Robin Opsahl covers the state legislature and politics for Iowa Capital Dispatch, where this article first appeared.

In their final days of the 2024 legislative session, Iowa lawmakers approved $8.9 billion in state spending for the upcoming year, financing the state government and public services. Most of those decisions now await a thumbs up or down from the governor.

Appropriations bills included funding for topics discussed often this session, like increasing pay for Iowa judges, as well as spending cuts to Area Education Agencies (AEAs), the provider of special education and other school support services in Iowa.

Budget bills can also include policy components. This year, language restricting on diversity, equity and inclusion programs at the state’s public universities was passed as part of the education spending bill.

Iowa House Speaker Pat Grassley (left) and Senate Majority Leader Jack Whitver speak to members of the media on March 14 (photos by Laura Belin)

If you didn’t know Iowa was in the eighth year of a Republican trifecta, you might be forgiven for thinking different parties controlled the state House and Senate after watching the past week’s action.

Dozens of bills approved by one chamber failed to clear the legislature’s second “funnel” deadline on March 15. While it’s typical for some legislation to die in committee after passing one chamber, the 2024 casualties include several high-profile bills.

The chambers remain far apart on education policy, with no agreement in sight on overhauling the Area Education Agencies, which is a top priority for Governor Kim Reynolds. The legislature is more than a month late to agree on state funding per pupil for K-12 schools, which by law should have happened by February 8 (30 days after Reynolds submitted her proposed budget). The Senate Education Committee did not even convene subcommittees on a few bills House Republicans strongly supported.

House Speaker Pat Grassley and Senate Majority Leader Jack Whitver struck an upbeat tone when speaking to journalists on March 14. Both emphasized their ongoing conversations and opportunities for Republicans to reach agreement in the coming weeks.

But it was clear that Grassley and Whitver have very different ideas about how the legislature should approach its work.

Ralph Rosenberg of Ames is a retired attorney, former state legislator, former director of the Iowa Civil Rights Commission, and former leader of statewide Iowa nonprofit organizations. He and Barbara Wheelock, also of Ames, signed this open letter on behalf of PRO Iowa 24, a group of concerned rural Iowans with progressive values from Greene, Guthrie, Boone, Story, and Dallas counties.

Now is a good time for the public to make their wishes known for 2024 state policies. Tell your legislators to act on behalf of all Iowans, create an economy that works for all Iowans, and use the government to protect the most vulnerable. Republicans can enact each and every one of these items on a bipartisan basis.

Doris J. Kelley is a former member of the Iowa House and former Iowa Board of Parole Chair, Vice-Chair and Executive Director.

After being re-elected to the Iowa House of Representatives, I met newly elected State Senator Kim Reynolds in 2009 at an event where a bipartisan group of “veteran” legislators were giving advice to newly elected ones. My next interaction with Reynolds was when she was lieutenant governor, and Governor Terry Branstad appointed me to serve as Vice-Chair of the Iowa Board of Parole. After I was promoted to chair that board, I met frequently with Branstad and Reynolds, apprising them of the progressive measures the board was undertaking.

Two recent surveys by Morning Consult, released in late October and late November, identified Reynolds as the country’s governor with the highest disapproval rating. A summary of the October poll noted, “her unpopularity increased partly because of a surge in negative sentiment among independent and Republican voters during a year in which she signed a strict anti-abortion law and took a lashing from former President Donald Trump …”

What has happened to Iowa since Reynolds assumed the office of governor on May 24, 2017?

John and Terri Hale own The Hale Group, an Ankeny-based advocacy firm working for better lives for all Iowans. Contact them at terriandjohnhale@gmail.com. An earlier version of this commentary appeared in the Des Moines Register and Cedar Rapids Gazette.

Twenty-seven years ago, the Quad-City Times published a six-part series on neglect and abuse in nursing homes. The articles told the stories of residents whose physical and mental health needs were not met, who were subjected to verbal or physical abuse by staff or other residents, and had been injured or had died.

The stories were tragedies. And sadly, tragic stories still regularly appear in Iowa Capital Dispatch and other Iowa media written by Clark Kauffman—the same journalist who authored the stories in 1996.

For more than 27 years, horrific stories of neglect and abuse have stemmed from far too many nursing facilities that have employed too few workers; failed to adequately compensate, train, and respect workers; routinely accepted exceptionally high levels of employee turnover; lobbied elected officials to increase annual appropriations of tax dollars but to also minimize oversight of their efforts; avoided criminal prosecution for their misdeeds; and have put the desire for profit ahead of the needs of the Iowans they exist to serve.

In 27 years, little has changed. At too many facilities, neglect, abuse and dehumanization of older Iowans continue.

Mary Weaver writes a regular column for the Jefferson Herald and Greene County News online, where this commentary first appeared. She is a former registered nurse and former public health nurse administrator, who currently chairs the Iowa Democratic Party’s Women’s Caucus. Mary resides on a farm near Rippey.

I am saddened, as well as shocked by the horror stories erupting statewide about the deplorable, life-threatening situations occurring in Iowa nursing homes. Stories of gangrene resulting in amputations, a story of a person choking in their own saliva, a story of a person freezing in the winter of 2023 when the alarm door triggered was never given a response.

