Iowa
New report details low staffing, high turnover in Iowa nursing homes
More than 43% of 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 has issued a detailed report 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 every 10 U.S. nursing homes would have met the new nurse-staffing standard 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 deficiencies 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 ― 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 neighbors 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 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 COVID-19 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.
Find this storyat Iowa Capital Dispatch, which is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Iowa Capital Dispatch maintains editorial independence. Contact Editor Kathie Obradovich for questions:kobradovich@iowacapitaldispatch.com.
Iowa
Iowa Republicans set up a shell game to mask the costs of tax cuts | Opinion
It is not “taxpayer relief” to use previously paid taxes to pay help pay for budget shortfalls caused by a “tax cut.”
This month, the state Revenue Estimating Conference reported new estimates showing Iowa revenue will drop by $602 million (6.2%) compared with fiscal year 2024. Further, state revenue is expected to drop by a further $428 million (4.7%) in fiscal year 2026, which begins July 1, 2025. Republicans attribute the fall in estimated revenue to the start of their 3.8% flat income tax rate next year. Republicans have promoted reducing the state income tax — which Sen. Jack Whitver derisively calls a “confiscation” — down to zero.
But Republicans have amassed a $2 billion budget surplus, $961 million in its reserve accounts, and $3.75 billion in the Taxpayer Relief Fund, which was supposed to be used to reduce taxes. All told, about $6.75 billion. One good question is: Why?
Republicans enacted a long-term commitment to reduced revenues due to the flax tax at an extremely volatile time during and after the COVID-19 epidemic. The federal government’s $5.2 trillion infusion into states and their economies was the largest fiscal stimulus package ever. One-time federal financial supports reduced state costs and artificially bolstered revenues. Recently, Pew Charitable Trusts observed: “The combination of temporary funds propping up budgets and the adoption of new recurring expenditures or tax cuts has left many states in a precarious position. Policymakers now must grapple with the possibility that their states’ finances are structurally imbalanced and vulnerable to deficits as one-time funds dry up but new commitments remain.”
Not wanting to “waste a good crisis,” as they say, Republicans rushed to enact a flat tax during an extremely uncertain economic time when the level of likely future tax revenues was cloudy at best.
As the COVID economic booster begins to fade, several states have experienced significant decreases in tax revenue as compared to their 15-year trend. Iowa was among states experiencing a negative difference in the fourth quarter of 2023 — mind you, before the flat income tax kicked in. Iowa experienced a 6% decrease in revenue from its historical trend, the fourth-highest difference among states that went negative, according to Pew.
Researchers explained: “State tax collections have been on a downward trajectory since their mid-2022 peak, reflecting, in large part, a decline from the unexpected highs of the pandemic revenue wave. … One question is whether states will be able to afford the budgetary commitments they made in the past three years — such as tax relief and pay raises for public employees — over the long term.”
Yet, Iowa Republicans want to enshrine their COVID-fueled tax cut into the Iowa Constitution. Last session, Republicans passed a constitutional amendment to require a two-thirds vote of both chambers of the state Legislature to pass a bill that would increase the individual or corporate income tax rate. They are expected to pass the legislation a second time this session, which would likely put it on the ballot for voters in November 2026. What a way to saddle future Iowans with a hasty tax cut enacted during a most abnormal period of artificially high revenue and reduced state expenses.
It is a sure thing Republicans will hoard Iowa’s surpluses and use it to cover predicted revenue gaps before the November 2026 vote on the constitutional amendment to mask from the voting public the true and lasting impacts of their opportunistic push for a flat tax.
In fact, Republicans and Gov. Kim Reynolds passed Senate File 2442 this year, which, among other things, changed the law regarding how the Taxpayer Relief Fund could be used. Tucked away in the second-to-last division of a 35-page bill is a section that provides that, if the actual net revenue is less than budgeted expenses “there is transferred from the taxpayer relief fund to the general fund of the state an amount equal to fifty percent of the difference or the remaining balance of the taxpayer relief fund, whichever is lower.” That is a preemptive coverup of the probable result of the Republican flat tax as conceded by Republicans, themselves.
