Iowa nursing homes’ staffing violations outpace neighboring states

State inspectors visited the Bishop Drumm Retirement Center in Johnston and spoke to residents who reported waiting 30 to 60 minutes for their call lights to be answered.

That was last April. When inspectors returned in July, the situation had worsened, with residents complaining of one- to two-hour waits. In September, inspectors were back, with residents saying the situation hadn’t improved.

A few weeks ago, inspectors returned to Bishop Drumm for a fourth visit and found the situation had only grown worse. Inadequate staffing was causing excessively long call-light responses; a dining room had been closed due to the lack of staff, forcing residents to eat in their rooms alone, and the home’s director of nursing was working the floor as a charge nurse despite federal regulations prohibiting the practice.

While one inspector watched, a female resident of the home switched on her call light. After 11 minutes, a worker entered the room, switched off the light, and left within seconds without providing assistance. The woman switched on her call light a second time, then a third time, then a fourth time. In each instance, a worker came to her room, switched off the light and immediately left, the inspector observed.

The resident later complained the employees had turned off her light “without a word” and left without even asking what she needed. Residents weren’t getting their scheduled baths, inspectors found, weren’t getting fresh water, and both the residents and employees were saying workers were sleeping on the job.

Bishop Drumm’s administrator, Adam Braden, declined to comment on the matter Friday, saying he didn’t have time to discuss it.

State records show that after each of the four occasions when Bishop Drumm was cited for insufficient staff, the home’s managers confirmed for inspectors they were aware of federal staffing requirements. However, no fines or penalties were imposed for any of the cited staffing violations.

That’s not unusual. Despite numerous studies that indicate staffing shortages are the single biggest cause of poor-quality care, the violations rarely result in any sort of sanctions.

An Iowa Capital Dispatch review of federal data shows that in 2025, 60 of Iowa’s 397 nursing homes — 15% of all the homes in the state — were cited for insufficient staffing.

That represents a rate of staffing-level violations that’s two to five times higher than most other nearby states:

— Iowa: 15% (60 of 397 homes cited.)

— Illinois: 12% (82 of homes 674 cited.)

— Missouri: 7% (33 of 487 homes cited.)

— South Dakota: 7% (Seven of 96 homes cited.)

— Wisconsin: 5% (15 of 325 homes cited.)

— Nebraska: 4% (Seven of 180 homes cited.)

— Minnesota: 4% (13 of 340 homes cited.)

— Kansas: 3% (Nine of 303 homes cited.)

In fiscal year 2023, 14% of Iowa’s 422 nursing facilities were cited for insufficient staffing, which was more than double the 5.9% national average at that time. Only five other states had a worse record of compliance with the sufficient-staffing requirement.

Nationally, a new report from the Long-Term Care Community Coalition indicates that in the third quarter of 2025, almost 9 in 10 nursing homes fell below their expected their staffing levels, with the average facility under-staffed by 24% on a daily basis. The report is based on federal data derived from the homes’ self-reported payroll information and assessment of residents’ needs.

It shows the average American nursing home provided 3.77 total nurse staff hours per resident day, with the homes in Iowa averaging slightly better at 3.81 hours. The states that fared the worst in terms of total nurse staffing were Illinois, Texas, Missouri and Georgia.

New staffing mandates challenged by GOP

In 2023, the Biden administration sought to impose new staffing requirements on all nursing homes that collect taxpayer money through Medicare and Medicaid. The new requirements, which would have allowed rural homes facing workforce shortages to receive a waiver, would have required homes to have a nurse on staff 24 hours per day.

In November 2023, Iowa Gov. Kim Reynolds and 14 other Republican governors sent Biden a letter objecting to the new rule and predicting it would “force over 80% of facilities nationwide to hire more staff,” which would result in many of them closing.

In 2024, Iowa Attorney General Brenna Bird, along with other Republican attorneys general and industry representatives, sued the Biden administration to block implementation of the rule, with Bird calling it an “attack on senior care that will force nursing homes out of business, increase costs for families, and remove access to senior care altogether.”

The Trump administration eventually dropped the federal government’s legal defense of the rule, effectively killing most of its requirements.

Dean Lerner, the former head of the state agency that inspects Iowa’s nursing homes, says the staffing-level violations and deficient care documented by the state’s own inspectors won’t improve until voters take action.

“I shake my head in disgust, as should all Iowans,” said John Hale, co-owner of The Hale Group, an Ankeny-based consulting, advocacy and communication firm focused on older Iowans. He said any inspection process that does little more than document violations needs to be changed.

“The continuing neglect and abuse of Iowa nursing home residents due to insufficient staffing is an outrage,” he said. “Equally outrageous is the policy of state government to inspect these homes and issue meaningless citations that do nothing more than enable neglect and abuse to continue.  While the Iowa Legislature is moving to strengthen oversight and enforcement of laws regulating puppy mills to protect and improve the lives of animals, it’s doing nothing to better protect and improve the lives of nursing home residents.

“The only hope for change is if the next governor of Iowa recognizes how unacceptable this situation is and will say, ‘This ends on my watch. Improving the care of nursing home residents will be a priority of my administration.'”

The Iowa homes cited most often

While the new federal staffing mandates have effectively been killed, states can impose their own requirements as a condition of licensing.