In complete transparency regarding this subject, in part of my former work life, I was a surveyor for the Iowa Department of Inspections and Appeals. That involved inspecting State Certified Home Care agencies as well as nursing homes.

The long-term care or nursing home survey team consisted of three or four people, and the team was usually in a facility for three or four days. Policies were reviewed, charts were audited, comparing orders written to implementation, interviews with residents were conducted, the ombudsman assigned to the facility was visited, staffing ratios for Registered Nurses and Certified Nurses Aids were reviewed using established formulas. Temperature checks of food served were done at mealtime.

It took one day for the team to write the report of the findings, usually a Friday, and the following Monday we were sent to the next facility. Facilities were visited once each year, but unannounced, and if a complaint was received regarding a facility, it was immediately visited.

Photo by Jonathunder of Cornerstone Assisted Living in Mason City, available through the GNU Free Documentation License via Wikimedia Commons

Randy Evans is executive director of the Iowa Freedom of Information Council and can be reached at DMRevans2810@gmail.com. 

A few months ago, I bumped into a former aide to Governor Robert Ray. As we reminisced about the governor, our conversation turned to his nearly daily meetings with journalists.

The aide said yes, those press conferences provided reporters with access to the governor and his comments on issues the state was handling and hearing about from Iowans.

But Ray believed the daily press gatherings had another important benefit, too: Ray could do his job more effectively by listening to the journalists’ questions, the aide said.

Randy Evans is executive director of the Iowa Freedom of Information Council and can be reached at DMRevans2810@gmail.com. 

Deanna Mahoney was like countless Iowa women through the years. She nurtured three children. She worked outside the home to supplement the family income. She loved bowling and mushroom hunting.

That is how she lived.

How she died tells us so much about the way some business owners, and too many government leaders in Iowa, have pushed aside their legal, moral and humanitarian obligations, especially to vulnerable Iowans.

John and Terri Hale own The Hale Group, an Ankeny-based advocacy firm working for better lives for all Iowans. Contact them at terriandjohnhale@gmail.com.

A crisis ignored eventually leads to catastrophe. That’s what we’re witnessing in long-term care services. 

As far back as 1990, the U.S. Bipartisan Commission on Comprehensive Health Care described as a “crisis” the challenges the nation faced in providing long-term care services to people with disabilities and older citizens.

That commission also used phrases like an “urgent need for action” and “current conditions that are unconscionable” when urging Congress to act on recommendations that would ensure all Americans have access to high-quality, affordable long-term care services in the setting they prefer.

Tony Leys is Rural Editor/Correspondent for Kaiser Health News, where this story was first published. Follow him on Twitter @TonyLeys.

KNOXVILLE, Iowa ― Bette Helm was glad to have someone to talk with about her insomnia.

Helm lives in a nursing home in this central Iowa town of about 7,500 people, where mental health services are sparse. On a recent morning, she had an appointment with a psychiatric nurse practitioner about 800 miles away in Austin, Texas. They spoke via video, with Helm using an iPad she held on her lap while sitting in her bed.

Video visits are an increasingly common way for residents of small-town nursing homes to receive mental health care. Patients don’t have to travel to a clinic. They don’t even have to get cleaned up and leave their bedrooms, which can be daunting for people with depression or anxiety. Online care providers face fewer appointment cancellations, and they often can work from home. While use of some other telehealth services may dwindle as the COVID-19 pandemic winds down, providers predict demand for remote mental health services will continue to increase in rural nursing homes.

Randy Evans can be reached at DMRevans2810@gmail.com.

People in the health care field have worked their tails off since the COVID-19 pandemic hit Iowa with a vengeance in 2020.

Doctors, nurses, and all manner of technicians and support staff have performed heroically under circumstances that often were trying.

But the death this year of a patient at a Centerville care center has struck a chord with many Iowans — and not just because COVID claimed another life. The reaction has ranged from sadness to anger because the person’s treatment was unprofessional, uncaring and incompetent, if not bordering on criminal.

An earlier version of this commentary appeared in The Prairie Progressive‘s fall 2021 issue.

In a media release earlier this year and a commentary published in some Iowa newspapers, Senator Chuck Grassley asserted, “it appears that the standard of care and quality controls at many state veterans homes falls well short of those required by other government supported nursing homes.” He was referencing the number of COVID-19 deaths and infections in veterans homes across the country.

How many is many? The senator’s letter to U.S. Veterans Affairs Secretary Denis R. McDonough cited a handful of media reports in footnotes. Although some of those articles cited statistics provided by the government, the numbers Grassley used are flawed.

State Medical Director and Epidemiologist Dr. Caitlin Pedati is leaving the Iowa Department of Public Health (IDPH) in late October, the agency announced on September 22.

The leader of Iowa’s COVID-19 response had hardly been seen in public all year and granted few media interviews. Pedati was an occasional speaker at Governor Kim Reynolds’ televised news conferences during the first eight months of the pandemic, but had not appeared at one since November 2020.

The unexplained departure raised questions about whether Pedati walked or was forced out. Reynolds’ new spokesperson Alex Murphy told Bleeding Heartland via email that no one in the governor’s office asked the medical director to leave. “This was a personal decision by Dr. Pedati.” Murphy also said the governor won’t pick her successor; rather, IDPH Director Kelly Garcia “and her team will handle the hiring.”

