Iowa cuts protection for people in nursing homes, Trump administration may make it even worse

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The State Capitol shown on Friday, July 21, 2017. — photo by Zak Neumann

Budget cuts have forced the state agency charged with safeguarding the well-being of Iowans in nursing homes and other long-term care facilities to stop regular quarterly visits to those facilities. The $1.3 million dollars the state had provided to the Office of the State Long-Term Care Ombudsman in recent years was cut by approximately $500,000 in the most recent budget.

The state’s six ombudsmen visited long-term care facilities, such as nursing homes, to assess the quality of care being given to residents. The ombudsmen would interview residents and staff in order to assess facilities, and could refer complaints to the Iowa Attorney General’s Office for enforcement action. The agency’s in-state travel budget was its second-largest annual expense, costing between $65,000 and $85,000 each year. According to a review of state data by the Des Moines Register, the ombudsmen visited care facilities more than 5,000 times during the 2015 fiscal year.

Ombudsmen visits to Iowa facilities were already well below the national average. Twelve percent of the state’s long-term care facilities were visited on a quarterly basis in FY 2015. The national average was 67 percent.

“These employees of the long term care ombudsman office exist for no other reason than to protect the health and safety of some of Iowa’s most vulnerable citizens,” John Hale told Little Village. “They simply cannot do their jobs, unless they are in the facilities.”

Hale is the founder and owner of the Hale Group, an Ankeny-based consulting and advocacy firm focused on long-term care public policy issues.

“[The ombudsmen have] got to be out there, seeing people, listening to people, talking to staff members, talking to family members, in order to identify situations that need to be resolved before they get to the point where there are really problems,” Hale said. “It’s a whole lot easier to solve problems at an earlier stage, than to wait.”

A proposed rule change being considered by the Trump administration could add to the difficulty nursing home residents and their families face in resolving problems.

In 2016, the Obama administration created a new regulation to prohibit nursing homes and other care facilities that receive Medicare or Medicaid payments from forcing patients to agree to binding arbitration to resolve any disputes. It’s standard practice, particularly among nursing homes, to require residents to sign contracts waiving their right to sue as a condition of being admitted, even in cases of alleged physical abuse. Studies have shown that decisions by arbitration panels heavily favor businesses over consumers with complaints.

The American Health Care Association (AHCA), a business group that lobbies on behalf of nursing home owners, sued to stop implementation of the new regulation. In November 2016, a federal judge in Mississippi issued a temporary injunction preventing the regulation from taking effect, until the AHCA lawsuit is resolved. The injunction is still in effect.

In June, the Trump administration proposed eliminating the regulation. The AHCA and the U.S. Chamber of Commerce support the proposal. Forcing nursing home residents and their families into arbitration is opposed by most patient advocates, including Hale.

“Any of us who have ever been part of a process to admit a loved one to a nursing home know how difficult and stressful it is,” Hale said. “To be presented with something at that point, when you’re already frustrated and stressed, that says that as a condition of admission you’re going to have to sign your rights away to ever seek justice in the court system — to me, that’s just fundamentally wrong.”

“Arbitration can be appropriate, if both parties willingly agree to it,” Hale continued. “But I’m concerned that proposals like this, and the effects of budget cuts like we’re seeing in Iowa, are tipping the playing field too far in favor of owners and the industry, and taking away fundamental fairness.”


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