The now-closed Aspire of Lake Park nursing home. (Photo via Google Earth)
Two western Iowa nursing homes with a history of regulatory violations have been added to a federal list of the nation’s worst care facilities.
The Garden View Care Center in Shenandoah and the now-shuttered Aspire of Lake Park nursing home were recently added to the nationwide list of nursing homes whose quality-of-care issues make them eligible for what’s called “special-focus status.”
The Special-Focus Facilities list is updated periodically by Centers for Medicare and Medicaid Services and includes homes deemed by the agency to have “a history of serious quality issues.”
Nationally, there are 88 nursing facilities designated Special-Focus Facilities, with one or two slots filled by each state. Those homes are enrolled in a special program intended to stimulate improvements in their quality of care through increased regulatory oversight.
It’s not clear why the federal government added Aspire of Lake Park to its list of homes eligible for special-focus status. In the wake of dozens of regulatory violations cited last year, the state revoked the home’s license to operate.
On Sept. 30, 2024, CMS announced it was shutting off all Medicare and Medicaid money to the home, which was two months before the agency added the home to the special-focus eligibility list.
Asked why a closed facility would be added to the list, a CMS spokeswoman stated that because of a recent order by the Trump administration, the agency is pausing all communications with the public and the media that are not directly related to emergencies.
Because the number of Special-Focus Facilities in any given state is capped, additional facilities — even those that have earned CMS’ lowest ratings for quality — cannot be enrolled in Special-Focus Facility program until other special-focus facilities in that same state have either shut down or improved and “graduated” from the program.
That’s a process that can take four years or more. As a result, there are several homes in each state that are designated “eligible” for special-focus status due to their ongoing quality-of-care issues, but they are unable to benefit from actual enrollment in the program.
Currently, three Iowa nursing homes have been eligible for special-focus assistance for more than a year without actually receiving it, including Des Moines’ Greater Southside Health and Rehabilitation Center, which has been deemed eligible for 29 months.
Currently, the two Iowa nursing homes actually designated as Special-Focus Facilities are the Aspire care facility in Gowrie, and the Arbor Court facility in Muscatine. Aspire of Gowrie has been a special-focus facility for 14 months, and Muscatine’s Arbor Court has had the designation for 20 months.
In addition to the Aspire of Lake Park, Garden View Care Center and the Greater Southside Health and Rehabilitation Center, the Iowa nursing homes currently deemed eligible for the special-focus designation are Des Moines’ Bishop Drumm Retirement Center, Correctionville Specialty Care, Harmony West of West Des Moines, The Ivy at Davenport, Parkview Manor in Wellman, Pine Acres Rehabilitation and Care Center in West Des Moines, and Via of Des Moines.
‘Get over here, old lady.’
Aspire of Lake Park is part of a chain of Iowa nursing homes operating in Iowa under the “Aspire” name. Federal records indicate the chain is owned by Beacon Health Management of Florida.
Last fall, state officials acknowledged that nine Aspire care facilities in Iowa, including the Lake Park home, owed the state a total of $2,399,575 in unpaid, past-due fees. State officials said the homes had been placed on a payment plan to reimburse taxpayers for the money that was owed.
During the first nine months of 2024, Aspire of Lake Park was cited for more than 100 regulatory state and federal regulatory violations — an extraordinarily high number of violations for a home with only 28 residents.
In March 2024, state inspectors cited the home for 30 violations related to food service, residents’ rights, inaccurate medical assessments, overall quality of care, a lack of physician supervision, insufficient staffing, COVID-19 vaccinations, improper arbitration agreements signed by residents, and pests and garbage in the facility.
As a result of the violations, the Iowa Department of Inspections, Appeals and Licensing proposed a state fine of $7,250. The state fine was held in suspension, allowing CMS to impose a federal penalty of $49,530 in its place.
