Care facility complaints up 45% from 2020, state data shows

State regulators have seen a significant increase in complaints about health care facilities this year.

The Iowa Department of Inspections and Appeals, which oversees nursing homes, assisted living centers and other health care providers, fielded an average of 151 complaints per month in 2020. Through October of this year, the average number of complaints was 219 per month — an increase of 45%.

The number of complaints remained relatively constant from 2020 through 2021, but began growing in early 2022. Since May, the number of complaints each month has consistently topped 200.

The DIA data shows the rate of increase:

2020: A total of 1,828 complaints were filed, averaging 151 per month.

2021: A total of 1,840 complaints were filed, averaging 158 per month.

2022: Through October, a total of 2,186 complaints were filed, averaging 219 per month.

Asked for the department’s perspective on the numbers, DIA spokeswoman Stefanie Bond said, “The data shows an increased number of complaints recently. The department processes the complaints and works to investigate them in a timely manner.  The department publishes its findings on our website for the public to review.”

John Hale, a consultant and advocate for older Iowans, said the increased number of complaints is not surprising.

“The department is seeing the same thing that we and other consumer advocates are seeing — a growing number of upset residents and family members who believe that they deserve better care and a better quality of life,” he said.

Hale said he believes several factors have contributed to that dissatisfaction:

— Staffing levels: Care facilities don’t have enough staff on hand to deliver prompt and compassionate care to residents.

— Turnover rates: Many care-facility workers are leaving the profession for better paying, more rewarding jobs.

— Temporary staff: Care facilities are increasingly relying on temporary staffing agencies to supply workers who do not know the residents or understand their needs.

— Government oversight: Iowa has not prioritized quality of care, with state lawmakers spending decades discussing the issue without pursuing potential solutions.

DIA has acknowledged that it has been struggling to keep up with the volume of complaints, with inspectors taking a year or more to investigate some cases.

In January 2020, an Iowa woman filed a complaint with DIA over the care her grandmother, Connie Roundy, was receiving at the Rose Vista Home in Woodbine.

It wasn’t until March 25, 2021 — 14 months later — that DIA investigated the matter and substantiated the complaint. By that time, Roundy had been dead for six months.

In March 2021, a female resident of Correctionville Specialty Care was seriously injured in a fall and had to be hospitalized. It wasn’t until this summer, 15 months after the fall, that DIA investigated the matter.

When a DIA inspector asked a worker at the Correctionville home about the incident, the worker said he didn’t “remember much about (the fall) because it happened a long time ago.” Two other workers reported they couldn’t recall details of the incident.

Earlier this year, DIA acknowledged as of June 2022, there were 410 complaints pending against Iowa nursing homes that were at least 30 days old. Of those, 201 complaints — almost half the total number — were more than 120 days old, and 24 uninvestigated complaints were more than one year old.

Complaints accumulate prior to inspections

The department’s published inspection reports show that by the time inspectors visit a care facility for an annual review or to investigate self-reported incidents, there is often a backlog of complaints to address:

— Aspire of Washington: Five weeks ago, DIA inspectors visited this eastern Iowa nursing home in response to 11 separate complaints, all of which were substantiated.

— Ravenwood Specialty Care: In early October, DIA inspectors visited this Waterloo care facility in response to 19 complaints, 18 of which were substantiated.

— Westwood Specialty Care: In August, inspectors visited this Sioux City home to investigate 15 separate complaints, 11 of which were substantiated.

— Bettendorf Health Care Center: In May, inspectors visited this eastern Iowa facility in response to 15 separate complaints, 13 of which were substantiated.

Bond, the DIA spokeswoman, said earlier this year that the COVID-19 pandemic, which hit Iowa in March 2020, is largely to blame for the agency’s backlog of uninvestigated complaints.

After the federal Centers for Medicare and Medicaid Services, or CMS, suspended inspections at nursing homes due to the pandemic, it developed a COVID-19 “focused infection control” process that directed state agencies like DIA to focus their inspections strictly on infection prevention.

As a result, Bond said, complaint investigations were temporarily limited to those involving infection issues and those involving allegations of immediate jeopardy to residents’ health and safety.

That, in turn, led to a growing nationwide backlog of uninvestigated complaints and the inspections that are needed to recertify care facilities, she said.

DIA inspectors are “working through the backlog,” Bond said in July, adding that the agency has hired federally certified contractors to help in that effort.

Federal work-performance reviews of DIA show that long before the pandemic hit, the state agency had difficulty meeting federal standards for investigating complaints.

Those reviews indicate that between September 2018 and September 2019, DIA fielded 971 nursing home complaints that residents’ mental, physical or psycho-social status were being harmed.  “Complaints” include self-reported incidents that emanate from the homes themselves.

Those cases were considered serious enough that a “rapid response” by DIA was required, which meant that an on-site visit was to be made by state inspectors within 10 days.

The agency failed to meet that standard in 631 cases, or 65% of the time. In fact, 41 of those homes still hadn’t been visited by an inspector at the time of the federal performance review, which was concluded in March 2020.