Clark Kauffman, staff writer for DesMoines Register wrote the following review of recent nursing home fines in Iowa.

Clearview Home, Mount Ayr:
A nurse aide was improperly transferring a resident who had a long-standing, serious head injury when the two lost their balance and the resident fell face-first to the floor. The resident was treated at a hospital for broken teeth and facial lacerations, then returned to the home. The resident died the next day. The home was fined $10,000.

Denison Care Center, Denison:
A resident was injured while being transferred, suffering spiral fractures in both legs, but was not taken to a hospital for three days. At the time of the accident, the resident told workers, "You broke my leg." The resident died at the hospital. A physician concluded the accident and injuries were the cause of the resident’s death. The home was fined $10,000.

Eldora Nursing Home, Eldora:
A resident with a history of respiratory problems was found dead on a floor one morning. Employees said they had not checked on the man for at least nine hours, even though the resident was to have been checked every two hours. The home was fined $10,000 for failing to provide a safe environment. Three months later, the home was fined $300 for the same type of violation. In that instance, a resident had been physically attacking and threatening other residents for several months. Five months later, the home was again cited for failing to provide a safe environment.

The Manor, Malvern:
A physician was to be contacted if a resident with end-stage liver disease became drowsy or lethargic. Nurses documented that the resident was "noticeably lethargic" and napping in the lobby, but they did not contact the doctor. A nurse allegedly told a concerned co-worker that the resident was "going to die anyway." Several hours later, an employee noted that the resident was still in the lobby and was dead. A doctor told inspectors the resident might have lived had he been contacted. The home was fined $10,000.

New Homestead Care Center, Guthrie Center:
Six workers reported to managers and supervisors that a male employee had committed multiple acts of abuse and neglect against residents. Managers did not act on those concerns, which allowed the abuse to continue. In one instance, the man allegedly put a chair against the door of a female resident’s room while he was inside. Another worker forced her way in and saw the employee bent over the mentally disabled resident, who was partially undressed and bleeding from her vagina. The man turned his back on the other worker and claimed he was cleaning the resident, but he had no washcloths, towels or other supplies. The home was fined $7,000. Eleven months later, inspectors returned to the home and filed a 64-page report of violations.

Park Place, Glenwood:
Four workers noted that a mentally retarded female resident was moaning and groaning in pain one night after having refused food and medication for days. The workers repeatedly asked the nurse on duty to check on the woman, expressing concern that the woman was dying and in serious pain. The nurse did not respond or contact a doctor. Hours later, the woman was found dead, face down at the foot of her bed. Two workers alleged the nurse was often talking on her cell phone or text-messaging her boyfriend. The home was fined $10,000.

Risen Son Christian Village, Council Bluffs:
A resident was placed in a bed with a broken side rail and fell to the floor, suffering a broken leg. The resident was taken to a hospital and died. The fall was the underlying cause of death. Several workers were aware the side rails on the bed were not working properly. The home was fined $10,000.

Scottish Rite Park, Des Moines:
A female resident fell in a shower, causing a serious, overlapping break in the bones of one leg. At the time, the woman told workers, "I guarantee you my leg is broken," but none of the employees notified the woman’s family or doctor, or ordered an X-ray, until the next day. Three workers told inspectors they were fearful of losing their jobs or state licenses. The resident later died, and the home’s medical director told inspectors the death was directly related to the fall. The home was fined $10,000.

Windmill Manor, Coralville:
A resident was entering other residents’ rooms, blocking their exit and then hitting and threatening them. One of the victims tearfully told inspectors she was afraid of the man and wished she could live somewhere else. The director of nursing told inspectors she was aware of the attacker’s history but said the victim who complained was "over-dramatic." While inspectors were at the home, they noticed the attacker was sleeping in the nurses’ station. A worker explained that is where the man stayed, otherwise he would enter the rooms of other residents and "make them scream." The home was fined $500. Two weeks later, inspectors were back at the home investigating a death. A resident had been admitted to the home after a leg amputation. While at the home, the resident’s skin deteriorated. The director of nursing never looked at the wounds. Eventually, the resident was hospitalized and doctors alleged the home had failed to treat a large, open sore. The resident was diagnosed with an infection, developed complications and died. The home was fined $10,000.

Clark Kauffman also has an excellent article about how the nursing home lobbyists have limited the amount of fines for neglect and abuse to a maximum of $10,000.  Continue reading for a brief summary.

Iowa’s nursing home owners can pay only $10,000 for serious health and safety violations, abuse, and negelct causing death.  The amount of fines have not changed in 22 years.

"I tell you, somebody’s been doing a great job of lobbying to keep the fines at that level," said John Tapscott, an advocate for seniors who spent six years in the Iowa Legislature. "The reason the fines haven’t changed is all the political influence these homes have." 

Nursing home corporations are aggressively lobbying state legislators. They host campaign fundraising events for key lawmakers, and are collecting information on the registered nurses who work as state nursing home inspectors.

The battle could come to a head during this year’s legislative session, with lawmakers being asked to side either with state inspectors or with an industry that has a team of lobbyists and a well-funded political action committee.

The debate over fines first surfaced 14 months ago when USA Healthcare nursing home in Urbandale was fined $400 after being accused of failing to protect residents from numerous instances of assault and sexual abuse. According to state records, elderly residents and workers at the care center were choked, kicked, punched, sexually assaulted and threatened by at least two residents who suffered from dementia. There were at least 18 attacks – some by a man wielding a coat hanger – that were documented by the home. One of the attackers broke the clavicle of a fellow resident. 

A private foundation that surveys Iowa nursing homes about the inspection process gives the state inspectors high marks for professionalism and courtesy.

Iowa’s fines are lower than those imposed by other states in the Midwest. The Government Accountability Office reported earlier this year that fines are so small nationally that some nursing homes view them as part of the "cost of doing business."

It’s now cheaper for an Iowa nursing home to pay a Class 1 fine every year than it would be to hire just one additional nurse aide.

The finances of Iowa’s for-profit nursing homes are not subject to public-disclosure laws. But the state’s nonprofit care centers – which pay no income tax – must disclose some of those details. The latest available reports show that some of these nursing homes and their owners are doing well financially.

For example, Care Initiatives of West Des Moines, which owns 47 Iowa care centers, posted $140 million in revenue during 2006. Although that was $13 million less than the charity spent, Chief Executive Hulon Walker collected $2.1 million in salary, benefits and deferred compensation. The chief financial officer was paid $1.5 million, and members of the board of directors were paid up to $412 an hour.

The company, which is considered a public charity, has its own for-profit insurance company in the Turks and Caicos Islands, an off-shore tax haven. At the end of 2006, that insurance company, which provides coverage exclusively for Care Initiatives, had almost $1.4 million in cash on hand.

The Evangelical Lutheran Good Samaritan Society, a South Dakota charity that owns 230 nursing homes, including 21 in Iowa, collected $851 million in revenue in 2006, which was $30 million more than was spent operating the facilities. The charity paid its chief executive $437,784 and spent $87,000 on lobbying.

The organization, which has $1.2 billion in assets, also has its own for-profit insurance company, based in the Cayman Islands, another off-shore tax haven. At year’s end, that insurance company, which provides coverage exclusively for Evangelical Lutheran Good Samaritan Society, had $4.8 million in cash on hand.

A spokesman for the "charity" said the insurance company is in the Cayman Islands because a "consultant" determined that was the "best fit" for the corporation.

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