I’ll be seeking records that could show whether Pedati (a board-certified pediatrician) disagreed with any aspects of Iowa’s COVID-19 mitigation strategy, such as grossly inadequate guidance for schools or the retreat from recommending masks, even for unvaccinated people crowded together indoors.

Whether or not Pedati had any private misgivings, she repeatedly failed to keep Iowans safe or adequately informed during this pandemic, which has already killed more than 1 in 500 Iowa residents who were alive eighteen months ago.

A third Democrat joined the race for Iowa’s U.S. Senate seat on July 29. Dr. Glenn Hurst made clear that one issue in particular is driving his campaign.

“I went back to school and became a doctor because I saw a need in the rural communities I love and call home,” Hurst said in a news release. “I’ve had a front-row seat to the tricks insurance companies use to avoid paying for care, drowning providers in paperwork when we should be with our patients. I’m running for the U.S. Senate because Iowans deserve better. We deserve Medicare for All.”

State Medical Director and Epidemiologist Dr. Caitlin Pedati asserted that publicly available information about coronavirus cases in Iowa nursing homes is “pretty similar” to what was long disclosed on the state’s official COVID-19 website.

Pedati made the false claim during a wide-ranging interview with Andy Kopsa of Iowa Watch, conducted soon after the state switched from daily to weekly updates on coronavirus.iowa.gov. As part of the revamp, officials removed a page that had shown current outbreaks in long term care facilities.

This story has been updated to note that a second resident infected in the latest outbreak has died.

Two of the seven Iowa Veterans Home residents who recently contracted COVID-19 have died, the home told relatives and guardians. The first resident who passed away “was in end of life care prior to testing positive” for coronavirus, an email sent on July 2 said. The message announcing the second death on July 4 did not provide further details.

All residents and staff affected by the latest coronavirus outbreak–the fifth at the state-run facility in Marshalltown–had been living or working in the Malloy 3 unit, which “remains in isolation.” Five of the residents who tested positive in late June returned from the facility’s COVID unit to Malloy 3 last week.

According to previous emails the facility sent to relatives and guardians, the residents who became infected in late June were all vaccinated for COVID-19.

The Iowa Veterans Home is currently experiencing a COVID-19 outbreak. Families and guardians of loved ones living at the state-run facility in Marshalltown–the largest nursing home in Iowa–were notified on June 22 that four employees and five residents had tested positive that day. All lived or worked in the same building. An email sent on June 25 indicated that another resident in the same unit (Malloy 3) had tested positive, and all six affected residents were in the home’s COVID unit.

As of June 25, the long-term care dashboard on the state’s coronavirus website was showing eight positive cases and no recoveries at the Iowa Veterans Home within the last fourteen days.

The state website doesn’t break down how many cases have been identified among staff and how many among residents, or whether anyone has been hospitalized. Emails to relatives and guardians indicated that one Iowa Veterans Home resident was hospitalized on June 23 but had returned to the home by June 25.

The governor signed this bill on May 20. Original post follows.

“I look forward to signing this important legislation into law!” Governor Kim Reynolds tweeted on May 6, after the Iowa House and Senate approved a bill purportedly banning “vaccine passports.”

House File 889 fits a pattern of Republican bills that are best described as solutions in search of a problem. No state or local government agency intends to issue COVID-19 vaccine passports, nor are Iowa-based businesses rushing to require that customers show proof of coronavirus vaccinations.

A “message” bill can be useful politically, if it pleases a constituency Republicans need in the next election. The odd thing about this last-minute push is that Iowa’s most vocal vaccine skeptics don’t support the bill heading to the governor’s desk. On the contrary, they’re demanding a veto in the name of freedom.

Eight groups representing workers, Latinos, immigrants, and civil rights advocates have filed a federal complaint documenting wide-ranging failures of Iowa’s Occupational Safety and Health Administration (OSHA) to do its job.

The November 13 complaint asks federal OSHA officials to investigate the state agency and compel it to address six broad problems:

Richard Lindgren: Governor Kim Reynolds lost a good two months of time pretending that her state was immune from the virus when she could have been turning over rocks testing for emerging hot spots. -promoted by Laura Belin

I do not live in Iowa anymore, although I did spend a lot of my years in a very rural part of the state. I still have grandchildren in Iowa and I can’t help but watch with horror the slow-rolling disaster that is the “economic re-opening” of the state by Governor Kim Reynolds. It has brought from the deep recesses of my mind a classic short story written by Shirley Jackson, and I have realized that we are living this tale in real-time.

“The Lottery” was first published in 1948. During my youth, this work became a part of every American Literature curriculum. I confess that I neither understood the story nor grasped its importance until now.

Dr. Glenn Hurst: The nursing homes know that if they accept one COVID-19 patient in their facility, they will likely be sending ten new patients to either the hospital or the coroner. -promoted by Laura Belin

As we look to reopen the U.S. economy, many questions arise regarding whose interests the economy serves. In the health care sector, the answer is large health systems, often at the expense of some of the most vulnerable populations in our state. Their vertical integration of the profitable components of health care provision, hospitals, surgery centers, rehab and physicians, and the casting off of components such as nursing care and hospice have acutely left the older generation at grave risk.

