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Nurse alleges understaffing and unsafe conditions in Iowa care facility


Nurse alleges understaffing and unsafe conditions in Iowa care facility

Jun 13, 2024 | 11:57 am ET
By Clark Kauffman
Nurse alleges understaffing and unsafe conditions in Iowa care facility
The Avoca Specialty Care nursing home in Pottawattamie County is run by Care Initiatives of West Des Moines, a tax-exempt nonprofit entity. (Photo via Google Earth)

The former director of nursing at an Iowa care facility claims her employer violated state and federal laws by forcing residents into the home when it was understaffed and unsafe.

Stephanie Schlegelmilch is suing the Avoca Specialty Care facility of Pottawattamie County, and its owner, Care Initiatives of West Des Moines, in U.S. District Court.

In her lawsuit, Schlegelmilch claims she was hired as the Avoca facility’s director of nursing in April 2023 and worked there as a salaried employee averaging $52.88 an hour.

Schlegelmilch claims that Care Initiatives “has a policy of forcing residents into facilities that do not have space or staff to appropriately care for residents and to provide a safe environment for these residents.”

She claims such actions violate state law and that she had “tense conversations” with corporate officials over the issue between April and December of 2023. She alleges that even after those conversations, Care Initiatives continued to steer individuals into the Avoca facility where they were accepted as residents “even though the facility was understaffed.”

She claims that in November 2023, the company’s regional nurse, Julie Simons, visited the Avoca facility during a COVID-19 outbreak and refused to wear personal protective equipment, such as a mask, to minimize the risk of spreading the virus to uninfected residents. Schlegelmilch alleges that after she confronted Simons she was disciplined for insubordination and, within 10 days, was fired by Care Initiatives.

Schlegelmilch also alleges the company required her to work an “excessive number of hours” as a floor nurse, giving her little time to handle her administrative duties, and then docked her pay when she took as little as two hours off work.

She also alleges that when she was hired she attempted to have “years’ worth of medical records” electronically scanned so the company would be in compliance with the federal Health Information Portability and Accountability Act, but the company refused to provide the assistance she requested.

Her lawsuit seeks unspecified damages for violations of the Fair Labor Standards Act and the Iowa Wage Payment Collection Act. Care Initiatives has yet to file a response to the lawsuit and declined to comment on the allegations.

According to data from the Centers for Medicare and Medicaid Services, 14% of Iowa’s 422 nursing facilities were cited for insufficient staffing in fiscal year 2023. That’s more than double the national average, which was 5.9%.

Only five other states – Hawaii, Michigan, Montana, New Mexico and Oregon — had a worse record of compliance with staffing requirements. Iowa’s neighboring states of Nebraska, South Dakota, Wisconsin and Missouri had no more than 2% to 6.8% of their facilities cited for insufficient staffing in 2023.

Staffing levels in nursing homes are now a national issue, with top industry officials — as well as Republican governors, including Iowa’s Kim Reynolds — fighting proposed federal regulations that would require taxpayer-funded facilities to provide a sufficient and specific number of licensed medical staff to meet the needs of their residents.

Care Initiatives’ Iowa facilities have been cited for inadequate staffing in the past. In 2022, state inspectors visited the company’s Ravenwood Specialty Care in response to 19 separate complaints and found that one wing of the dementia unit where seven residents lived had been left completely unstaffed.

An inspector saw one resident sitting by the nurses’ station, waiting for assistance from the staff. The inspector asked the man where all of the workers were, and the man said he didn’t know. When the assistant director of nursing appeared at the nurses’ station, the inspector alerted her to the fact that the wing was unstaffed. The assistant director of nursing replied that was a “problem,” and then turned and left.

After watching a resident rummage through the trash receptacle attached to an unlocked medication cart parked in a hallway, the inspector informed a registered nurse of the incident. The nurse became tearful and said she was doing the best she could but was working alone while trying to cover both wings of the dementia unit.