[Bleeding Heartland Logo]

Bleeding Heartland is a community blog about Iowa politics: campaigns and elections, state government, social and environmental issues. Bleeding Heartland also weighs in on presidential policies and campaigns, federal legislation and what the Iowans in Congress are up to. Join our community, post your thoughts as comments or diaries, help keep our leaders honest and hold them accountable.
- desmoinesdem
- Iowa 2012 election coverage
- Who's who in the Iowa House for 2015
- Who's who in the Iowa Senate for 2015
- Iowa wildflowers
2014 Election Coverage
- Absentee ballot numbers
- IA-Sen
- IA-Gov
- IA-01
- IA-02
- IA-03
- IA-04
- Secretary of Agriculture
- Secretary of State
- State Auditor
- Iowa Senate overview
- Iowa House overview
- Senate district 5
- Senate district 7
- Senate district 9
- Senate district 12
- Senate district 13
- Senate district 15
- Senate district 17
- Senate district 27
- Senate district 29
- Senate district 39
- Senate district 41
- Senate district 47
- Senate district 49
- House district 8
- House district 15
- House district 25
- House district 26
- House district 28
- House district 30
- House district 33 (2013)
- House district 40
- House district 51
- House district 60
- House district 63
- House district 65
- House district 68
- House district 73
- House district 82
- House district 91
- House district 92
- House district 95
- House district 99

Advanced Search

Paid Advertising

Bleeding Heartland
It's what plants crave.

Bait and switch leaves nursing home inspectors' jobs vacant

by: desmoinesdem

Sun Aug 21, 2011 at 22:25:27 PM CDT

It doesn't get more cynical than this: the Iowa Department of Inspections and Appeals eliminated 10 of its 38 nursing home inspector positions, ostensibly to save money. In response, the state legislature appropriated funding for those jobs in the current fiscal year. However, department leaders still refuse to hire any more nursing home inspectors.
desmoinesdem :: Bait and switch leaves nursing home inspectors' jobs vacant
Clark Kauffman has the story in the Sunday Des Moines Register, and it's worth clicking over to read the whole piece. During the final months of Governor Chet Culver's administration, the Department of Inspections and Appeals hired additional 10 nursing home inspectors. Attrition and budget cuts over the years had reduced the number of inspectors, and a 2009 report by the federal Government Accountability Office exposed Iowa's shameful record of external pressure on those enforcing rules on nursing homes.

Governor Terry Branstad saw a different problem. In his view, the Iowa Department of Inspections and Appeals took too much of a "gotcha" approach to regulating nursing homes. He put former State Representative Rod Roberts in charge of that department, even though Roberts had not applied for the position and lacked "staff management or regulatory experience." Roberts and his wife also had ties to care facilities in Carroll.

Roberts quickly cut the 10 nursing home inspector positions his predecessor had added a few months before.

According to Kauffman's latest article, state legislators appropriated an extra $650,000 to the Department of Inspections and Appeals' Health Facilities Division for the 2012 fiscal year. Democratic State Senator Jack Hatch, who chairs the Iowa Senate Health and Human Services Appropriations subcommittee, told Kauffman that the department agreed to restore the inspectors' positions. Democratic State Representative Pam Jochum told Kauffman that legislators made their intent clear in allocating the funding. However, the text of the appropriations bill "didn't specify that the money had to be spent on inspectors' salaries," Kauffman writes. Note to lawmakers: next time, don't assume Branstad administration officials are negotiating with you in good faith. Legislative intent means nothing to them:

Inspections and Appeals spokesman David Werning said the department has become more efficient this year, in part by having some inspections handled by nurses who would otherwise be working strictly as program coordinators. There is also less "mirco-managing" in the system, he said.

"The bureaus that deal with long-term care facilities - the nursing homes - are, right now, probably about 50 percent ahead of their workload," Werning said. "We aren't behind on anything in terms of long-term care inspections. I know that raises the question of whether there ever was a need for those 10 positions. Frankly, probably not." [...]

Werning said last week that two-thirds of the $650,000 appropriation will be used to support the general operation of the department's Health Facilities Division, which regulates hospitals, nursing homes and other care facilities. [...]

The new money appropriated by the Legislature is cash recovered from companies that have committed Medicaid fraud. It's the same pot of money the Culver administration intended to use for the 10 additional nursing home inspectors.