Today’s crisis illustrates the problem. The continued outbreak of novel coronavirus (COVID-19) cases in Iowa nursing homes should be shocking. The response to calls for assistance to protect these patients should be met with the same distress.

Bill Witt represented part of Black Hawk County in the Iowa House for ten years and is a well-known advocate for improving health care services and environmental causes. -promoted by Laura Belin

While the big political noise machines have traded barrages in a host of high-profile battles over border security, student debt, the Affordable Care Act, Afghanistan, and more, U.S. Senator Amy Klobuchar has quietly, and with her customary adroitness, slipped around the flanks of the clanking, clattering behemoths and planted her standard on strategic, long-term high ground: the security and health of America’s seniors.

This Sunday’s Des Moines Register carried another front-page story by Tony Leys about the substandard treatment some patients have received since being transferred from the now-closed state mental health facility in Clarinda. Leys reported last month that eight former Clarinda patients were sent to nursing homes “rated ‘below average’ or ‘much below average’ on a federal registry,” and that two of the patients “died shortly after their transfers.”

“Transfer trauma” can endanger a frail person’s health even if the new facility offers excellent care. Unfortunately, the Perry Health Care Center’s handling of three former Clarinda patients left much to be desired, according to an Iowa Department of Inspections and Appeals report cited at length by Leys. Failure to monitor and care appropriately for one man led to severe dehydration and breathing problems, and eventually his hospitalization. The man died two weeks later. Staff carelessness caused a shower accident that broke a woman’s leg. A third woman did not receive a blood-clot prevention medication for six days in a row. Click through for many more depressing details. The whole 28-page inspector’s report is embedded at the bottom of the page. The company that owns the nursing home rejects the inspector’s findings and will appeal the fines, its manager told the Register.

From where I’m sitting, the nursing home is fortunate to face only $13,500 in fines for the long list of documented problems. I’m shocked that failure to administer a medication for six days, or to inform the prescribing physician that the patient had not received the drug, resulted in only a $500 fine (pages 24 and 25 of the report). Failing “to provide adequate supervision when transferring a resident from a shower chair,” leading to a broken leg, resulted in only a $5,000 fine (pages 16 to 23).  

Most stunning: the nursing home will receive only an $8,000 fine for repeated staff failures to properly assess or treat a man who was becoming lethargic and dehydrated. Nor did staff always provide supplemental oxygen as indicated when the man’s saturation levels dropped below 90 percent. The brother of the (now dead) man told Leys that a doctor at Mercy Medical Center “said she’d never seen a person so dehydrated in her life.”

Eight years ago, an Iowa nursing home received state and federal fines totaling $112,650 for failing to change a woman’s wound dressing for 25 days, resulting in gangrene and amputation of the affected leg. A settlement later reduced that fine to $75,397.

I don’t know how much discretion state inspectors have in assessing penalties. Iowa nursing homes can’t be fined at all for some of the most common health and safety violations, under a law Governor Chet Culver signed in 2009. The Iowa House and Senate had unanimously approved that bill, ignoring concerns raised by some advocacy groups, the Iowa Department of Elder Affairs, and the Iowa Department of Inspections and Appeals.

Leys reported that the woman who failed to receive her anti-clotting meds has moved “a more highly rated nursing home near Bloomfield, which specializes in treating elderly people with mental illnesses.” The woman whose leg was broken would like to move from the Perry facility but has no place to go.

While the four presidential hopefuls attracted the most attention at last night’s “Wing Ding” in Clear Lake, some big Iowa political news preceded their pitches. Kim Weaver delivered her first major speech as a Congressional candidate in the fourth district. Given the smooth delivery, I would never have guessed she hasn’t run for office before.

After telling the audience a little about her background, Weaver talked about some of her key issues: protecting Social Security, Medicare, and Medicaid; supporting the middle class; raising the minimum wage; fighting to change a “predatory” student loan system; supporting women’s access to health care; immigration reform including a pathway to citizenship; clean water and environmental protections. The packed house frequently applauded, especially loudly when Weaver said, “These are some of the things I stand for. What I stand against is Steve King.” Iowa Democrats love to hate King. Weaver argued the seven-term incumbent “doesn’t represent Iowa values,” citing his offensive comments about immigrants and votes against Katrina aid and even a Farm Bill (because he thought it contained too much hunger assistance).

Weaver’s campaign is online at WeaverforCongress.com, as well as on Facebook and Twitter. Her website contains brief statements on most of the issues her stump speech covered. After the jump I’ve posted her announcement video and excerpts from her official bio.

Taking on King is a daunting task for any Democrat. The 39 counties in IA-04 contain 119,020 active registered Democrats, 176,515 Republicans, and 174,355 no-party voters, according to the latest figures from the Iowa Secretary of State’s office.

What’s on your mind, Bleeding Heartland readers? This is an open thread: all topics welcome.