Iowa Republicans are not using the Taxpayer Relief Fund as it was originally intended. It is not “taxpayer relief” to use previously paid taxes to pay help pay for budget shortfalls caused by a “tax cut.” Most would call that a shell game. It is like giving yourself a “raise” by moving a dollar from one pocket to another. Why not just give those “confiscated” funds back to Iowans directly via refunds? Ah, but that would spoil the game, wouldn’t it?
Unmet needs and underfunded state accounts exist now. That will get worse.
Governor Reynolds states Republicans have a “commitment to shrinking the size and scope of government.” However, should not elected officials be committed first to ensuring that our government is the “right size,” before deciding it should be shrunk? That is, the right size to fully accomplish basic functions that individuals cannot meet themselves —no matter how much of their own money they have in their pockets — such as prevention and mitigation of natural disasters, ensuring safe bridges and roads, making sure promised pensions are not underfunded, cleaning up Iowa’s fouled waters, and helping public schools at least meet their costs of operation.
Tom Walton is an Iowa lawyer.
Iowa
Iowa 95, Utah 88: A Balanced Comeback
Iowa 95, Utah 88: A Balanced Comeback
Nine months ago, Utah ended Iowa’s 2023-24 season in the second round of the NIT. Saturday night, Iowa faced off with Utah again at the Sanford Pentagon in Sioux Falls, South Dakota, and came away with a very solid 95-88 win over the Utes. The Hawkeyes used a dominant second half and a balanced scoring effort from the starting lineup to earn the victory.
Here are three takeaways from the game.
1. The Big Finish
Finishing strong hasn’t always been a strength for this particular Iowa team. The Hawkeyes couldn’t make enough shots (or get enough stops) in their neutral-site loss to Utah State last month and ran out of steam after playing very well against Iowa State for 35 minutes a few weeks ago.
Saturday, Iowa trailed 40-36 at halftime and was down 11 early in the second half after conceding a 9-2 run to the Utes out of the break. The Hawkeyes caught fire after that, rattling off 25 points in the next seven minutes of game action to tie the score at 63-all.
Down the stretch, it was the Hawkeyes who were making shots and getting stops. Iowa outscored Utah 20-13 after the game was tied at 75 with 6:59 to play. Iowa scored 59 points in the second half (to 48 from Utah), led by 16 points from Payton Sandfort, who shot 5-of-8 from the floor and was perfect at the free throw line (6-of-6).
Notably, Iowa scored 59 points in the second half despite shooting just 4-of-6 from 3-point range. After attempting 14 three-pointers in the opening 20 minutes (and making five of them), Iowa adjusted on offense in the second half, attacking the rim more and getting higher-percentage shots — and more trips to the free throw line, where the Hawkeyes went 17-of-24 after the break.
“We were moving the ball and driving the ball [in the second half],” Iowa head coach Fran McCaffery said after the win. “We settled too much in the first half. Payton said it [and] he was right, we hit a couple early and started settling.”
“[Then] they don’t have to play defense, they don’t get tired, they come down and they carve you up, they run good stuff. So we kept the ball moving the ball side to side, driving the ball, intelligent screening, back-cuts, that was the difference in the game.”
The sellout crowd at the Pentagon had a noticeable (and unsurprising) Hawkeye flavor, which helped fuel Iowa’s second half comeback. That, as well as the veteran core of this Iowa roster that’s had plenty of experience in these situations — both good and bad — at this point.
“Veteran guys,” said McCaffery on how Iowa was able to turn the game around in the second half. “We’ve got good players, we’ve got good ball-handlers, guys who’ve been through it, [the] crowd was great. I think [it was] a combination of all those things.”