In September 2024, inspectors returned to the home and cited it for an additional 73 violations related to abuse and neglect, a failure to meet professional standards, insufficient nursing staff, the administration of unnecessary drugs, inadequate infection control, widespread food service problems, staff training, housekeeping, overall resident care and a major infestation of mosquitoes in the building.
Residents and employees of the home reported that two workers were verbally abusive to residents, routinely yelling at them and refusing to answer their call lights in a timely fashion. One elderly woman reported the workers would yell at her and say, “Get over here, old lady,” and said that after she was left to soil herself in bed she felt “worthless” and wanted to commit suicide.
The issues were reported to the director of nursing and the administrator, but nothing was done, the staff told inspectors.
Nurse: Owner ‘doesn’t care,’ not paying bills
A licensed practical nurse reportedly told inspectors she was the only night shift nurse employed by the facility that worked the overnight shift from 6 p.m. to 6 a.m. She told inspectors there were not enough workers in the home to care for residents and that some nights she would be passing evening medications to residents at 1 a.m. or 2 a.m., long after they had gone to bed. She reported that the director of nursing had to cover a lot of shifts, essentially working as a certified nurse aide, even when she had already worked a full day.
Inspectors also reported that the nurse said the “building was crumbling” and the nursing staff sometimes had to make repairs to the toilets because the maintenance staff wasn’t doing it.
The home’s director of nursing allegedly told inspectors the home had not been paying bills submitted by its temporary-staffing agency and as a result, the agency was now refusing to send any workers to the home – adding that she feared the home’s corporate owners would retaliate against her for revealing that information to inspectors.
She allegedly stated that she had just resigned due to her desire to maintain her nursing license that she had worked hard to obtain, adding the corporate owners didn’t “care what is going on” in the home.
The company’s regional vice president of operations then told inspectors she had been instructed by other company officials to refrain from speaking to the state’s health facilities bureau chief and was ordered to not answer any questions or she would be fired.
The regional vice president also reported that the company “failed to pay for fire inspections” at the home and that was why there were problems with compliance with the state’s Life Safety Code requirements, inspectors reported. She added that the corporation “did not invest any money into the buildings and therefore they were falling apart,” according to inspectors.
She also expressed a concern that “only the owner had the ability to stop admissions” to the home, even if the facility staff was reporting that they couldn’t meet residents’ needs to due to the lack of staff.
According to inspectors, the home’s administrator then told inspectors that the home “had been given a corporate instruction to gain business” and so she didn’t have the authority to deny new admissions. She refused to answer when inspectors asked who possessed that authority, the inspectors reported.
No state fines were proposed as a result of the 73 violations, although DIAL records show the state did revoke the home’s license.
Sister facility was also shut down
In August 2024, one of the Lake Park home’s sister facilities, Aspire of Donnellson, underwent an emergency evacuation after inspectors found the home was so short-staffed workers had to call 911 on occasion for assistance.
At the time, officials at Beacon Health Management, the home’s owner, said the evacuation was triggered by a problem with the electrical panel that controls the fire alarms and sprinklers. Two weeks after the evacuation, on Sept. 9, CMS took the rare step of terminating Medicare funding for the home, effectively shutting off the home’s primary source of revenue.
According to state inspectors, the Donnellson home’s former administrator told state officials she had been working weekends and cooking meals for residents to deal with staff shortages, adding that “there were months and months of emails begging for help” — presumably referring to written appeals for assistance she had sent to Beacon.
State inspectors reported that they contacted the chief operating officer at Beacon and asked whether he had prevented the Donnellson home from hiring additional staff until more residents were recruited.
According to the inspectors, the executive responded that he had, in fact, questioned whether the home was overstaffed, adding that he felt the number of nursing hours allotted to the home per day was “a key performance indicator” of financial health.
The chief operating officer also indicated he had repeatedly notified the state that because the company owed “a large amount of money to a temporary staffing agency” it was having a hard time securing more temporary workers, inspectors reported.