Ryan Foley’s August 3 story for the Associated Press was disturbing on several levels. A “Serious Mismanagement Report” described a “decade of dysfunction” at the Effigy Mounds National Monument in northeast Iowa. Between 1999 and 2010, “78 construction projects costing a total of $3.4 million were approved there in violation of federal laws meant to protect archaeological resources and historic sites.” Also troubling: National Park Service officials have suppressed the report’s publication and recently denied that it existed. They have commissioned another team to write a separate (less critical) review of Effigy Mounds operations. National Park Service deputy regional director Patricia Trap delivered some unintentional comedy when she said, “I’m not denying some serious mismanagement […] But also there were actions taken along the way that were actually appropriate management.” I’m so relieved to know that Effigy Mounds officials handled some matters appropriately in addition to the seventy-eight projects that failed to comply with federal law.

Iowa Public Radio’s Morning Edition with Clay Masters interviewed Foley about the mismanagement and next steps at Effigy Mounds. Click through for the audio and transcript.

The Des Moines Register published a front-page piece by Grant Rodgers on August 5 about the “uncertain future” for Iowa’s regional drug courts. Those courts steer defendants into treatment rather than prison, turning lives around at lower cost than incarceration. “Yet despite their popularity among prosecutors, judges and community leaders, several Iowa drug courts have experienced sluggish legislative funding – so much so that they now are in jeopardy,” Rodgers reports. What a classic case of penny-wise and pound-foolish budgeting by state legislators who brag to their constituents about fiscal responsibility. With an ending balance (surplus) of at least $300 million expected for Iowa’s budget in the 2016 fiscal year, it’s ridiculous that the drug court in Council Bluffs will shut down on October 1, with courts in Burlington and Ottumwa “at risk of closing” later this year.

The front page of today’s Sunday Des Moines Register features a depressing must-read by Tony Leys about former residents of the now-closed Iowa Mental Health Institute at Clarinda, which “cared for some of the frailest and most complicated psychiatric patients in the state.” Of the eighteen people who lived in the Clarinda facility earlier this year, eight

were transferred to four traditional nursing homes, all of which are rated “below average” or “much below average” on a federal registry. The four facilities are in the bottom 29 percent of Iowa nursing homes for overall quality, according to the Medicare registry. Two of those eight patients died shortly after their transfers.

I’ve enclosed excerpts from all of the above stories after the jump, but I recommend clicking through to read the articles in their entirety.

The nursing home industry already had too much political power in Iowa before Terry Branstad returned to the governor’s office. Since late 2010, Branstad has repeatedly demonstrated that he prefers a more lax inspection regime for residential care facilities, with fewer nursing home inspectors than state lawmakers are willing to fund.

But Branstad may have hit a new low this month, according to a story by Clark Kauffman in Monday’s Des Moines Register. Kauffman has reported extensively on substandard care in Iowa nursing homes. Following up on this year’s winners of the “Governor’s Award for Quality Care in Health Care Facilities,” Kauffman learned that one of the three honored facilities “was cited by inspectors seven weeks earlier for widespread unsanitary conditions and failure to meet residents’ nutritional needs.”

At this writing, I could not find the July 9 press release announcing the awards on the governor’s official news feed. I found it on the Department of Inspections and Appeals website and posted the full text after the jump.

I also enclosed excerpts from Kauffman’s report, but you should click through to read every disgusting detail about the Woodland Terrace in Waverly (Bremer County). I challenge Branstad or Lieutenant Governor Kim Reynolds to move any of their own beloved relatives to a home with such low standards of hygiene. It’s bad enough that Woodland Terrace wasn’t fined after the conditions inspectors found when they visited in May. To honor that facility is outrageous.

Regarding the other two award-winners, Kauffman noted that Prairie View Home in Sanborn did not have any violations during its most recent inspection, but Friendship Haven in Fort Dodge was cited in late 2013 “for failure to provide adequate incontinence care for residents; failure to adequately treat bedsores; and failure to keep food at the proper temperature before serving.”

The year’s not even half over, but I doubt any public figure will surpass the brazen chutzpah former Vice President Dick Cheney displayed in television appearances on two consecutive days this week. Cheney asserted that former Secretary of State Hillary Clinton should be “held accountable” for the terror attack in Benghazi, and that President Barack Obama has abused executive power. Look who’s talking! The guy who never faced any consequences for his central role in leading the country into war on false pretenses. The Iraq war killed nearly 4,500 U.S. military personnel in the theater, contributed to hundreds of veteran suicides in the past decade, and left thousands of Americans with life-altering physical injuries or PTSD (not to mention the hundreds of thousands of Iraqi casualties).  I don’t know why anyone would listen to anything Cheney has to say about anything, particularly about being held accountable.

A remarkable example of home-grown chutzpah came from Jerry Rhoads, who recently filed for bankruptcy protection for himself and two Iowa nursing homes he owns. One of the homes is on the federal government’s list of most troubled care facilities, according to Clark Kauffman’s piece in the Sunday Des Moines Register. But to hear Rhoads tell it, he’s an innocent victim of over-zealous inspectors:

“I don’t think I’m the bad guy,” Rhoads said Wednesday [May 14]. “I believe this is criminal, the way we have been treated. They have fined us over $100,000, and we lost another $1 million because of the hold they placed on new Medicaid admissions.” […]

“We’re not bad people, but the state has treated us like criminals.”

No, if the state were treating you like criminals, you’d be facing criminal charges and not just civil fines for substandard care that may have led to several deaths. After the jump I’ve posted some of the shocking details from Kauffman’s article.

