Government should face up to care center concerns


A few months ago, I bumped into a former aide to Gov. Robert Ray. As we reminisced about the governor, our conversation turned to his nearly daily meetings with journalists.
The aide said yes, those press conferences provided reporters with access to the governor and his comments on issues the state was handling and hearing about from Iowans.
But Ray believed the daily press gatherings had another important benefit, too: Ray could do his job more effectively by listening to the journalists’ questions, the aide said.
State government is a sprawling operation. With reporters combing government agencies for news and bringing their questions to the governor, it meant Ray would be better informed about what was going on in the government he was responsible for managing. Sometimes, those questions dealt with concerns the governor was unaware of — matters that could be dealt with quickly before a small issue could grow into a bigger problem.
Today, Iowa is at the point where one issue has been allowed to fester into a significant problem — and this should alarm Iowans with elderly relatives or who expect to be elderly someday themselves. That issue is the quality of care provided by some of Iowa’s 414 nursing homes and care centers.
Reporter Clark Kauffman of Iowa Capital Dispatch has focused on this issue. He has written about tragic deaths and serious injuries that were due to neglect or lack of adequate, timely care from nursing home employees. He has informed Iowans about the backlog of complaints to state regulators.
And most recently, he wrote about a report from the U.S. Senate Special Committee on Aging that found Iowa has the second worst ratio of nursing home inspectors to care centers. “Inspection delays endanger nursing home residents,” the report said.
Iowa has 46 inspectors who are responsible for an average of nine care centers each. An inspector’s workload encompasses about 600 beds.
In contrast, the Senate report showed Nebraska’s 33 inspectors are responsible for 5.7 care centers each, or an average of 430 beds per inspector. Missouri’s 190 inspectors cover an average of 2.7 centers each, or 280 beds. And in Illinois, the 315 inspectors each cover an average of 2.2 care centers, or 280 beds.
John Hale, who advocates on behalf of Iowa nursing home residents, said the federal report shows the Iowa Department of Inspections, Appeals and Licensing has too few inspectors to ensure care centers are meeting their obligations to residents and to the government, which pays the nursing home bills for low-income people.
Hale told Iowa Capital Dispatch, “An analysis of the data shows that the department is significantly understaffed, deals with the under-staffing by contracting out inspection functions to private companies, and ends up paying more to get less. The Legislature’s oversight committees should be — but aren’t — routinely meeting with the Department of Inspections, Appeals and Licensing and other state agencies to ensure that they are giving taxpayers their money’s worth. Their failure to do so is appalling.”
Questions that are not being answered by state officials include this dollars-and-cents query: Why is Iowa government contracting with these inspection businesses when it would be far less expensive to hire a few more employees for the Department of Inspections, Appeals and Licensing? Iowa Capital Dispatch said the pay range for registered nurses who work for the department and inspect nursing homes is $66,600 to $93,800 for a year’s work. Iowa is paying a private company $33,300 or $40,950 for a single inspection, depending on the size of the nursing home.
These “why” questions are not being answered because reporters do not have the opportunity to meet with Gov. Kim Reynolds on any predictable basis and ask these questions. Like Governor Ray’s aide mentioned, that is a missed opportunity for Reynolds to offer her perspective on the federal report and the issues it identifies. That is a missed opportunity for her to explain what her administration is doing to rectify these concerns. And that is a missed opportunity for her to address anxieties of relatives of nursing home residents who are troubled by conditions their loved ones see.
Ralph Rosenberg is an Ames attorney who served in the Legislature during the 1980s and 1990s. He is a thoughtful man, not someone who is quick to spout off. He commented on social media about the Iowa Capital Dispatch report and said Governor Reynolds could convene a special committee to dig into the issues involving nursing homes, as some predecessors did, and the Legislature could hold hearings on concerns the report identifies.
Rosenberg encouraged Iowans to tell their lawmakers and the governor to hire more state inspectors to handle nursing home complaints. He would like to see the Medicaid reimbursement raised for nursing home care for low-income people so these front-line workers could be paid more. That should help address the staffing shortages care centers now wrestling with.
I have a hunch Robert Ray would be asking state government and the best minds in Iowa to be looking for solutions to this disturbing problem.
Randy Evans can be reached at

Randy Evans, Long-term care centers, inspections, seniors, editorial, opinion, commentary, Freedom of Information Council, Iowa, Des Moines Register, Capitol Dispatch, Clark Kauffman


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