2. Drew Thelwell’s Spark
One player who provided a notable spark in Iowa’s comeback effort was senior guard Drew Thelwell, making his third consecutive start. Thelwell didn’t make a basket in the second half — didn’t even attempt one, in fact — but he scored seven points on 7-of-8 shooting at the free throw line.
Thelwell drew five fouls (more than anyone else on the Iowa roster in the second half), although a few of those came late when the Utes were attempting to extend the game. Still, Thelwell’s ability to attack the defense and the energy he brought were key factors in Iowa’s comeback win.
“[His energy] is infectious,” McCaffery said after the game. “Everyone else goes with him, Brock [Harding]’s kind of that way as well. The energy in the building was phenomenal. Drew was right in the middle of that. His defense, drawing six fouls, those are stats that are critical to a team’s ability to win. You do that by driving the ball and drawing fouls and that’s what he did.”
McCaffery also expanded on what he was looking for when he was pursuing Thelwell out of the transfer portal earlier this year and what he’s brought to this Iowa team. “I was looking for a veteran point guard, who could run a team, who could play off the ball and score, guard his man,” he explained.
“I noticed immediately that this kid could play defense, and wants to play defense and wants to play at both ends, that he understands how to engineer a victory,” McCaffery said. “Drew Thelwell is a winner, that’s what I was looking for and that’s what we got.”
The man that Thelwell displaced in the starting lineup — Ladji Dembele — also had some key plays to spark Iowa’s comeback bid. After scoring zero points and grabbing just one rebound in the first half, Dembele had five points, three rebounds, and a steal after intermission. His two baskets came during Iowa’s surge after falling behind by 11 and helped cut a 7-point deficit to just two.
More importantly, he helped keep Iowa afloat in the second half, with Owen Freeman bolted to the bench with foul trouble (Freeman picked up three fouls in the second half and played under five minutes total after halftime). Dembele played 14:10 in the second half and he finished with a +13 plus-minus rating in those minutes, the highest of any Iowa player in the second half.
McCaffery praised the effort from Dembele and fellow sub Pryce Sandfort. “They’re just rock solid, both of them. All they care about is winning. Pryce, defensively, was tremendous. Ladji, boy was he great. [He] had his two big hoops. But then defensively, on the glass, [he had a] big time offensive rebound late, [a] couple in-traffic rebounds, just his awareness defensively was great.”
3. Balance Carries The Day
Recent years have seen multiple standout individual players that served as the focal points for their respective Iowa teams — Luka Garza, followed by Keegan Murray, and then Kris Murray. Those players were superstars at the college level, racking up All-Big Ten honors, winning Big Ten Player of the Year awards, and vying (or winning, in Garza’s case) for national honors as well.
There isn’t a player quite like that on this Iowa roster — but at its best, this is a team that has a lot of depth and scoring balance, with multiple players that can score and pass and put pressure on a defense. Saturday night saw them at something pretty close to their best, especially in the furious second half comeback effort.
All five Iowa starters finished in double figures in scoring, led by Payton Sandfort with 24 points and a game-high 8 rebounds. Freeman finished second on the team with 16 points, despite missing 75% of the second half with foul trouble. “Owen was really on his way to a big-time game, I felt bad when he got in foul trouble like that,” McCaffery said after the game. Freeman finished with 16 points and 6 rebounds.
Josh Dix and Drew Thelwell each added 15 points, with 10 of Dix’s points coming in the second half. Dix did his damage inside the arc in this game, going 7-of-9 on two-point shots and attempting just one three.
Finally, Brock Harding finished with 12 points, all in the second half. After going 0-for-5 in the first half, Harding went 4-of-8 in the second half, including 2-of-2 from deep. His first three gave Iowa its first lead of the second half at 68-67 and his second triple pushed Iowa’s lead to 88-80 with three minutes to play.
When Iowa is moving the ball well, setting screens, and attacking the rim like the offense was in the second half, this becomes a very difficult team to defend because there’s no one player that defenses can key on and try to slow down. Maintaining that focus and that aggressive mindset on the offensive end was key to Iowa’s win on Saturday — maintaining those same things over the next two-and-a-half months will be key to Iowa’s success in the Big Ten.
