Blood on their hands: The human cost to Iowa’s nursing home residents

Your mother presses her call button, then again. No one comes. nnShe requires help getting out of bed, toileting, repositioning to address agonizing pressure ulcers, taking life-sustaining medications, securing pain relief, eating, drinking or having her soiled bedclothes changed.

Minutes tick by, then more.

An everyday circumstance quickly deteriorates into a catastrophic fall, a severe infection, or a fatal medical crisis.  Or, maybe “just” wetting/soiling themselves. This happens seven days a week, every day, and every night. Why? Because there are simply not enough caregivers to help her.

When you are not there, you pray that she is safe.

Nursing home staffing is not an abstract political debate, nor is it a matter of bureaucratic red tape. It is a matter of health, safety, welfare, and, often, survival.

Safe, competent and dignified care is a basic moral obligation.

Yet, Iowa Attorney General Brenna Bird led a multistate lawsuit to block the federal minimum staffing standards rule specifically created to put more nurses and nursing assistants at residents’ bedsides.  Simultaneously, Iowa’s U.S. Representatives Nunn, Hinson, Miller-Meeks and Feenstra voted to delay these vital minimum staffing requirements until 2034.  With their support, accompanied by wealthy nursing home industry donations, President Trump then killed the rule.

Let’s be entirely clear about what exactly they all fought so hard to defeat. The federal rule established a baseline safety floor of 3.48 hours of nursing care per resident per day, required minimum time from registered nurses and nurse aides, and mandated an RN on site around the clock. It phased these requirements in over several years, explicitly offered rural facilities additional time, and included exemptions for facilities facing genuine workforce shortages.

By aggressively moving to dismantle this long-overdue, modest safety net, Bird, Nunn, Hinson, Miller-Meeks and Feenstra have done far worse than just kick the can down the road. They have consciously stripped away a life-saving solution while failing to offer a single alternative initiative — a total abdication of leadership on what is undeniably a life-and-death situation across Iowa. Instead of introducing concrete policies to fix longstanding chronic understaffing, their actions give known understaffed corporate for-profit facilities indefinite, countless chances to continue to neglect and harm vulnerable residents.

Iowa already knows the catastrophic cost of inadequate staffing, and the data proves the crisis is getting worse. In 2024, 14% of Iowa nursing facilities were cited for insufficient staffing — a rate more than twice the national average. By 2025, that number rose to 15%, with 60 of 397 certified homes in the state cited for staffing violations, a rate two to five times higher than most neighboring states. Moving into 2026, the crisis remains persistent; despite severe understaffing violations, Iowa overall continues to rank 47th nationally in total nursing staff per resident.

Consider Marvin “Pete” Jacobs, an 87-year-old Northwest Iowa farmer, father and U.S. Army veteran who lived at Fonda Specialty Care. He required skilled nursing care to keep his tracheostomy airway clear. On Feb. 19, 2023, Pete could not breathe. State inspection reports detail a horrific scene: nursing assistants repeatedly begged the only nurse on duty for intervention. Pete pointed to his neck, gasped for air and mouthed that he was suffocating. An aide pleaded, “Would you please suction him? He needs to be suctioned.” The suction machine sat entirely unused nearby. Pete turned pale, then purple, then blue, dying of a heart attack brought on by a total lack of oxygen. One staff member was told to keep her mouth shut, fired for not doing so.  Inspectors had previously cited that exact facility for failing to employ sufficient nursing staff.

Pete’s agonizing death is the real-world consequence of a hollowed-out healthcare system. His case is not unique, tragedies are reported constantly:

• At Good Shepherd Health Center in Mason City, a nurse admitted to inspectors that critical assessments were missed because a single nurse was left responsible for up to 165 residents; an elderly man died after a severe fall went unaddressed for hours.

• At Azria Health Park Place in Des Moines, inspectors documented vulnerable residents left stranded on toilets and call lights completely ignored because there were simply not enough aides on duty.

Hiding behind the powerful, profitable industry’s false talking points shows willful ignorance and cowardice.  Stripping away a solution without cementing an alternative leaves exhausted, underpaid and scapegoated caregivers trapped in a broken system. It leaves vulnerable residents entirely defenseless. This is not a philosophical debate about the size of government, or other legitimate discussion. This is about whether someone answers when your mother presses her call button, whether an aide notices when your father falls, and whether a qualified professional is present when a veteran suddenly cannot breathe.

Bird, Nunn, Hinson, Miller-Meeks and Feenstra can take their victory laps, issue their press releases, and run their distorted campaign commercials, but they cannot walk away from the harms they’ve inflicted upon Iowa's seniors and their families.

The rule they killed would have saved approximately 13,000 lives nationally, hundreds right here in Iowa. Their claims of widespread closures are false. 

When elected officials systematically dismantle or delay the very rules known to prevent these tragedies, relying upon industry-inspired falsehoods to do so, they cannot wash their hands of the outcomes.

There is blood on their hands.

Kevin Techau is an attorney-at-law in Cedar Rapids. Dean Lerner is an attorney-at-law in Des Moines.