Iowa Meets Federal Nursing Home Inspection Standards After Major Improvements, Auditor Says

Without your donation, some stories vanish. Support Decorah News. DES MOINES, Iowa — Iowa has dramatically improved its oversight of nursing homes over the past two years and now meets federal inspection requirements after previously falling behind, State Auditor Rob Sand announced Monday, while warning that persistent staffing shortages and facility closures continue to threaten long-term care across the state. The update follows a 2024 report from Sand's office that found Iowa was taking an average of 17.1 months between inspections of Medicare- and Medicaid-certified nursing homes, well beyond the federal requirement that statewide inspections average no more than 12.9 months. Using updated data from the Centers for Medicare and Medicaid Services through June 1, 2026, the auditor's office found Iowa now conducts nursing home inspections every 360 days, or roughly every 12 months, bringing the state into compliance with federal standards. The report also found Iowa inspects nursing homes more frequently than neighboring states, where the average inspection interval is 449 days. "I believe it demonstrates what happens when government agencies are held accountable and have proper oversight," Sand said during a news conference announcing the findings. The report attributes much of the improvement to increased staffing among state inspectors. Sand said the Iowa Department of Inspections, Appeals and Licensing added personnel dedicated to nursing home inspections, allowing inspectors to complete more visits on schedule. During the news conference, he said the number of inspectors increased from about 22 to 32, though he said his office would verify the exact figures. "More people can get more inspections done. Pretty simple," Sand said. The improvements extend beyond statewide averages. Federal guidance requires individual nursing homes to be inspected at least once every 15.9 months. According to the report, only 2.8% of Iowa's 389 certified nursing homes exceeded that interval during any of their three most recent inspections, down from 85.4% reported in 2024. The auditor's office said the decline represented the largest improvement among all states. The report also found Iowa nursing homes averaged 0.04 inspection gaps exceeding 15.9 months during their three most recent inspections, compared with 1.27 gaps two years earlier. Despite those gains, Sand said staffing within nursing homes remains a significant concern. The report ranks Iowa 47th nationally in licensed nursing staff per resident. Licensed nurses, including registered nurses and licensed practical nurses, provided an average of 1.29 hours of care per resident each weekday, below the national average of 1.55 hours. Turnover among nursing staff also remains high, although it has improved. The report found the average annual nursing staff turnover rate declined from 54% in 2024 to 44.4% over the past year. Sand called the improvement encouraging but said the continued loss of nearly half of nursing staff annually remains troubling. "If we worked in a job where 44% of our coworkers were gone within a year, we would think that was a high number," Sand said. He declined to speculate on the reasons behind the improvement in turnover, saying the auditor's office lacked data to support any specific conclusions. However, he noted direct-care workers often earn wages comparable to those offered in fast-food jobs despite caring for elderly residents. "These are the people who are taking care of our grandparents and parents," Sand said. "They are bathing them, dressing them, feeding them." He said reducing turnover would likely improve continuity of care for residents while lowering training costs for nursing home operators. The report also documents continued contraction in Iowa's nursing home industry. Since 2024, the number of Medicare- and Medicaid-certified nursing homes has fallen by 17, leaving 389 facilities statewide. Available beds declined by more than 2,000 to 25,254. Although average occupancy stands at about 80%, Iowa averages only 52 residents per certified nursing home, the fourth-lowest resident density in the country. Sand said many closures occur in rural communities, where lower population density makes it more difficult to sustain both staffing and resident populations. "That can make it harder for folks in rural areas who need to be in a nursing home to have access to one in their community or close to their family," he said. Asked whether the report recommends policy changes, Sand said the auditor's office generally avoids advocating for specific policies and instead focuses on whether state agencies are carrying out existing responsibilities. "That'd be a good question for the administration," Sand said. "We in the auditor's office always remind people: 'We are not in the wisdom business. We are in the integrity business.'" While emphasizing that staffing challenges remain, Sand said the report's central finding is that state oversight has moved in a positive direction. "We've seen the government inspection piece of this, the oversight piece of this, improve substantially," he said. "That is a good thing." Your inbox, upgraded! Subscribe for free and enjoy handpicked stories, helpful advice, and local insights delivered weekly.