New report details low staffing, high turnover in Iowa nursing homes

More than 43% of all Iowa nursing homes do not meet upcoming federal mandates on staffing levels, a new national report shows.

The report also indicates 21 Iowa care facilities each cycled through three to five nursing home administrators during 2023.

Using newly published data collected by the federal government, a nonprofit advocacy group called the Long-Term Care Community Coalition issued a detailed report this week outlining the staffing levels at every Medicare-certified nursing home in the nation during the fourth quarter of 2023.

The report compares actual staffing levels with the Biden administration’s new rule mandating specific staffing levels in Medicare-certified nursing homes. That rule requires the presence of a registered nurse 24 hours per day, seven days a week in all facilities, as well as 3.48 hours per day, per resident of total nursing-staff time.

The rule will be phased in over the next five years and includes exemptions and waivers for facilities in rural areas that are making a good-faith effort to meet the new mandates.

The coalition’s report shows that 6 in 10 of all U.S. nursing homes would have met the new nurse-staffing standard of 3.48 hours in the fourth quarter of 2023. Iowa homes fell below the national average, with 56.5% of them meeting the new standard.

The fact that a majority of facilities already meet the new minimum standard while still facing quality-of-care issues has been an issue with many advocates who say the standards don’t go far enough. They point to a federal study that shows each resident needs at least 4.1 hours of nursing care each day – which is a standard met by only 26% of all nursing homes nationally and 24% of all homes in Iowa, according to the coalition’s report.

The report indicates the Iowa homes with the lowest nurse staffing levels in the fourth quarter of 2023 were Arbor Springs of West Des Moines, Midlands Living Center of Council Bluffs, Linn Haven Rehab & Health Care of New Hampton, Pleasant Acres Care Center of Hull, Northbrook Healthcare and Rehabilitation Center of Cedar Rapids, Crest Haven Care Centre of Creston and Aspire of Perry. All reported less than 2.5 hours of total nursing care per resident, per day, according to the report.

A separate set of data published by the Centers for Medicare and Medicaid Services indicates that 14% of Iowa’s 422 nursing facilities were cited for insufficient staffing in fiscal year 2023. That’s 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. Iowa’s neighboring states of Nebraska, South Dakota, Wisconsin and Missouri had no more than 2% to 6.8% of their facilities cited for insufficient staffing in 2023.

Report pinpoints high turnover in some Iowa homes

The report also highlights a problem in many nursing homes nationwide: high staff turnover, which disrupts continuity of care and leads to errors by workers who aren’t familiar with residents’ needs.

According to the data, several Iowa homes had annual nurse staffing turnover rates of more than 85%, indicating that, on average, almost every nursing position in the facilities had been vacated and refilled in 2023.

The Iowa homes with the highest rate of nursing-staff turnover, ranging from 85% to 100%, were Risen Son Christian Village of Council Bluffs, Sunrise Retirement Community of Sioux City, Wesley Acres of Des Moines, Arbor Springs of West Des Moines, Dunlap Specialty Care, Azria Health Park Place of Des Moines, Sunny Knoll Care Centre of Rockwell City, and Montezuma Specialty Care.

The report also identifies the Iowa nursing homes that had the highest number of administrators who left employment with the facility during 2023.

The Elmwood Care Centre of Onawa and Heritage Specialty Care of Cedar Rapids, are each reported to have had five administrators who left the facility in 2023. Azria Health Park Place of Des Moines, Sunny Knoll Care Centre of Rockwell City, Crest Haven Care Centre of Creston, Cedar Falls Health Care Center, Premier Estates of Muscatine, Westwood Specialty Care of Sioux City, Casa De Paz Health Care Center of Sioux City, Wesley Park Centre of Newton, and Garden View Care Center of Shenandoah each are reported to have had four administrators leave during the year. Ten other Iowa nursing homes had three administrators leave during the year.

The coalition’s report shows that nationally, 4 out of 5 nursing home residents live in facilities that are providing less than the federally recommended, but not mandated, 4.1 hours of total nursing-staff time per resident, per day. In addition, more than half a million nursing home residents live in facilities that don’t meet the new federal staffing requirement of 3.48 hours.

The report suggests one positive trend in nursing homes: a decreased reliance on temp-agency workers who often cost more but are less familiar with individual residents’ needs. After years of increased use of temp-agency workers during the pandemic, the use of such workers nationwide accounted for 8% of all nursing staff hours, which is down from 8.7% the previous quarter.

In Iowa, the average percentage of temp-agency workers was 7.3% in the last quarter of 2023, which was down slightly from 7.6% the previous quarter, and down significantly from 10.2% the previous year.