Iowa nursing homes added to national list of worst care facilities

Three Iowa nursing homes have been added to the federal government’s list of the worst care facilities in the nation.

Over the past two months, the three homes were deemed eligible for inclusion on the Centers for Medicare and Medicaid Services’ national list of Special-Focus Facilities. They join seven other Iowa care facilities already deemed eligible for inclusion on CMS’ periodically updated list of nursing homes that have recurring, serious quality-of-care problems.

The three Iowa homes added to the eligibility list since February are Fleur Heights Center for Wellness and Rehab in Des Moines, Pine Acres Rehabilitation and Care Center in West Des Moines, and Dunlap Specialty Care.

They join seven other Iowa facilities that were already considered eligible for special-focus status and increased oversight by regulators: Correctionville Specialty Care; Embassy Rehab and Care Center of Sergeant Bluff; Genesis Senior Living of Des Moines; Harmony West of West Des Moines; Iowa City Rehab & Health Care Center; The Ivy at Davenport; and Westwood Specialty Care of Sioux City.

Of the 10 eligible facilities in Iowa, three of them – those located in Dunlap, Sioux City and Correctionville — are operated by the West Des Moines chain Care Initiatives.

In addition to the homes deemed eligible for special-focus status, Iowa has two care facilities that are officially designated special-focus facilities and, as a result, are operating under additional scrutiny and oversight by the government.

Iowa’s special-focus facilities are Aspire of Gowrie, which has had special-focus status for seven months, and Arbor Court of Mount Pleasant, which has had special-focus status for 13 months.

The three Iowa homes deemed newly eligible for inclusion on the federal list have a recent history of regulatory issues:

— Dunlap Specialty Care: In December 2023, state inspectors alleged the staff at the Dunlap home failed to adequately respond to a fatal head injury sustained by a resident in a fall.

In June 2023, CMS imposed a $45,075 against the home due to allegations of resident abuse and failure to keep residents safe. At the time, inspectors alleged a female resident of the home had physically abused her fellow residents – slapping one of them in the face, hitting another in the back of the head, punching a resident in the face, and throwing water at another resident.

A woman who was struck by a full can of soda thrown by the resident later told inspectors the abuse was part of a pattern the facility failed to address.  The police were summoned on at least two occasions, but the abuse continued, she said, adding, “I’m not a target, I am a human being. Something has to get done … How do I know if I am going to be safe?”

Dunlap Care Center was on the list of “eligible” special-focus facilities for most of 2023, but appears to have dropped off the list at some point, then added back to it, as CMS currently claims it has been on the list for only one month.

— Pine Acres Rehabilitation and Care Center: In July 2023, state officials visited this nursing home to conduct an inspection, but not before the home had racked up 13 complaints — the oldest of which dated back 109 days. Over the next several weeks, an additional 12 complaints were filed against the home, and a second inspection took place. Eventually, all of the 25 complaints were substantiated by inspectors and Pine Acres was cited for 62 regulatory violations.

Last year, CMS fined the facility $189,685 for violations tied to a resident’s leg amputation as the result of the home’s failure to respond to signs of blood poisoning, septic shock, a serious bone infection and gangrene. Pine Acres’ primary owner, New York investor Akiko Ike, has ties to other nursing home owners who currently stand accused of defrauding the government, according to CMS.

— Fleur Heights Center for Wellness and Rehab: This nursing home has Iowa’s worst record of compliance with a federal requirement that nursing homes maintain “sufficient” staffing levels to care for residents. Over a nine-month period between May 2023 and February 2024, the home was cited, but never fined, five times for insufficient staff — more than any other care facility in the state.

In October 2023, state inspectors visited this facility to investigate a backlog of 14 complaints alleging substandard care. While one inspector watched, a male resident of the home called out from his bed, “Help me.” A worker reportedly turned off the man’s call light and left, telling the man she was busy. “I’m a human being, I need help,” the man told the inspector. The man switched his call light back on, and after 15 minutes another worker allegedly came in, asked what he needed, switched off the light, and left.

In their report, the inspectors noted there had been no director of nursing on the Fleur Heights payroll for three months, and there weren’t enough workers on hand to get residents out of bed, serve meals or assist those who needed help eating.

Homes ‘eligible’ for oversight don’t receive it

The federal Special-Focus Facilities list is updated periodically by CMS and includes homes deemed by the agency to have “a history of serious quality issues.”

Nationally, there are 88 nursing facilities on the list, with one or two slots filled by each state. Those homes are enrolled in a special program intended to stimulate improvements in their quality of care through increased regulatory oversight.

Because the number of Special-Focus Facilities is capped, new facilities – even those that have earned CMS’ lowest ratings for quality — can’t be named a special-focus facility until other homes in that same state shut down or improve and “graduate” from the program.

That’s a process that can take four years or more. As a result, there are several homes in each state that are designated as “eligible” for special-focus status due to their ongoing quality-of-care issues, but they are unable to benefit from actual enrollment in the program. Iowa generally has 10 nursing homes on the list of eligible facilities.

Currently, the only Iowa home listed as having graduated from the program after a sustained period of improving care is Touchstone Healthcare Community in Sioux City. However, Touchstone’s graduation appears to coincide with the home’s closing in July 2022 amid ongoing quality-of-care issues.

Typically, all of the homes that are deemed eligible for special-focus designation have about twice the average number of violations cited by state inspectors; they have more serious problems than most other nursing homes, including harm or injury to residents; and they have established a pattern of serious problems that has persisted over a long period of time.