Iowa has some outstanding nursing homes and skilled care facilities, but I would still recommend keeping a close eye on any loved ones receiving long-term care, given our state’s weak enforcement of violations and limited capacity for inspections.  

Clark Kauffman published a must-read story in today’s Des Moines Register about the advocacy group Disability Rights Iowa firing its longtime executive director, Sylvia Piper. About six weeks ago, Piper published a harsh open letter to Governor Terry Branstad about his administration’s policy on inspecting Iowa nursing homes.

Background and more details are after the jump.

Former State Representative Rod Roberts had no experience in staff management or regulation when Governor Terry Branstad picked him to head the Iowa Department of Inspections and Appeals. In fact, Roberts admitted that he hadn’t applied for the position Branstad offered him in early November.

It didn’t take long for Roberts to figure out how to please his boss, who had complained last year about nursing home inspectors’ “gotcha attitude.” The Des Moines Register’s Clark Kauffman reports today,

The Iowa Department of Inspections and Appeals will now have 28, rather than 38, inspectors to monitor the care received by 30,000 residents in the state’s 442 nursing homes.

The reduction comes five months after state officials warned the federal government that a shortage of inspectors had already put Iowa at risk of failing to meet minimum federal standards for overseeing nursing homes.

The cuts will result in annual savings of $125,000 in state salaries. The 10 inspectors were paid a total of about $500,000, but 75 percent of that was paid by the federal government.

“That just shows you that this isn’t about saving money,” said John Tapscott, a former state legislator who now advocates for the elderly.

“This has to do with the fact that the nursing home industry wants less oversight,” he said. “How much clearer can it be that the governor is a pawn of the industry?”

I encourage you to click through and read Kauffman’s whole story. Roberts was a natural pick to pursue the more “collaborative” approach Branstad desires, because he and his wife have direct ties to regulated nursing homes. Roberts also spent a decade serving in the Iowa legislature, where the assisted living industry usually gets what it wants.

Branstad’s record on nursing home regulations was dismal during his previous four terms as governor, and even in recent years inspectors have found it hard to enforce rules for care facilities.  A 2009 Government Accountability Office report described disturbing pressure on Iowa nursing home inspectors (see the references to “State A” on pages 40 through 42 of the GAO report). Reducing the number of inspectors will increase the chance for negligence or maltreatment of residents to go unnoticed and/or unpunished. I would hesitate to move a loved one to an Iowa assisted living facility unless I were able to visit frequently and keep a close eye on conditions.

Given our state’s aging population, Iowa politicians should be demanding more oversight of care facilities. Nearly 15 percent of Iowa residents (roughly 445,000 people) are over the age of 65.  

For years, Iowa legislators have been eager to do whatever the nursing home industry asks of them. The Iowa Health Care Association’s lobbying efforts on behalf of nursing home owners have yielded impressive results. In 2009, the Iowa House and Senate unanimously passed a bill eliminating fines for dozens of violations at elder care facilities. Lawmakers from both parties have lobbied for the industry’s wish list in Washington. They have whined about inspectors “gotcha mentality” and in some cases interfered with the work of nursing home inspectors.

The Iowa Health Care Association’s influence will increase in the next administration. Governor-elect Terry Branstad told Iowa Public Television in October that he will appoint new leadership for the Department of Inspections and Appeals, with a view to more “collaborative and cooperative” work with nursing homes. That’s not good news for residents whose lives literally depend on how standards of care are enforced.

What happens when you fracture your ankle and no one checks on your wound or changes your stocking for 25 days? Ruth Louden, an otherwise healthy 89-year-old, developed gangrene, leading to the amputation of her leg. Her health went downhill quickly, and she died within months. Federal officials hit the Friendship Manor nursing home in Grinnell with a fine of $112,650. But the owner, Tim Boyle, appealed the fine and has settled for $75,397.

If management had brought Friendship Manor into compliance with all regulations on patient care during the past year, reducing the fine might be justified. But according to Clark Kauffman of the Des Moines Register, another patient died last year because of an accident linked to an unsafe walkway at the facility. That’s not all:

• In November, state inspectors compiled a 45-page list of deficiencies at the home, including:

• Improper use of physical restraints.

• Failure to meet a professional standard of care.

• Failure to provide incontinence care.

• Failure to prepare food under sanitary conditions.

• Failure to adhere to infection-control guidelines.

Current protocols for nursing home inspections and fines don’t appear to be compelling this facility’s managers to meet reasonable standards of care. It may be cheaper for owners to accept the occasional federal fine (after appealing to get it reduced) than to bring conditions up to par.

Iowa nursing homes have less to fear than ever from state regulators. During last year’s legislative session, lawmakers voted unanimously to eliminate “a broad range of fines against Iowa nursing homes that fail to meet minimum health and safety standards.” Friendship Manor owner Tim Boyle heads the nursing home industry’s main lobbying group, which provided a a textbook case of how to buy influence at the Iowa statehouse.

Even now, some Iowa legislators think regulators are too tough on nursing homes. What a sorry state of affairs in a state with one of the highest proportions of elderly people in the population.

Following up on my review of news from the first half of last year, I’ve posted links to Bleeding Heartland’s coverage of Iowa politics from July through December 2009 after the jump.

