Senior advocates concerned about Iowa ombudsman's independence

Thank Gannett for small favors: the successive rounds of newsroom layoffs at the Des Moines Register have spared Clark Kauffman. He’s been tenacious in covering flawed oversight of Iowa’s nursing homes. On Thursday, Kauffman reported on a recent act by Governor Terry Branstad that worries national advocates for senior citizens.

Before reading Kauffman’s latest article and a related piece last week, I wasn’t aware that Branstad had moved Iowa’s long-term care ombudsman back into the Iowa Department on Aging. In contrast to some other executive orders issued during Branstad’s fifth term, the governor’s office didn’t draw a lot of attention to the document he signed on March 30. That executive order was mentioned at the bottom of a press release about 17 bill signings:

In addition, Gov. Terry Branstad today signed Executive Order 76, rescinding Executive Order 24. The Executive Order, which can be viewed here, directs the Long Term Care Ombudsman to be administratively supported by and housed in the Iowa Department on Aging and allows the ombudsman to talk directly with legislators.

On April 26, 2010, the United States Department of Health and Human Services expressed concern that that a policy was in place that prevented the ombudsman from talking directly with state legislators. Since then, Iowa Department on Aging Director Donna Harvey and Long Term Ombudsman Deanna Clingan-Fischer have brought productive changes and a better working relationship to their respective offices and are in full compliance with state and federal laws, thus negating the need for Executive Order 24.

Excerpt from the executive order (pdf):

I, Terry E. Branstad, Governor of the State of Iowa, declare that the Long Term Care Ombudsman program is and shall remain an independent voice for Iowans in long- term care facilities and shall continue to meet all requirements of the Federal Older Americans Act, but shall be housed with and administratively supported by the Department on Aging. I hereby order and direct that Executive Order Number 24, dated May 28, 2010, issued by Governor Chester J. Culver, shall be rescinded.

Clark Kauffman reported in Thursday’s Des Moines Register that an out-of-state advocacy group for senior citizens has expressed concern about Branstad’s executive order.

The move caught the interest of senior advocates nationally, in part because the director of the Department on Aging has instructed the ombudsman’s staff to refrain from speaking out against the Branstad administration’s decision to cut the number of nursing home inspectors.

On Tuesday, Voices for Quality Care, a Maryland-based organization of nursing home residents and their advocates, sent a letter to Branstad, urging him to reconsider the move because of the potential conflicts of interest.

At the very least, the organization wrote, the move re-creates an organizational structure that led to “the muzzling” of the ombudsman in 2010 and 2011. Iowa’s elderly “are not well served by an ombudsman program that is not clearly and completely independent of political manipulation,” the letter said. […]

In response, Branstad spokesman Tim Albrecht said the governor “remains confident that Iowa’s long-term care ombudsman program is, and shall remain, an independent voice for Iowans” in nursing homes.

Albrecht said the move simply places the program in the Department on Aging to provide necessary administrative support. The head of the aging department will conduct the ombudsman’s annual performance reviews, he said.

The Branstad administration doesn’t deserve the benefit of the doubt on this issue. Iowa has had longstanding problems with enforcing regulations on nursing homes. Branstad criticized nursing home inspectors during his 2010 gubernatorial campaign and moved quickly to reduce the number of inspectors once he was back in power.

As Kauffman has previously reported, Department on Aging Director Harvey discouraged ombudsman staff from expressing their concerns.

[Branstad] said the department’s efforts to interfere in the work of the ombudsman were in the past and are no longer an issue.

However, the current director of the department is a Branstad appointee who last year told the ombudsman’s staff that they should not speak against the Branstad administration’s decision to cut the number of nursing home inspectors.

Dean Lerner, the former director of the state agency that inspects nursing homes, said the Branstad administration’s efforts to “silence voices of protest” are telling.

“Iowans can be trusted to separate form from substance,” he said. Lerner has been a vocal critic of the Branstad administration. He was forced from his job by Branstad, who said the inspections department had developed a “gotcha” mentality in regulating nursing homes.

The long-term care ombudsman Clingan-Fischer replaced in December 2011 also discouraged staff from criticizing the inspector cuts.

Why does the person holding this supposedly independent position need to receive administrative support from a department whose leader shields Branstad policies from criticism?

I don’t know the details on the “productive changes” and “better working relationship” between Harvey and Clingan-Fischer, who has only been ombudsman for a few months. According to Kauffman, Clingan-Fischer was previously an attorney in the Department on Aging. So the ombudsman’s former boss (a Branstad appointee) will be writing the ombudsman’s performance review going forward.

That doesn’t sound like a recipe for an outspoken, autonomous advocate for senior care.

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