The Iowa Department of Inspections, Appeals and Licensing is responsible for overseeing Iowa’s nursing homes. (Photo illustration via Getty Images; logo courtesy of the Iowa Department of Inspections, Appeals and Licensing)
Fourteen bills related to nursing home oversight were introduced in the Iowa Senate this week, although none are expected to win approval.
At the beginning of the 2025, Senate President Amy Sinclair, a Republican from Allerton, told Iowa Public Radio she didn’t anticipate any action on nursing home regulation, saying the state was already doing a good job overseeing the industry.
Prior to the session, Sen. Claire Celsi, a Polk County Democrat, had called for stricter oversight and increased enforcement of nursing home regulations. On Wednesday, just ahead of this week’s deadline for approving non-appropriations bills, she introduced 14 separate bills dealing with nursing homes.
Celsi acknowledged that since the GOP controls both the House and Senate, it will be difficult to have the bills considered and discussed this session, let alone voted on, but said she’s prepared to pursue the matter.
“We’re not going to drop this issue,” she said. “Even though it’s an uphill battle, this is something that still needs to be handled and we’re going to shame the hell out of people until they start, you know, introducing some of this stuff. It might take forever, but we’re not going to give up.”
One of the 14 bills, Senate File 532, is a wide-ranging piece of legislation that would increase the penalties imposed for certain regulatory violations and would prohibit any Medicaid-certified home in Iowa from requiring residents or their families to agree to arbitration should they seek to make any claims for negligent care. In recent years, dozens of lawsuits filed against nursing homes have been tossed out of Iowa courts due to arbitration agreements that residents or their guardians signed at the time of admission.
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The bill would also make it a serious regulatory violation for any facility to retaliate against an employee or resident for filing a quality-of-care complaint with the state or cooperating with state investigators.
Senate File 532 would also provide a $600,000 increase in state funding, which would generate additional funding from the federal government, to pay for 30 more care-facility inspectors to visit assisted living centers and skilled nursing facilities.
John Hale, a consultant and an advocate for Iowa seniors, said the bills introduced Wednesday “present an opportunity to do what Iowans are asking elected officials to do — to discuss and pass bills that actually help people, that make the lives of Iowans a little better, and that give taxpayers assurances that their dollars are being well used.”
One of the bills, Senate File 527, would establish minimum staffing levels in Iowa nursing homes. Those levels would match those set under current federal rules approved by the Biden administration, which the Trump administration is widely expected to eliminate.
According to data from the Centers for Medicare and Medicaid Services, 14% of Iowa’s 422 nursing facilities were cited for insufficient staffing in fiscal year 2023. That was more than double the national average, which was 5.9%. Only five other states — Hawaii, Michigan, Montana, New Mexico and Oregon — had a worse record of compliance with the sufficient-staffing requirement.
Dean Lerner, who headed the state inspections department under Democratic Gov. Chet Culver, said the bill is necessary to protect seniors from insufficient staffing given the potential rollback of federal regulations.
“Republican Gov. Kim Reynolds and Attorney General Brenna Bird have gone out of their way to kill the recent federal minimum staffing standards rule for nursing homes,” Lerner said. “Republicans in Congress are also attempting to kill the rule. Nearly every resident in every nursing home will share their daily struggles with having enough trained, caring staff to help them. The Democrats care about these residents, the Republicans care about industry’s campaign contributions.”
As for the prospects of the 14 new bills, Hale said that “if legislators truly care and are on the side of the residents, the bills will move forward. If they really don’t care and fall on the side of nursing home operators and owners, the bills will die. Every Iowan needs to watch what happens to these bills and judge their legislators accordingly.”
Among the 14 bills Celsi introduced on Wednesday:
New levels of oversight: Senate File 539 would create a Long-Term Care Facility Safety Council to establish standards for nursing homes and review the licensing of facilities repeatedly cited for serious violations.
Taxpayer recoveries: Senate File 538 would establish a working group to study the potential recovery of Medicaid payouts after a care facility is closed or sold.
Cameras in rooms: Senate File 537 would bar care facilities from prohibiting the installation of video cameras in nursing home residents’ rooms by the residents or their guardians. It’s similar to House File 664, which has not advanced in the House since it was introduced on Feb. 28. Legislation along these lines has been vigorously opposed by the industry in years past.
More ombudsmen: Senate File 536 would increase the number of regional long-term care ombudsmen working for the state and would require them to prioritize on-site visits to nursing homes that have recently changed ownership or been taken over by private equity firms.
Ownership changes: Senate File 535 would require a more detailed state review of change-of-ownership applications by nursing homes and would involve a review of the new owner’s compliance with state and federal regulations in other jurisdictions. It would also increase the amount of money the new owner is required to have in escrow to ensure there is sufficient cash on hand for the continuation of services to residents.
Private equity ownership: Senate File 533 would bar the state from approving any change of ownership that result in a nursing home being acquired by a private equity fund or real estate investment trust.
Taxpayer dollars for lobbying: Senate File 531 would prohibit care facilities from using Medicaid dollars to pay for industry-association dues and lobbying expenses. “Around $2.3 million taxpayer dollars annually are funneled through membership dues to the Iowa Health Care Association,” Lerner said, noting that the head of the IHCA was paid $780,000 in 2023. “That association represents the interests of for-profit nursing homes: more taxpayer money and less government oversight. Residents’ health, safety, and welfare take a back seat to funding and accountability.”
Caregiver minimum wage: Senate File 530 would establish a new, minimum hourly wage of $15 for direct-care workers in nursing homes, with increases of $1 per year, to at least $20 per hour by the year 2031.
Personal needs allowance: Senate 528 would increase, from $50 to $85, the personal needs allowance collected each month by Medicaid beneficiaries in nursing homes. A similar bill, introduced earlier this year, would increase the allowance to $65. Iowa lawmakers haven’t increased the personal needs allowance for nursing home residents since 2001.
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