Hot topics on this blog during the second half of the year included the governor’s race, the special election in Iowa House district 90, candidates announcing plans to run for the state legislature next year, the growing number of Republicans ready to challenge Representative Leonard Boswell, state budget constraints, and a scandal involving the tax credit for film-making.

I expected 2009 to be a relatively quiet year in Iowa politics, but was I ever wrong.

The governor’s race heated up, state revenues melted down, key bills lived and died during the legislative session, and the Iowa Supreme Court’s unanimous ruling in Varnum v Brien became one of this state’s major events of the decade.

After the jump I’ve posted links to Bleeding Heartland’s coverage of Iowa politics from January through June 2009. Any comments about the year that passed are welcome in this thread.

Although I wrote a lot of posts last year, there were many important stories I didn’t manage to cover. I recommend reading Iowa Independent’s compilation of “Iowa’s most overlooked and under reported stories of 2009,” as well as that blog’s review of “stories that will continue to impact Iowa in 2010.”

Normally, people who write laws want the rest of us to follow those laws. However, when enforcing a statute costs a corporate interest group more money, prepare to hear some whining about government officials doing their jobs. So it was last week, when the Iowa Legislature’s Administrative Rules Review Committee unanimously approved rules formulated by Iowa Department of Inspections and Appeals.

The rules expand the number of hospital workers who are considered mandatory reporters of abuse to include food service workers and housekeeping staff, and define “gross negligence” as a form of abuse.

Lobbyists for Iowa’s hospitals and nursing homes attended Tuesday’s meeting and argued against approval. They said the state inspectors’ definition of gross negligence would result in too many caregivers being branded as abusers. They argued that gross negligence requires a willful, deliberate effort to harm a patient. […]

Representatives of Iowa AARP, the Governor’s Developmental Disability Council and Iowa Protection and Advocacy argued that industry proposals would weaken protection for seniors.

Rep. Bruce Hunter, a Des Moines Democrat who managed legislation related to the proposed rules, addressed the committee and said the industry’s proposed definition of gross negligence was unworkable.

“It would make it very, very difficult, if not impossible, to prosecute somebody in a nursing home or a hospital,” he said. “Yes, we want to make prosecution difficult because dependent-adult abuse is a serious charge, but we don’t want to make it impossible.”

Democratic State Representative Marcella Frevert

expressed dismay that regulators seemed to have regressed from “educational and helpful” enforcement to a “gotcha mentality” of penalizing violators.

Frevert joined the rest of the committee in approving the inspections department’s proposals, but said the full Legislature should consider revisiting the issue in 2010. “So, this isn’t over,” she said.

Here’s an idea: let’s stop issuing tickets for speeding and running red lights in favor of more “educational and helpful” enforcement of traffic laws.

Seriously, those talking points about the “gotcha” mentality of nursing home regulators sound familiar. That’s because legislators from both parties have made the same points in the past. By an amazing coincidence, those legislators have taken expenses-paid trips to Washington courtesy of the Iowa Healthcare Association, which represents nursing homes.

This issue bears watching during the 2010 legislative session, because nursing home operators know their way around the capitol and are good at getting what they want. Legislators could do this group a favor by relaxing the rules on “gross negligence” in nursing homes, and it wouldn’t cost an extra dollar from the general fund.  

The Des Moines Register’s Clark Kauffman reported Monday on some outside-the-box thinking by an assisted living center in Dubuque that has been fined repeatedly for providing inadequate care. I wouldn’t be happy if one of my loved ones were among the center’s 116 residents.

More details are after the jump.

July 1, 2009 is a big day: the 4,800 residents of Windsor Heights are no longer divided by three zip codes. It couldn’t have happened without Congressman Leonard Boswell’s legislative efforts last year, and that probably wouldn’t have happened without Ed Fallon’s primary challenge. (Note: WHO’s Dave Price attended last night’s event celebrating our new zip code.)

Don’t feel left out if you’re among the 3 million Iowans who aren’t enjoying the good life in our state’s only inner-ring suburb. You too may be affected by one of the many laws that take effect today.

The Iowa House Democrats posted a partial list of these laws on their site, and Jason Hancock provided additional information at Iowa Independent, such as the margin by which these bills passed during the 2009 session. Many won unanimous approval or overwhelming bipartisan majorities in one or both chambers.

Most of the new laws are steps in the right direction for Iowa: increased foreclosure protections; $30 million in historic tax credits; expanded health care for children, low-income pregnant women and adult children under 25; broader eligibility for wind energy tax credits; more job protection for volunteer emergency providers, electronic logbooks to track pseudoephedrine sales. A few of the highlights on the House Democrats’ list deserve additional comment.

New rules for sex offenders: I’m glad that legislators replaced pointless sex offender residency restrictions that did nothing to protect children from predators, according to prosecutors as well as advocates for exploited children.  Too bad nobody listened to State Representative Ed Fallon, who was the only legislator to vote against the 2002 law and got bashed for that vote during his primary challenge against Boswell (see also here). Speaking of campaigns, Chris Rants was one of only three state representatives to vote against the new sex offender law. Will he make this an issue in the gubernatorial race?