However, a 2024 analysis by KFF Health News, found that in five states with some of the toughest minimum staffing standards there was widespread noncompliance, with many nursing homes operating below the legally required staffing levels, often with tacit approval from regulators.

KFF reported, for example, that at Heritage Hills Rehabilitation & Healthcare Center in Smithfield, Rhode Island, the owners had up to 25% fewer nurses and aides than required by law. It never ran into trouble with regulators, however, because Rhode Island does not enforce the staffing law.

In Iowa, nursing homes are required to have “sufficient” staff on hand to meet residents’ needs — a standard that is open to interpretation even among care facility staff. In most cases, when an Iowa nursing home is cited for violating the federal requirement for sufficient staff, inspectors will report that front-line caregivers say the facility is seriously under-staffed while those who control staffing — the owners, administrator and  director of nursing — say staffing levels are adequate.

The Iowa Capital Dispatch’s review of federal inspection data for 2025 shows which Iowa homes have been cited for staffing-level violations, a lack of competent nursing staff, and resident abuse:

— Repeat violators: Two Iowa nursing homes, Bishop Drumm Retirement Center in Des Moines and the Good Samaritan home in Indianola, were each cited three times last year for insufficient staff. In addition, 11 other Iowa homes were cited twice for insufficient staff: The Bridges at Ankeny, New Homestead Care Center in Guthrie Center, Accura Healthcare in Carroll, Bettendorf Health Care Center, Altoona Nursing And Rehabilitation Center, Avoca Specialty Care, Azria Health in Longview, Garden View Care Center in Shenandoah, HallMar Village in Cedar Rapids, Iowa City Rehab & Health Care, Osage Rehab and Health Care, Southfield Wellness Community in Webster City, and Stone Cottage Care Center in Sigourney.

— Competent nurses: Thirteen Iowa nursing homes were cited at least once for a lack of competent nursing staff in 2025, including Garden View Care Center in Shenandoah, which was twice cited for the violation. The others were Accura Healthcare in Creston, Aspire in Washington, Birkwood Village in Fort Madison, Caring Acres Nursing And Rehab Center in Anita, Harmony Care Center in Marshalltown, Northern Mahaska Specialty Care in Oskaloosa, Pine Acres Rehabilitation and Care Center in West Des Moines, Scottish Rite Park in Des Moines, Silver Oak Nursing And Rehabilitation Center in Marion, Southfield Wellness Community in Webster City, Stacyville Community Nursing Home, and The Vistas in Bettendorf.

— Licensed nurses: Twelve Iowa homes were cited last year for violating the regulation that calls for one licensed nurse to be working at least eight hours each day and for a registered nurse to be working as a full-time director of nursing: Accura Healthcare in Onawa, Accura Healthcare in Shenandoah, Aspire in Muscatine, Garden View Care Center in Shenandoah, the Good Samaritan home in Indianola, the Good Samaritan home in Manson, Osage Rehab and Health Care Center, the Rehabilitation Center in Allison, Rockwell Community Nursing Home, Sheffield Care Center, Stacyville Community Nursing Home and Westbrook Acres in Gladbrook.

— Resident abuse: Two Iowa nursing homes were cited twice last year for failing to prevent resident abuse and neglect: Embassy Rehab and Care Center in Sergeant Bluff, and Greater Southside Health and Rehabilitation in Des Moines.

An additional 38 Iowa nursing homes were cited once for abuse: Accura Healthcare in Aurelia, Accura Healthcare in Cresco, Accura Healthcare in Knoxville, Accura Healthcare in Marshalltown, Accura Healthcare in Muscatine, Accura Healthcare of South Des Moines, Altoona Nursing And Rehabilitation Center, Aspire in Muscatine, Bethany Life in Story City, Bettendorf Health Care Center, Caring Acres Nursing and Rehab Center in Anita, Cherokee Specialty Care Center, Estherville Community Care Center, Friendship Haven in Fort Dodge, Garden View Care Center in Shenandoah, the Good Samaritan home in Forest City, and the Good Samaritan home in Indianola.

Also: Grundy Care Center, Harmony House Health Care Center in Waterloo, Harmony Waterloo, The Ivy in Davenport, Lakeside Lutheran Home in Emmetsburg, Laurens Care Center, Monticello Nursing & Rehab Center, New Hampton Nursing & Rehab Center, Oakland Manor, Parkview Manor in Wellman, The Pillar of Cedar Valley in Waterloo, Rehabilitation Center of Allison, Rehabilitation Center of Hampton, Ridgecrest Village in Davenport, Rose Haven Nursing Home in Marengo, Southeast Iowa Regional Medical Center’s Klein Center in West Burlington, Southern Hills Specialty Care in Osceola, The Cottages in Pella, New Homestead Care Center in Guthrie Center, The Village of Ackley and Woodland Terrace in Waverly.

— Abuse reporting: Fifty-five Iowa homes were cited for failing to report suspected abuse to the state in a timely fashion. Six of those homes were cited twice for that offense in 2025: Caring Acres Nursing and Rehab Center in Anita, Lakeside Lutheran Home in Emmetsburg, Oakland Manor, Rose Haven Nursing Home in Marengo, Silver Oak Nursing and Rehabilitation Center in Marion, and Stacyville Community Nursing Home. Among the homes that were cited once for the offense in 2025 were six facilities run by Accura Healthcare located in the cities of Aurelia, Carroll, Cresco, Marshalltown, Newton and Pleasantville.