Republican budget cuts reduce oversight of Iowa nursing homes

Iowa’s Long-Term Care Ombudsman has “eliminated virtually all staff visits” to our state’s 850 nursing homes and assisted-living facilities, Clark Kauffman reported for the Des Moines Register on August 23. A large reduction in state funding led to the policy change, announced last month. Republican legislators passed the health and human services budget on party-line Iowa House and Senate votes. Governor Terry Branstad approved the cuts in his final batch of bill signings.

Reducing oversight of nursing homes has long been a goal for Branstad, whose Department of Inspections and Appeals didn’t even fill all the nursing home inspector positions funded by state lawmakers. Iowa already ranked last among the 50 states in terms of ombudsman visits to nursing homes at least once per quarter, according to 2015 statistics cited by Kauffman.

Ending on-site visits by ombudsmen will put approximately 53,000 Iowans at greater risk of receiving substandard care.

Iowa’s budget was tight after revenue estimators revised downward the amount of money lawmakers could spend during fiscal year 2018, which began July 1. The ax fell more deeply on some state agencies than others.

While some departments had nearly status-quo budgets, Republican appropriators greatly reduced spending for the Department of Aging and its Office of Long-Term Care Ombudsman, well below fiscal year 2017 levels and even below Branstad’s budget request. The ombudsman’s office received $1.16 million, nearly 13 percent less money than the previous year. Lawmakers did not specify what should be cut from the ombudsman’s work. Rather, they approved a “general reduction” of $164,000 to the office. (The health and human services budget contained numerous “general reductions,” a departure from legislators’ previous practice of accounting for every dollar spent.)

Long-Term Care Ombudsman Deanna Clingan-Fischer informed staff on July 6,

Budget constraints and an impending staff departure have forced us to re-structure how this Office delivers services to Iowans. At this time, our Local Long-Term Care Ombudsmen will have limited ability to travel to any facility or program to visit with a resident/tenant in person.

Kauffman’s latest story noted that in-state travel was the second-largest expense for the ombudsman’s office, after salaries.

According to data from the ombudsman’s office, the staff there made more than 5,000 visits to Iowa care facilities in the 2015-16 fiscal year. […]

The most recent data from the Administration for Community Living indicates that in 2015 only nine other states had a higher ratio of long-term care ombudsmen to nursing home residents.

The data also show that Iowa’s ombudsman’s office ranked last in the percentage of nursing homes visited at least once per quarter. In Iowa, 12 percent of nursing homes were visited quarterly, while the national average was 67 percent. […]

Almost 700 visits made in the 2015-16 fiscal year were in response to specific complaints of poor resident care or violations of residents’ rights.

Regional ombudsmen also participated in 99 heath-and-safety inspections of care facilities, which are conducted by the Iowa Department of Inspections and Appeals.

John Hale, a consultant who works on issues related to Iowa’s elderly population, wrote in a guest column for the Des Moines Register last week,

The Iowans charged with protecting the health, safety and rights of residents in Iowa nursing homes can no longer go to these places in person to thoroughly investigate complaints and fully advocate for residents.

Past budgets supported by Iowa’s elected officials consistently understaffed the Ombudsman’s office, and limited what it could do. The most recent cuts will have it do even less.

This is unacceptable. It’s a decision that needs to be reversed.

I refuse to accept that there is no money available to fund such essential services.

If the state can find millions to pay consultants dealing with Medicaid issues, and to pay fees and fines to pursue or settle lawsuits, I think we can find the money needed to get long-term care ombudsmen back on the road to do the job we expect and need them to do.

Don’t hold your breath for Governor Kim Reynolds to think creatively about how to make $65,000 to $85,000 available to the Office of Long-Term Care Ombudsman, enough to cover in-state travel for the current fiscal year.

Iowans with loved ones in assisted living would do well to keep a closer eye on what’s happening in the facility. People receiving nursing home care may not be in a position to spot red flags or communicate with ombudsmen by phone or e-mail.

Final note: No journalist in Iowa knows more about the nursing home industry than Kauffman, who recently returned to a reporting role after a few years on the Des Moines Register’s editorial board. The Register should compile all of his past work on this subject in one online archive. Unfortunately, links to many of Kauffman’s articles about lax oversight and pitifully small fines for shoddy treatment of nursing home residents lead to 404 “not found” errors.

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