Audit Report: Iowa Nursing Home Inspections Fail to Meet Federal Standards

Iowa’s Auditor of State, Rob Sand, recently announced the state is not meeting federal standards for timely nursing home inspections. During a press conference, he highlighted the inadequate performance of Iowa’s Department of Inspections, Appeals, and Licensing (DIAL) in regulating these facilities, indicating a crisis in the state’s nursing homes.

Sand’s remarks coincided with the release of an official report revealing that Iowa has been conducting nursing home inspections every 17.1 months on average, failing to meet the federal of every 12.9 months by over four months.

Alongside the federal requirement for doing nursing home inspections every 12.9 months, CMS mandates each facility be inspected at least once every 15.9 months. However, the auditor’s report reveals that Iowa has not met this standard either. Specifically, inspectors failed to conduct timely inspections for 85.4 percent of the state’s 403 nursing homes at least once during the last three inspection cycles.

What Other Issues Did the Audit Report Address?

The failure to meet federal standards for inspections is only one issue affecting Iowa nursing homes.

Staffing shortages

Understaffing continues to be a major issue in at least 45.2 percent of Iowa nursing homes, according to a recent report. Reportedly, Iowa facilities only average 1.32 hours of care by a licensed nurse per resident per day. The national average is 1.53 hours.

According to the Iowa Capital Dispatch, federal data indicates that 14% of Iowa’s 422 nursing facilities were flagged for inadequate staffing in fiscal year 2023. This figure is more than twice the national average of 5.9 percent

High Staff Turnover

Staff turnover in Iowa nursing home facilities is another major factor affecting the growing decline in the quality of care for residents. High turnover creates staffing gaps, increasing facility dependence on temporary workers. Unfortunately, temporary workers are not familiar with the residents or their specific medical needs.

Between June 2023 and May 2024, over half of the nursing staff at Iowa nursing homes left their jobs within the year, resulting in Iowa having the 17th highest turnover rate for nursing staff in the country.

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