Manure application during winter: On principle I think it’s a bad idea for legislators to interfere with the rulemaking process at the Department of Natural Resources. However, amendments greatly improved this bill from the version that passed the Iowa Senate. In fact, the new law includes tougher restrictions on liquid manure application than the rules that the DNR would have eventually produced. It’s important to note that these restrictions only apply to manure from hogs. Cattle farmers face no new limits on what to do with solid manure during winter.

Consumer fraud protections: Iowans rightly no longer need permission from the Attorney General’s Office to sue some types of businesses for fraud. Unfortunately, this law contains an embarrassingly long list of exemptions.

Nursing home rules: It’s pure chutzpah for House Democrats to write, “Nursing homes will face higher fines for incidents resulting in death or severe injury.” More like, nursing homes will no longer be fined for the violations most likely to result in death or severe injury, but are subject to higher fines for offenses regulators never charge anyone with.

Let’s end this post on a positive note. The septic tank inspection law approved during the 2008 session also takes effect today. Over time these inspections will reduce water pollution produced by unsewered communities in Iowa. Credit goes to the legislators who approved this bill last year and to Governor Chet Culver. He wisely used his line-item veto to block State Senator Joe Seng’s attempt to sneak a one-year delay of the septic tank inspections into an appropriations bill.

This thread is for any thoughts about Iowa’s brand-new laws. Probably none of them will be as controversial as the public smoking ban that took effect on July 1, 2008.

When Governor Chet Culver took final action on the last two dozen bills from the 2009 legislative session, my biggest disappointment was his decision to sign Senate File 433, a bill that “eliminates a broad range of fines against Iowa nursing homes that fail to meet minimum health and safety standards.”

Governors rarely veto bills that pass out of the state legislature unanimously, as this one did. However, when Culver didn’t sign Senate File 433 right away, I hoped he was seriously considering the advice of the Iowa Department of Elder Affairs and the Iowa Department of Inspections and Appeals. Both of those state agencies opposed the bill.

Instead of listening to the public officials who have the most in-depth knowledge of nursing home regulations and violations, Culver sided with a corporate interest group:

Former state legislator John Tapscott, who now advocates for Iowa seniors, said the new law is an example of what the nursing home industry can buy with its campaign contributions.

“It only proves that our legislative leaders and governor are willing to sell out the most vulnerable of our citizens – the sick and elderly residing in nursing homes – for a few thousand campaign dollars,” he said.

Click “there’s more” to read about the substance of this bill and the winning strategy of the Iowa Health Care Association, which represents nursing homes. I couldn’t have written this post without an outstanding series of reports by Clark Kauffman of the Des Moines Register last November (see also here and here).

At Talking Points Memo, Josh Marshall just opened nominations for the second annual “Golden Duke Awards,” “given out for excellence in corrupt acts, betrayals of the public trust and generalized shameful behavior.” You have until December 17 to submit nominations in the following categories:

Sleaziest Campaign Ad

Best Election Season Fib

Outstanding Achievement in Corruption-based Chutzpah

Best Scandal — Sex and Generalized Carnality

Best Scandal — Local Venue

Best Scandal — General Interest

Click here to view last year’s Golden Duke winners.

Talking Points Memo also has launched a contest to determine the most corrupt state. Reader WO named the short list:

I think it’s pretty clear that the only three serious contenders are Illinois, Louisiana, and Alaska. My money would be on the young upstart, Alaska, over the grizzled corruption veterans of Illinois and Louisiana, but who knows. Statistics should play a part in the contest, but style points are important, too. Cash in the freezer is pretty impressive, as is trying to shake down the President-Elect.

One of Marshall’s readers in New Orleans argues here that Louisiana is the “all time champ”.

A reader in Arizona explains why that state should be a finalist.

Another reader makes the case for Nevada.

Marshall also received a bunch of e-mails nominating New York, New Jersey or Rhode Island. He explained here why those states are not in the same league as Illinois, Louisiana or Alaska:

I know there are a lot of hurt feelings out there. A lot of people feel slighted on behalf of their states. But while a number of these states have impressive histories of corruption, as I told a few emailers, a lot of it really comes down to a case of ‘what have you done for me lately?’ […]

Sure, there’s plenty of crooks in New York and New Jersey and Rhode Island. And Massachusetts has its moment. But I’m just not sure any of them can put the kind of serious and recent per capita muck on the table as these three other worthy states. Certainly not when it comes to governors and federal officeholders.

I think we can all agree that Iowa is never going to win any (mock) awards for political corruption.

Historically and today, our problem is not so much law-breaking by elected officials but the “legal corruption” that stems from the influence of money in our system. So, we get state lawmakers traveling on the dime of the Iowa Healthcare Association, which represents nursing homes, and then lobbying Congress and state officials to reduce regulation of nursing homes.

Similarly, we won’t get any legislative action to give counties zoning authority over agriculture (which would allow greater regulation of large hog lots), even though Governor Chet Culver as well as the Iowa Democratic and Republican party platforms ostensibly support “local control.”

Iowa is not a particularly corrupt state, but we should not let our squeaky-clean image blind us to the influence of money in politics, even here.

To get involved with solving this problem, check out the Voter-Owned Iowa website. Public Campaign’s site has tons of information on how “clean elections” systems work in other states.