A persistent grievance of nursing homes around immediate jeopardy (IJ) citations is that due to survey delays, the most severe citations remain on their records long after they have been resolved. A state bill passed on Tuesday aims to give nursing homes a second chance by allowing them to contest the violation before a citation is issued.

The Iowa Senate passed a bill that will enable facilities to provide “context and evidence” before the state agency makes a decision on issuing a citation.

The bill was described by state senator Kara Warme (R-Ames) as a small, technical fix to a law passed in 2024 regarding Iowa nursing home oversight, “with the goal of problem solving and improving care in our nursing facilities.”

In 2024, nursing homes could only review and provide additional context after citations were issued by the Iowa Department of Inspections, Appeals and Licensing (DIAL), the state entity charged with nursing home oversight.

Now, the Republican-led bill clarifies that the review process would happen for each instance of a “deficient practice identified by the department for which a citation may be issued,” and that the review process only applies to nursing facilities and not all health facilities, according to a story in the Iowa Capital Dispatch.

Critics of the bill pushed back against it, saying it could conflict with federal law or lead to fewer citations for legitimate cases of low quality care.

The bill also failed to approve changes suggested by Democratic senators aimed at increasing oversight and regulation at nursing homes in Iowa, which they argued would prevent resident abuse and neglect.

Out of a total of four amendments proposed by Democrats, Senate Minority Leader Janice Weiner introduced one that would allocate $600,000 in funding for DIAL to hire 30 new inspectors, increase penalties for certain regulatory violations by facilities and give DIAL a shorter time frame to respond to complaints. It was ruled out of order.

“The bill as currently written is lopsided in favor of those who run nursing homes, when those we should be protecting are our seniors,” Weiner said. “And this amendment balances and remedies that.”

Other Democratic amendments included a ban on acquisition of nursing homes in Iowa by private equity, such the $85 million sale of 29 Iowa nursing homes by the Iowa-based ABCM Corp. to a private-equity firm called the Cascade Capital Group. Some critics of PE have argued reduce quality of care and staffing. 

“According to a federal database, Iowa is one of the worst performing states for nursing home violations, with triple the violations of what would be expected for our state’s population,” Weiner said.

Two other amendments proposed by Democratic lawmakers were aimed at allowing residents and their guardians to install cameras in rooms and enabling them to submit context and evidence to DIAL during the review process. The were also rejected by the Republican-controlled Senate.

“These amendments would have materially improved legislation and created important protections for Iowa seniors who live in these facilities and whose families count on these facilities to provide these services,” said Sen. Zach Wahls, (D-Coralville).