Promises made, promises kept

Dean Lerner

In December 2023, John Hale, and by association his wife Terri, were the subject of name-calling by Gov. Kim Reynolds’ office, accused of being “so-called ‘advocates.’” At that time, the Hales offered commentary on a “...corrupt and broken [system]” that results in lawmakers indulging the nursing home industry to the extreme detriment of residents. Written by Capital Dispatch reporter Clark Kauffman, the 2023 article containing the Hale comments and associated Governor’s accusal is worth reading once more, as it adds historic context to the Hales’ recent writing concerning the just adjourned 2026 session: Legislature fails older Iowans — once again.

For years, the Hales and Kauffman have exposed the problems of how grossly understaffed Iowa’s facilities are, the billions of taxpayer dollars going to these unaccountable mostly for-profit homes, private equity ownership, “tunneling” of hidden profits to make it appear as if the nursing home is barely getting by, individual and industry political contributions to the Republican trifecta, Iowans wanting home and community-based services instead of nursing homes’ institutional care, and Iowa’s lack of oversight and slap on the wrist/cost of doing business fines and penalties.  

Additional articles exposed Gov. Reynolds’ and Attorney General Bird’s leadership efforts to kill the federal minimum staffing standards rule adopted under President Biden.  This long-overdue common sense rule would have saved over 13,000 lives per year nationally, hundreds every year in Iowa. Not surprising, Reynolds’ and Bird’s industry-inspired talking points concerning nursing home closures were subterfuge. In fact, wholesale nursing home closures would not result from implementing the minimum staffing standards rule.      

Hale’s recent Storm Lake Times Pilot article specially references an Iowa hero, Senator Claire Celsi, who, before her passing, was Iowa’s outspoken elected champion for care. Senator Celsi knew that conditions in Iowa’s nursing homes had reached a state of crisis, and called for action: “There’s so many other issues, hundreds of them, that come before us every day, but I can’t think of one that is more important than this one because it’s a matter of life and death for our Iowa citizens who are in these facilities right now.” Senator Celsi didn’t just chatter, she filed 14 health, safety, welfare and rights bills to protect Iowa’s seniors and improve their lives.

This year’s Republican controlled House and Senate could have taken up any of these 14 bills. They didn’t. But, not every Republican is to blame for this inexcusable neglect. For example, Rep. Jason Gearhart introduced his own version of two of Senator Celsi’s bills.  His HF 2471 was “[a]n Act relating to electronic monitoring device requirements and health care facilities, including health care facility violations, and making penalties applicable.”

Of course, this bill requiring allowance of cameras in residents’ rooms and additional sanctions for care violations went nowhere. Camera legislation that would protect residents and provide comfort to families has been opposed by industry and killed by Republican legislatures for years.  There’s a detailed discussion of how and why camera legislation is dead on arrival in Kauffman’s 2023 article.  Simply put, the industry won’t allow it.    

Newly elected, maybe Gearhart hadn’t yet received leadership's memo: “the nursing home industry calls the shots, we listen — more money, leave them alone.” For members, failing to heed the memo and fall in line activates potential personal consequences: condemnation, unfavorable committee assignments, ostracism, being primaried and others. Sadly, that’s the way this works.        

The Hale article attributes some of the legislature’s neglect to insufficient advocacy, the “squeaky wheel gets the grease.” More “so-called ‘advocates’” are essential, but overcoming paid lobbyists and wealthy industry donors will prove difficult. With the midterm elections around the corner, here’s a sure-fire solution: How about Iowans elect new officials who will change course, honor their oaths of office and prioritize exceptional care for the most vulnerable among us. As outgoing Gov. Reynolds joins Iowa’s senior community, most of whom will need care at some point, maybe even she will reflect upon the industry’s harmful influence and become one of those “so-called ‘advocates.’”

Dean Lerner is a graduate of Grinnell College and Drake University Law School. He served for nearly 30 years as an Iowa Assistant Attorney General, Chief Deputy Secretary of State, then Deputy/Director of the Iowa Department of Inspections & Appeals. He then worked for the CMS Director of the Division of Nursing Homes and the United States Attorney for the Northern District of Iowa.