Amid Rising Citations and Complaints, Lawmakers Advance Nursing Home Inspector, Staff Joint Training Bill

In a move to enhance the quality of care in Iowa’s nursing homes, Iowa lawmakers advanced a new bill that proposes joint training for nursing home staff and inspectors in order to better address complaints. Recent data shows complaints and citations have drastically increased over the last year.

The Department of Inspections, Appeals and Licensing will oversee the training, which will be conducted on a twice yearly basis. These sessions will address at least three of the ten most common complaints from the previous year, aiming to align both inspectors and nursing home staff on key issues, according to the Des Moines Register.

Rep. Ann Meyer, R-Fort Dodge, said it is important that nursing homes and inspectors are synchronized in addressing the top complaints.


The initiative is a response to concerns raised by data showing Iowa’s low ranking for nursing home inspectors per capita. Advocates argued that insufficient oversight had led to an increase in complaints and citations, with several nursing homes shutting down in recent years due to staffing challenges.

On the other side of the aisle, Senate Democrats introduced a set of bills to strengthen nursing home oversight. Led by senators Claire Celsi and Janice Weiner, their proposals included more frequent inspections, stricter penalties, studying alternatives to institutional care, raising the minimum wage for nursing home workers, and increasing the monthly allowance for long-term care residents on Medicaid.

SNN has reported that adding to the heavy regulatory burden on SNFs, the survey process is stressful, and operators see benefits to aligning the SNF survey process to the hospice survey process. Operators shared that they found the hospice survey to be less frustrating due to its focus on patient satisfaction, staff interviews, and less reliance on documentation. This collaborative approach contrasts with the more punitive and anxiety-inducing nature of SNF surveys, which in turn perpetuate staff burnout and turnover.


Factors contributing to the disparity include backlogs in state skilled nursing surveys, which cause turnover and insufficient training for new survey staff. Additionally, SNF operators undergo stringent Medicare audits, with operators facing a prolonged and cumbersome process to rectify errors.

Hospice providers undergo less frequent accreditation surveys but receive more personalized attention from surveyors who prioritize patient interviews and caregiver interactions. This contrasts with SNF surveys that heavily focus on documentation rather than patient-centered care. Despite regulatory differences, there’s a call from industry leaders for the sector to incorporate aspects of hospice survey practices to alleviate the burdensome and punitive nature of current processes.

And in the meantime that the industry mulls over changing the survey process, efforts such as the Iowa bill also be helpful.

“Delivering quality care is a continuous process, and there is always more we can do,” Brent Willett, CEO of the Iowa Health Care Association, told the Register in a statement. “Which is why IHCA continues to advocate for common-sense policies designed to attract, train, equip and retain more permanent direct care workers in Iowa communities to meet the growing demand for long-term care services and support.”

While the training bill moved forward, discussions on nursing home oversight will continue between the parties.

Companies featured in this article: