DES MOINES, IOWA — Iowa's nursing homes faced insufficient staffing citations at rates significantly exceeding those of neighboring states in 2025, according to state inspection data, with 15% of facilities statewide receiving violations compared to as low as 4% in adjacent states.
Sixty of Iowa's 397 nursing homes were cited for insufficient staffing during 2025, according to inspection records. By comparison, Illinois cited 12% of its facilities, Missouri 7%, Wisconsin 5%, Nebraska 4%, and Minnesota 4% for similar violations during the same period, as reported by The Gazette.
The violations highlight a pattern of understaffing that has affected resident care across the state. At Bishop Drumm Retirement Center in Johnston, residents reported significant increases in call light response times throughout 2025. Wait times grew from 30 to 60 minutes in April to between one and two hours by July, according to inspection reports. State inspectors cited the facility multiple times during the year, with observers documenting staff members repeatedly ignoring call lights during visits.
Bishop Drumm was among the most frequently cited facilities in the state, receiving four separate violations for insufficient staffing during the inspection period, according to Southern Minnesota News. The facility was joined by Good Samaritan homes in Indianola and Mansfield, Garden View Care Center in Shenandoah, and multiple Accura Healthcare locations as repeat violators.
Eleven Iowa facilities received two separate citations for insufficient staffing in 2025, according to Nonpareil Online. These included The Bridges at Ankeny, Bettendorf Health Care Center, Accura Healthcare in Carroll, and New Homestead Care Center in Guthrie Center.
The 2025 citation rate continues a trend documented in previous years. In fiscal year 2023, 14% of Iowa's 422 nursing facilities were cited for insufficient staffing, more than double the national average of 5.9%, according to federal data reported by the Nonpareil.
Beyond staffing violations, several Eastern Iowa facilities faced significant fines for serious care failures. Stacyville Community Nursing Home received a $5,000 fine after administering incorrect medication to a resident, resulting in hospitalization, and for operating without a registered nurse on-site for eight consecutive hours, according to the Iowa Department of Inspections, Appeals and Licensing.
Osage Rehab and Health Care Center faced a $7,250 fine, later suspended, following an incident in which a resident was left flat on his back during tube feeding despite vomiting. The resident subsequently developed aspiration pneumonia and septic shock, with possible brain damage from oxygen deprivation, according to state inspection records documented in August 2024.
Aase Haugen Home in Decorah received an initial fine of $4,500, which was tripled to $13,500 as a repeat violation before being suspended. The citation stemmed from a resident injury during a mechanical lift transfer, as reported by CBS2 Iowa.
Regulatory Context
Federal regulations establish minimum staffing requirements for nursing facilities receiving Medicare and Medicaid funding. The Centers for Medicare & Medicaid Services issued a staffing mandate in 2023 aimed at establishing minimum nurse-to-resident ratios nationwide.
Iowa Governor Kim Reynolds joined 14 other Republican governors in opposing the federal staffing mandate. Iowa Attorney General Brenna Bird characterized the regulation as an "attack on senior care," according to statements reported by Nonpareil Online.
Dean Lerner, former head of Iowa's nursing home inspection agency, stated that elected officials must be held accountable at the ballot box to ensure protection for vulnerable seniors, according to Southern Minnesota News.
Industry Challenges
Nursing home operators nationwide have cited workforce shortages, competitive wages in other healthcare sectors, and regulatory compliance costs as factors affecting staffing levels. Iowa's citation rate suggests these challenges have had a more pronounced impact in the state compared to neighboring jurisdictions.
The repeated citations at specific facilities indicate persistent rather than isolated staffing challenges. Facilities receiving multiple violations within a single year suggest systemic difficulties in maintaining adequate staff-to-resident ratios.
Oversight and Enforcement
The Iowa Department of Inspections, Appeals and Licensing conducts regular inspections of nursing facilities and investigates complaints. Citations for insufficient staffing are issued when facilities fail to provide adequate personnel to meet residents' needs for care, treatment, and services.
Federal regulations require nursing homes to have sufficient staff to provide necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. Violations can result in fines, mandatory corrective action plans, or in severe cases, denial of payment for new admissions.
Resources for Families
Families concerned about staffing levels or care quality at Iowa nursing homes can contact the Iowa Long-Term Care Ombudsman program, which advocates for residents in long-term care facilities. The National Long-Term Care Ombudsman Resource Center provides assistance at 1-800-677-1116 or through their website at ltcombudsman.org.
Residents and family members can also file complaints directly with the Iowa Department of Inspections, Appeals and Licensing. Federal inspection reports and facility ratings are available through Medicare's Care Compare website at medicare.gov/care-compare.
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