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Iowa House passes bill allowing more exceptions to on-site nursing home inspections

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Iowa House passes bill allowing more exceptions to on-site nursing home inspections

Feb 26, 2024 | 9:26 pm ET
By Robin Opsahl
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Iowa House passes bill allowing more exceptions to on-site nursing home inspections
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(Stock photo via Canva)

Iowa nursing homes could be subject to fewer on-site inspections if legislation approved by the Iowa House Monday is signed into law — but the state would be required to hold more trainings for nursing home staff and inspectors on the most common complaints.

House File 2585 passed 87-8 Monday, and goes to the Senate for consideration. Under current law, the Iowa Department of Inspections, Appeals and Licensing (DIAL) is required to make an on-site inspection following a preliminary review of a nursing home complaint, unless DIAL concludes the complaint does not have a reasonable basis or is intended to harass a facility or worker.

The bill proposes adding exceptions to the on-site inspection requirement in situations where a complaint is about the same subject as another complaint or facilities self-report in the immediately preceding 90 days, or if DIAL is able to investigate the issue off-site through electronic records and telephone interviews.

Some advocates for Iowa seniors, including John Hale, have criticized the exemptions, saying that “repeat complaints should be seen as a great concern rather than a nuisance.”

The bill would also require DIAL to establish a new process giving nursing home representatives the opportunity to participate in a review of complaints where citations are issued for substandard quality of care or the immediate jeopardy of a resident. The review would allow nursing homes to provide “context and evidence” about the subject of a complaint before the department determines whether to issue a citation.

Rep. Timi Brown-Powers, D-Waterloo, said she was “very afraid” the bill would not have the effect intended by lawmakers, saying some of the exceptions to on-site inspections were “bothersome” to many.

“At the end of the day, I don’t know that we’re taking a step forward,” Brown-Powers said. “In fact, I’m not sure we’re doing anything except idling there. I think what we need to do is really work with the nursing homes, those directors, listen to the families of Iowa, and do what we can to get more eyes and bodies in the nursing home to protect those folks that are vulnerable.”

Rep. Megan Srinivas, D-Des Moines, introduced an amendment that incorporated components of legislation Democrats introduced earlier in the 2024 session, such as hiring 30 new full-time inspectors and assisted living monitors, costing $2.4 million annually.

Her proposal also would  shorten the allowable timeline for investigating some complaints. DIAL would have one working day — down from two days — to initiate an on-site investigation into a complaint determined by the department to involve potential for immediate jeopardy. Inspections into complaints involving an “alleged high-level, nonimmediate jeopardy situation” would be required within five days, a drop from the 10 days currently allotted.

Srinivas said the amendment would also solve the “loophole” presented by the on-site inspection exceptions. She compared nursing homes having repeated complaints over the same issue to instances where cars of the same model have the same mechanical failure.

“If there are repeated mistakes, that’s a sign that something is wrong,” Srinivas said. “We don’t just turn our back. But this bill says, ‘Oh, if there’s more than one mistake, we can turn our back. We don’t need to identify a pattern. We don’t need to identify the fault.’ This amendment is going to close that loophole and ensure that we actually respond, especially when we see high incidence of the same mistake that’s causing the same transgression and it’s endangering lives.”

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The amendment, ruled not germane, did keep a component of the bill requiring trainings. Under the bill advanced Monday, DIAL would be required to host semiannual “joint training sessions” with inspectors and nursing homes.

The training would be required to cover at least three of the top 10 most frequently issued federal citations at Iowa facilities in the previous calendar year. The state department would be required to “develop a protocol to identify regional citation patterns related to complaints, standards and outcomes” in the inspection process for nursing homes.

Rep. Thomas Moore, R-Griswold, said the bill will improve collaboration and training between DIAL and nursing homes, which in turn will “improve outcomes as far as lessening citations.”

“No, I don’t believe this solves all of our nursing home issues,” Moore said. “I believe there are many things that we can continue to work on to improve outcomes in our nursing homes. But what I think this does is create a collaboration between DIAL and our nursing homes which I believe is not, is not in great existence right now.”