After a recent string of deaths and serious injuries connected to regulatory violations by Iowa’s nursing homes, an initiative to change the current law on how investigations of complaints from such facilities have borne fruit.[1] The Subcommittee on Health and Human Services proposed House File 2585, a bill proposing to create more exceptions to the currently required on-site investigation of complaints from facilities such as nursing homes. This bill would create more ways for complaints to be dismissed without an on-site investigation of the nursing home.[2] The point of the current statute about on-site investigations is to protect vulnerable people by regulating the quality of care residents receive in facilities like nursing homes. The backers of the proposed changes stated that the purpose behind the bill was to allow for more collaboration between the state agency tasked with investigating complaints against nursing homes – the Department of Inspections, Appeals, and Licensing (DIAL) – and nursing homes themselves to help improve the quality of care for residents.[3] This proposed bill passed 87-8 in the House and has been sent to the Senate for review.[4] It has progressed even though the bill reduces the oversight of nursing homes not long after four of Iowa’s nursing homes were added to the list of the worst nursing homes in the United States.[5] Iowa nursing homes are dangerous to not only their resident’s health and happiness, but the lives of its residents.[6]  

Iowa’s current law on on-site investigations has already proven to be ineffective. The current law requires that if a properly made complaint[7] about a facility, such as a nursing home, is made, the agency or a third-party investigator conducts an on-site inspection of the healthcare unless 1) there is no reasonable basis for the complaint or 2) the complaints was made to harass a facility or licensee such as nursing homes.[8] The second exception already creates a clear path for collaboration between the agency and nursing homes as it addresses the potential use of complaints to impede the work of a nursing home. Considering the recent news on the current state of nursing homes in Iowa, if anything, further oversight is required to protect residents.[9] 

House File 2585 aims to create two additional situations that would no longer require an on-site investigation of a complaint in facilities. The situations include 1) complaints made within 90 days of each other that address the same issue or the issue in the complaint had been reported to the government by the facility itself, and 2) DIAL determines that the complaint can be properly investigated using electronic records and conducting telephone interviews.[10] It is understandable for the legislature to want to improve the agency’s efficiency. According to a report by the United States Special Committee on Aging, Iowa had the second worst ratio in the country of surveyors to nursing homes.[11] Complaints, especially repeated ones, should be treated as a cause for concern, not an administrative nuisance. On-site investigations are incredibly important for such complaints. Not only do they provide greater context for the complaint filed, but cause surveyors to serve as a witness to the conditions that some of our most vulnerable populations are currently living in. The first-hand accounts of surveyors are instrumental to the system that Iowa uses to keep facilities such as nursing homes accountable.[12] It is baffling why the Legislature’s solution is to reduce the response to complaints. 

The Legislature’s response to the crisis Iowa’s elders are facing cannot be to reduce oversight over Iowa’s nursing homes. House File 2585 would decrease the amount of oversight that the state would have over an industry that not only has been struggling to meet the needs their residents require but has proven time and time again that it will not change without intervention—even at the cost of human life.[13] 


[1] Clark Kauffman, Republicans and Democrats Offer Competing Solutions to Nursing Home 'Crisis', Iowa Cap. Dispatch, (Feb. 13, 2024, 3:40 PM), [].

[2] H.F. 2585, 90th Gen. Assemb. (Iowa 2024). 

[3] Robin Opsahl, Iowa House Passes Bill Allowing More Exceptions to On-Site Nursing Home Inspections, Iowa Cap. Dispatch, (Feb. 27, 2024), [].

[4] Id.

[5] Clark Kauffman, Four Iowa Care Facilities Added to Federal Watchlist of Nursing HomesIowa Cap. Dispatch (Nov. 29, 2023, 3:42PM), [].

[6] Kauffman, supra note 1.

[7] Iowa Code § 135C.37. 

[8] Iowa Code § 135C.38. 

[9] Clark Kauffman, Assisted Living Center Fined $6,000 After Resident Dies, Iowa Cap. Dispatch (Feb. 16, 2024, 4:08 PM), []; Clark Kauffman, East Iowa Care Facility Resident Dies After Being Found Soaked in Blood, Des Moines Reg. (Oct. 21, 2023, 3:17 PM), []; Alexandra M. Baumann, For-Profit Healthcare and the Negative Effect on Iowans in Nursing Homes, J. of Gender, Race & Just. (Feb. 16, 2024), [].

[10] H.F. 2585, 90th Gen. Assemb. (Iowa 2024).

[11] Majority Staff of the U.S. Senate Special Committee on Aging, Uninspected and Neglected: Nursing Home Inspection Agencies are Severely Understaffed, Putting Residents at Risk (2023), [].

[12] State of Iowa Department of Health and Human Resources, Dependent Adult Abuse: A Guide for Mandatory Reporters (2023), []. 

[13] Id.

Tuesday, April 2, 2024