Three more Iowa nursing homes prepare to shut down

Three more Iowa nursing homes are in the process of closing, including a Sioux City facility plagued by regulatory violations related to resident injuries and multiple deaths.

Countryside Health Care Center announced Thursday that due to financial pressures, it will be closing within the next 60 days. It is the 26th Iowa nursing home to announce its closing since June 2022.

Earlier this year, state inspectors cited Countryside for violations related to four resident deaths. By the time state inspectors investigated in April, the home had compiled a backlog of 19 complaints awaiting investigation by the state

Countryside is one of Iowa’s larger nursing homes, with a maximum occupancy of 101 residents. State records indicate the facility’s resident population had been dwindling and in May, there were only 54 residents living at Countryside.

In addition to Countryside, two other care facilities — Valley View Community Home in Butler County and Pocahontas Manor in Pocahontas County – are now in the process of closing.

An ongoing wave of nursing home closures in Iowa prompted the Legislature and governor this year to approve a moratorium on the licensing of any new nursing homes. The moratorium provides industry players with protection from added competition, which could lead to fewer closures. But it also has the potential of leaving residents with fewer options when a closure forces them to relocate.

The moratorium law states that for at least the next 12 months – and possibly the next three years – the state will prohibit the submission of any applications for either new construction of a nursing home or a permanent increase in the bed capacity at an existing nursing home.

The moratorium can be waived by the state if it’s determined there is a “specialized need” for the added nursing facility beds that would be created, or if the average occupancy rate at nursing homes in a county exceeds 85%.

The Legislature also passed a $15 million increase in the Medicaid reimbursement rate for Iowa nursing homes which, when combined with federal matching dollars, should generate a total of $47 million in added reimbursements.

Workforce shortage blamed for closures  

During a taping of “Iowa Press” that will air Friday on Iowa PBS, Brent Willett of the Iowa Health Care Association, one of the nursing home industry’s primary lobbyists, said Iowa has “seen a slowdown in closures” this year.

“Since 2020, really, the advent of the pandemic, we’ve lost 29 nursing homes in Iowa,” he said. “The action of the Iowa Legislature this session — pertaining both in terms of a number of policy priorities that assisted facilities as well as appropriations — has helped to slow that down. But we still have a long road ahead of us.”

He said the wave of closures “predominantly relates to the availability of qualified workforce” in Iowa and noted that there “a number of rural nursing homes are really hanging on right now.”

Brad Anderson, state director for AARP, said the shortage of caregivers in Iowa nursing homes is “absolutely critical.” He noted that 40% of the state’s nursing homes are experiencing a workforce shortage – which is double the national average, he said.

“One of the things we know is workforce shortages lead to poor quality of care and closures,” Anderson said on “Iowa Press,” adding that “one of the best ways to address the workforce shortage, at least in the short-term, is to increase the pay of direct care workers who are currently making on average about $15 to $16 an hour.”

Willett cited federal data showing the average wage for a certified nurse aide in the first quarter of 2023 was $21.13. “So we’ve certainly seen a major increase in that marker,” he said.

Biden administration proposes staffing mandates 

Anderson also noted that nationally, insufficient staff has long been cited as one of the primary drivers behind inadequate nursing home care.

“In Iowa, we’ve seen about a 45% increase in complaints to the Department of Inspections and Appeals, which investigates nursing homes,” he said. “We’ve seen an increase in complaints to the long-term care ombudsman. I dare anybody to read the Iowa Capital Dispatch on a regular basis and you will be really concerned about what we’re seeing in Iowa nursing homes today regarding abuse, neglect and various other issues.”

The Biden administration, through the Centers for Medicare and Medicaid Services, is now considering a proposed rule that would establish the first-ever federal staffing standards for nursing homes. In Iowa and many other states, nursing homes are required to have “sufficient” staff, but that term is left undefined in state law.

Willett said on “Iowa Press” that the industry opposes such a rule, which he called a “federal, arbitrary mandate.” He said the proposed rule would “require, under penalty of ruinous fines, the mandated hiring of people who do not exist to care for people who do … The proposal shows a shocking lack of awareness about what is actually happening in rural health care by the Biden administration. Instead of creating an arbitrary mandate, we should be taking about real solutions to create more workforce to care for Iowa seniors.”

Anderson said AARP supports a staffing mandate.

“I don’t know how arbitrary it is only because my understanding of the mandate or regulation is that experts believe that is going to improve the quality of care,” he said. “And in Iowa, it’s something that we need to do.”

Countryside cited for resident deaths 

According to state and county records, Countryside Health Care Center is owned by 6120 Morningside Avenue Propco, a New York-based real estate company. Over the past three years, federal regulators have levied at least 14 fines against Countryside’s owners, with the penalties totaling $98,405, although federal records suggest that not all of those fines have been paid.

Earlier this year, Countryside was added to the federal government’s list of the nation’s worst nursing homes.

State records indicate that over the course of two inspections in April and May, Countryside was cited for 30 regulatory violations by the Iowa Department of Inspections, Appeals & Licensing, and was fined a total of $74,000 — although all of the state fines were being held in suspension so federal officials could determine whether to impose penalties of their own.

At the time of the first inspection in April, DIA had compiled a backlog of 19 complaints to investigate at Countryside. Seventeen of those complaints were substantiated by the state during the inspection.

The home was cited for a Jan. 25 incident that involved a female resident who was found unresponsive on the floor of her room. The woman was sent by ambulance to a hospital and died en route. Countryside was cited for failing to provide the woman with adequate supervision and for failing to report the incident to the state.

In May, inspectors returned to Countryside and cited the home for additional violations.

According to the inspectors’ reports, a resident of the home had been found slumped over in her wheelchair, unresponsive and cold to the touch, on the afternoon of May 2. The woman was treated at a local hospital for acute kidney injury and died a few days later. Countryside was cited for failing to contact the woman’s physician after her urine output slowed and for failing to adequately assess her condition.

Similar concerns were noted with regard to a female resident who had been found in late April sitting in a recliner, slumped over and unresponsive. She was taken to a hospital and diagnosed with acute respiratory distress and sepsis. She died two days later.

In March 2021, state inspectors visited the facility in response to a backlog of nine uninvestigated complaints. The inspectors reported they watched a female resident of the home hollering “help me” and “hurry up” from her bed, with her yelling audible at the nurses’ station. Inspectors said 47 minutes passed before two workers checked on the woman.

A medication aide at the home told inspectors that on Dec. 12, 2020, he looked in on a COVID-19 patient and the resident appeared happy and smiling. Two hours later, the aide said, the director of nursing emerged from the resident’s room, saying the resident was dead. About 10 or 15 minutes later, the aide alleged, the director of nursing asked what should be done because the resident’s status was “full code,” indicating CPR should be attempted. After another 30 minutes passed, a third worker arrived on the scene and initiated CPR but was unsuccessful in reviving the resident.

The director of nursing was fired after the incident, according to inspectors.