(Des Moines, IA) – Auditor of State Rob Sand has released an update on nursing home inspections and staffing levels in Iowa compared to those outlined in a report released September 16, 2024. The update shows that after
substantial improvements, the State of Iowa is meeting the federal mandate on inspections of nursing homes certified to accept Medicare or Medicaid, and that Iowa is now inspecting certified nursing homes at a faster rate than neighboring states.
The Auditor’s Office calculations find that the State of Iowa now conducts inspections, on average, every 12 months, bringing the state’s performance to within the federal mandate requiring certified nursing homes to be inspected, on average, every 12.9 months. It is considerable progress compared to the 17.1-month average reported in 2024.
CMS also instructs states to inspect individual nursing homes at least once every 15.9 months. The State’s calculations show 2.8% of Iowa’s 389 certified nursing homes did not meet this expectation on at least one occasion in the past 3 inspections, compared to 85.4% noted in the 2024 report. This 83-percentage point decline is the largest in the Country. Out of the three most recent standard inspections, Iowa’s certified nursing homes averaged less than 0.04 of those inspections occurring more than 15.9 months apart, down from 1.27 in 2024. Using this metric too, Iowa witnessed the largest improvement in any state over the past two years.
Based on the data, the Iowa Department of Inspections, Appeals, and Licensing (DIAL) appears to have made great strides in conducting timely standard nursing home inspections. The State Auditor’s Office hopes the Department will continue to improve the delivery of prompt and effective oversight of nursing homes for Iowa taxpayers that not only meets, but exceeds, federal standards.
Staffing challenges within nursing homes; however, remain a concern. Iowa still ranks among the lowest in the Country – 47th nationally – in licensed nursing staff per resident. Licensed nursing staff averaged 1.29 hours per resident per day, a slight dip from the year before, and less than the national average of 1.54. While the turnover rate improved from 54% to 44%, more than 9 out of 20 nurses who worked at a certified nursing home in the previous year are no longer employed by the facility.
Since 2024, the number of certified nursing homes in Iowa has declined by 17, reducing the number of available beds to 25,254. On average, 80.1% of those beds are occupied each day, resulting in an average of 52 residents per facility, the 4th lowest density in the Country.
In preparing the report, the Auditor’s Office used updated publicly available data from the Centers for Medicare and Medicaid Services (CMS). The Auditor’s Office calculated figures identically to the 2024 report in order to easily gauge progress over time; this includes taking into consideration the national pause on inspections during the COVID-19 pandemic.