'One-time source' vs. ongoing expense

Although that fund has grown by several million dollars in the past year, Branstad and Roberts said it shouldn't be used to pay for inspectors' salaries since the money represents a "one-time source" of revenue and the inspectors' salaries represent an ongoing expense. Now, however, the department will use the money to pay the salaries of other departmental staffers.

Werning said Roberts would have preferred to use state general fund money, but that's not possible because of the way the appropriation was crafted by the Legislature.


Branstad won't criticize Roberts for using a "one-time source" of revenue to fund permanent positions, as long as nursing home inspections remain few and far between. The governor appears to have no ambition to improve on his embarrassing past performance in regulating care facilities.

Republican state legislators won't complain about department officials using appropriations however they wish. Iowa House Speaker Kraig Paulsen considered Culver's director of Inspections and Appeals "a detriment to the state of Iowa." Lawmakers from both parties have reduced fines for nursing home care violations and engaged in the political pressure exposed by the 2009 GAO report. (Note: Iowa is "State A," discussed on pages 40 through 42 of that pdf file.)

Kauffman will have no shortage of material for Des Moines Register stories like this one about unnecessary deaths and serious injuries at nursing homes. I would hesitate to put a loved one in any assisted living facility in this state unless a relative or close friend were able to check on his or her care frequently.

Share any relevant thoughts in this thread.

P.S. I'm not comforted by Werning's assurances that the department is now ahead of schedule on nursing home inspections. There's good reason to question whether their schedules adequately protect patient safety:

The Des Moines Register reported earlier this year that the department now inspects stronger hospice facilities on a schedule of once every 20 years. The agency exercises no oversight of privately run home health agencies; is unable to impose fines of any size on hospitals or hospital-owned nursing homes; is years behind in the inspection of dialysis treatment centers; and doesn't require licensing or government inspection of outpatient surgical centers.

The department also changed its restaurant inspection policies this year, meaning that facilities deemed "low risk" may be checked by state or county inspectors only once every two years.

UPDATE: A Des Moines Register unsigned editorial criticized Branstad's stance on nursing homes but argued,

Adding more nursing home inspectors wouldn't necessarily better protect nursing home residents - not if the message being sent to regulators by the Branstad administration and its actions is to befriend nursing homes, rather than regulate them.

The editorial also paraphrased Senator Hatch as saying that next year, "he plans to specify exactly how agencies are supposed to spend money because he said the Branstad administration has proven it can't be trusted to follow the Legislature's intent."

Tags: , (All Tags)
Print Friendly View Send As Email
Tweet This!

not all are alike (0.00 / 0)
I am not sure why you are so full of hate but to label all assisted living and nursing homes in the state as (I would hesitate to put a loved one in any assisted living facility in this state), would be the same as if I would to say that all journalist are liars because one New York reporter fabricated a story.

no doubt some are very good (0.00 / 0)
I said I wouldn't put a loved one in any home unless someone were able to check frequently on the standard of care provided. It's clear that state regulators are not in a position to enforce the rules.

Invite other Iowa political junkies to join us at Bleeding Heartland.

[ Parent ]

Make a New Account



Forget your username or password?

Iowa Liberal Blogs
- Blog For Iowa
- Iowa .Gif-t Shop
- Iowa Independent (archive)
- Iowa Policy Points
- Iowa Starting Line
- Iowans for a Future That Doesn't Suck
- John Deeth
Iowa Conservative Blogs
- Hawkeye GOP
- The Bean Walker
- Caffeinated Thoughts
- The Conservative Reader: Iowa
- The Iowa Republican
Journalists' blogs and research
- 24-Hour Dorman
- Cedar Rapids Gazette government page
- Iowa Fiscal Partnership
- Iowa Policy Project
- Iowa Politics Insider
- Iowa Watchdog.org
- On Brief: Iowa's Appellate Blog
- On the Campaign Trail with Ed Tibbetts
- Politically Speaking
- Price of Politics, etc.
- O.Kay Henderson at Radio Iowa
Iowa Democrats
- Dave Loebsack (IA-02)
- Iowa Democratic Party
- Iowa House Democrats
- Iowa Senate Democrats

Powered by: SoapBlox