State Auditor Sand’s report should be a call to action

John and Terri Hale

Rob Sand, Auditor for the State of Iowa, recently did what no statewide elected official in Iowa has done in a long time — he brought attention to problems in nursing homes. A report from his office discussed the lack of timely nursing home inspections by the Iowa Department of Inspections, Appeals and Licensing and the staff shortages that impact quality of nursing home care.

DIAL and the nursing home industry immediately dismissed the report’s data and conclusions. They want us to believe one of two things: that there are no problems with nursing home inspections or staffing, or if there are, improvements are being made. Could there be a third choice — that Sand’s report hit an exposed nerve?

We believe the third — Sand’s report provided a window into vexing concerns about Iowa nursing homes and the apparent lack of meaningful state government oversight of the money that flows to the industry, the inspection process, and the historic inability to recruit and retain sufficient nursing home staff.

His report should serve as a call to action on the part of the governor and leaders in the Iowa legislature. Regardless of whether Republicans or Democrats hold power in the upcoming 2025 session, action is needed. Serious sustained action, not token action.

Let’s avoid a replay of last year at the State Capitol, where Republican leaders refused to acknowledge that problems existed in nursing homes, refused to ask questions, refused to do any research — essentially refused to do their jobs. They ignored Democrats and the legislation they offered to make nursing home care better.

If voters choose to bring these Republican leaders back, they remain in the majority, and again choose to stick their head in the sand (no pun intended), our request of Democratic representatives is this – work around them. Don’t wait for their permission to conduct meetings or hold hearings. Do your job whether they do theirs or not.

And what is that job?

It’s to use Auditor Sand’s report as a launching pad for more questions.

We could give you dozens of questions to ask about inspections and staffing. Here are a few:

On inspections:

• Is quality of care for vulnerable residents in Iowa being improved as a result of the inspections? How do we know? What data or other evidence tells us that?
• If lasting improvements aren’t happening, what needs to change in the inspection process to make it happen?
• If a person calls DIAL and makes a complaint about resident care, how long does it take to investigate that complaint and give the person a response?
• What do inspections tell us about the time it takes for nursing home staff to respond to a resident’s call light? Is the response time acceptable?

On staffing:

• If there isn’t sufficient staff on duty to serve and protect residents, when does the insufficiency reach the point where it can no longer be tolerated? How bad must it get, and for how long, before DIAL recommends suspension of taxpayer dollars flowing to the facility, requires a change of ownership or management, or takes action to move residents to a better, safer place?
• During inspections, what concerns do residents and family members express about staffing levels, turnover and training of staff, and the use of staff from temporary staffing agencies?
• What are DIAL, and other entities of state government, doing to address these staffing issues?

The list of questions would be lengthy, because the issues are numerous, widespread, and historic. The questions should be asked, and answered in detail.

Contrary to what Iowans may believe, there are many state legislators who are good people willing and able to work across the aisle to tackle problems and get results. Our request to them is make these issues personal; to think about them and act on them as if it’s their loved one who’s a resident of a troubled nursing home.

Their loved ones, like all of ours, deserve to live out their lives in dignity. To be well served and respected.

Legislators should act to ensure that happens.

John and Terri Hale own The Hale Group, an Ankeny-based advocacy firm focused on older Iowans, Iowans with disabilities and the caregivers who support them. Email: terriandjohnhale@gmail.com