NEXT: Iowa finishes off non-conference play with a home game against New Hampshire on December 30 (6 PM CT, BTN).
Iowa
Utah tries to make it three straight against Iowa: MBB Game Preview
Utah and Iowa will face off in a compelling rematch just nine months after their battle in the National Invitational Tournament (NIT), where the Utes secured a 91-82 victory. This non-conference clash marks an important point in the season for both programs, as Utah (8-2) hits the road following a six-game homestand, while Iowa (8-3) looks to build on their recent momentum. The game will take place at the Sanford Pentagon in Sioux Falls, South Dakota, a neutral site far from Iowa’s usual home at Carver-Hawkeye Arena.
Both teams enter this matchup in solid form. Utah has won two straight, including a dominant 89-59 win over Florida A&M, where they saw significant contributions from their bench. Mason Madsen and Mike Sharavjamts each posted 15 points in that contest, demonstrating the Utes’ depth. Meanwhile, Iowa comes off their most commanding performance of the season, a 104-57 rout of New Orleans. Five Hawkeyes scored in double figures, with Owen Freeman tying his career high of 22 points. This sets the stage for what promises to be a competitive showdown between two high-scoring teams, both eager to build their résumés before entering conference play.
Battle of the Floor Generals
One of the most intriguing storylines heading into the game is the point guard duel between Utah’s Miro Little and Iowa’s Brock Harding. Both sophomores have been instrumental in orchestrating their respective offenses. Harding, averaging 9.8 points and 6.2 assists per game, ranks 16th nationally in assists. His ability to control the tempo and facilitate scoring opportunities has been vital to Iowa’s success, as they rank third in the nation with 20 assists per game.
On the other side, Utah leads the country in assists, with 21 per contest, thanks in large part to Little’s contributions (5.4 assists per game). His size advantage over Harding—nearly 30 pounds—could be a key factor. Little’s physicality and ability to drive the lane will test Harding’s defensive abilities. For Iowa, limiting Little’s impact will be essential, as Utah’s offense flows through him. Conversely, Utah’s defense will need to focus on containing Harding’s playmaking to disrupt Iowa’s offensive rhythm. With both teams ranking in the top 10 nationally in assist-to-turnover ratio, the game may ultimately hinge on which point guard takes better care of the ball.
Slowing Down Iowa’s Twin Towers
Iowa’s offense is powered by forwards Owen Freeman and Payton Sandfort, who form a formidable frontcourt duo. Freeman, a dominant presence in the paint at 6’10, leads the team with 17.2 points per game and shoots an impressive 66% from the field. Sandfort, standing at 6’8, complements Freeman’s inside game with perimeter shooting, having already knocked down 29 three-pointers this season. Their contrasting styles make them difficult to defend, contributing to Iowa’s status as the 11th-highest scoring team in the country, averaging 87.2 points per game.
Utah’s defense will have to rise to the occasion, with Lawson Lovering tasked with handling Freeman inside. Sharavjamts’ size and versatility should allow him to match up with Sandfort, but Utah will likely need to employ frequent defensive switches to counter Iowa’s efforts to create mismatches. Rotational defense and contesting shots at the perimeter will be crucial for the Utes.
Building Momentum
Utah’s leading scorer, Gabe Madsen, continues to be a focal point for the Utes, averaging 19.8 points per game, good for 19th in the nation. His scoring versatility mirrors Sandfort’s, making him a potential game-changer in this matchup. Utah’s ability to score from both inside and beyond the arc has propelled them to 14th in the nation in scoring at 86.6 points per game.
A victory over Iowa would give Utah their first marquee win of the season, providing a significant confidence boost as they head into Big 12 play. With a tough matchup against Baylor looming on New Year’s Eve, this game represents a pivotal opportunity for the Utes to establish momentum and strengthen their standing in the national landscape.
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