action lawmakers might take next year.
“It’s certainly something that merits some attention,” he said. “I think that article probably had some people wondering what’s going on, so I assume it will get some attention.”
Asked whether he thought House Republicans would be willing to hold Government Oversight Committee hearings on the matter even if they reflect poorly on the Reynolds administration, Siegrist said, “I understand that concern, but I don’t know that it is a fair assessment. I think those (decisions) are made on a case-by-case basis. And we’ll obviously have a new oversight committee chair since Rep. Brink is not running for re-election. So that might change some things.”
Rep. Mike Bergan, a Dorchester Republican, said he’s not sure how receptive lawmakers will be to providing additional, on-going appropriations for more nursing home inspectors or long-term care ombudsmen, but said lawmakers did provide new money this year for the inspections department to bring itself up to date on complaint investigations over the next 18 months.
DIA officials have said the COVID-19 pandemic is largely to blame for the backlog of uninvestigated complaints.
After the federal Centers for Medicare and Medicaid Services, or CMS, suspended state inspections at nursing homes to protect residents, it developed a COVID-19 “focused infection control” process that directed state agencies like DIA to focus their inspections on infection prevention.
As a result, complaint investigations were temporarily limited to those involving infection issues and those involving allegations of immediate jeopardy to residents’ health and safety. That, in turn, led to a growing nationwide backlog of uninvestigated complaints.
Currently, CMS is requiring state agencies to reduce their complaint backlogs by 60%. DIA inspectors are working on the backlog with federally certified contractors who have been hired to help in that effort.
Backlog pre-dates the pandemic
Federal work-performance reviews of DIA show that long before the pandemic hit, the state agency had difficulty meeting federal standards for investigating complaints.
Those reviews indicate that between September 2018 and September 2019, DIA fielded 971 nursing home complaints that residents’ mental, physical or psycho-social status were being harmed. Those cases were considered serious enough that a “rapid response” by DIA was required, which meant that an on-site visit was to be made by state inspectors within 10 days.
The agency failed to meet that standard in 631 cases, or 65% of the time. In fact, 41 of those homes still hadn’t been visited by an inspector at the time of the federal performance review, which was concluded in March 2020.
The previous year, DIA fielded 1,041 nursing home complaints that alleged harm. In 646 of those cases, or 62% of the time, the agency failed to conduct an inspection within the 10-day time frame. Six complaints languished for more than 130 days with no inspection taking place.
In 2017, the inspector general for the U.S. Department of Health and Human Services studied states’ compliance with the federally imposed deadlines for investigating complaints. The study revealed that almost one-fourth of all states had failed to meet performance thresholds for timely, onsite investigations of high-priority complaints in each of the five years studied.
At that time, Iowa was one of four states that failed to meet the standard in four of the five years.
“Investigations shouldn’t take 120 days to complete,” said Hale. “And investigations taking over a year to complete? That, pure and simple, is a total failure of government to protect the health and safety of Iowans … Frankly, I’m tired of witnessing and being told stories about inadequate care at too many of these facilities. Residents deserve better care. Taxpayers deserve better use of their dollars.”
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