Hundreds of Iowa Nursing Home Complaints Go Uninvestigated for Months  

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

This was the headline here in Iowa last Friday (July 8th) and throughout this past weekend. The article – found here – is not a pretty one but the information needs to see the light of day. We need to do better, as a state and as a nation.

Here’s a look at the age of pending complaints now before the Iowa Department of Inspections and Appeals, the state agency that oversees nursing homes, hospices, surgical centers, dialysis centers and other medical facilities in Iowa:

Pending complaints against Iowa nursing homes:
Filed 30-60 days ago: 80 cases
Filed 60-90 days ago: 85 cases
Filed 90-120 days ago: 44 cases
Filed more than 120 days ago: 201 cases (24 of these are more than a year old)
Total: 410 cases

Pending complaints against other types of Iowa facilities:
Filed 30-60 days ago: 24 cases
Filed 60-90 days ago: 22 cases
Filed 90-120 days ago: 23 cases
Filed more than 120 days ago: 54 cases
Total: 123 cases

Source: Iowa Department of Inspections and Appeals

“Iowa is not the only state struggling with a backlog of uninvestigated complaints.

In May, the USA Today Network reported that 96% of the complaints filed in the state of New York during the first two years of the pandemic were either ruled unsubstantiated or remained unresolved.

That same month, Arizona’s auditor general issued a report saying the state had placed its nursing home residents at risk by failing to properly investigate complaints of abuse and neglect in care facilities.

The auditor general reviewed 156 high-priority complaints and found that in 73% of those cases, the state had failed to investigate the complaints within the federally mandated timeframe of 10 workdays.

The report also alleged the state’s inspection agency had inappropriately downgraded 98% of its high-priority complaints to a lower priority, artificially extending the federal deadline for investigating them from 10 days to a full year.

At the national level, it has been five years since the inspector general for the U.S. Department of Health and Human Services last studied states’ compliance with the federally imposed deadlines for investigating complaints.

The 2017 study revealed that almost one-fourth of all states had failed to meet performance thresholds for timely, onsite investigations of high-priority complaints in each of the five years studied.

At that time, Iowa was one of four states that failed to meet the standard in four of the five years.

According to the guidance CMS gives to state agencies, serious complaints alleging immediate jeopardy to the safety of nursing home residents must be investigated within two working days.

Complaints of high-priority issues that don’t involve immediate jeopardy are to be investigated within 10 working days.

State agencies like DIA should still “strive to meet these timelines,” CMS told the states last fall, but if they can’t, they should work toward investigating the complaints “as soon as possible.”

As for the less serious, medium-priority complaints, those can be placed on the back burner and investigated during the next scheduled inspection for the facility, which could be a year or more from the date the complaint was received.

In fact, medium-priority complaints that don’t suggest “a pattern of poor care,” and all complaints deemed to be of low priority needn’t be investigated at all, according to CMS. The state agencies are now allowed to simply close out those cases and then classify them in the federal complaint-tracking database as “withdrawn/expired.”

In its written guidance to state agencies, CMS said last fall that it “is very concerned about how residents’ health and safety has been impacted” by state inspectors having less of a presence in nursing homes during the pandemic.

The agency pointed out that due to the pandemic, it waived certain regulations and allowed nursing homes to employ nurse aides for more than four months even if the aides didn’t meet federal training and certification requirements.

As a result, CMS is now asking state inspectors to “pay additional attention” to homes’ compliance with the federal requirement that they have sufficient, competent nursing staff.

The federal agency also wants inspectors to be on the lookout for residents being placed on antipsychotic medications that are unnecessary and are used to simply control residents’ behavior.”