WEST DES MOINES, Iowa — Care Initiatives, a nonprofit organization that operates 43 nursing homes across Iowa serving approximately 2,800 residents, is facing at least 17 legal claims alleging wrongful deaths and serious harm to residents, according to reporting by the Iowa Capital Dispatch and KCRG. The lawsuits, filed over a span of roughly 16 months, describe a pattern of alleged neglect at multiple facilities, with the first trial scheduled for March 30, 2026. The company has denied wrongdoing in all cases.
The scope of the allegations is sweeping, spanning facilities from Waterloo to Pleasant Hill and involving deaths attributed to untreated wounds, suffocation, burns, and delayed medical intervention. In addition to the wrongful death suits, Care Initiatives also faces at least three whistleblower retaliation claims from former employees, as reported by Nurse.org.
Among the most disturbing cases detailed in court filings is the death of Marvin "Pete" Jacobs at Fonda Specialty Care in Pocahontas County. According to the Cherokee Chronicle Times, Jacobs had a tracheostomy tube that required suctioning every eight hours. Court documents allege that a licensed practical nurse assigned to his care was told to "watch a video and figure it out" regarding the procedure. As reported by the Chronicle Times, at least four workers asked the nurse to suction Jacobs' airway as he struggled to breathe and changed color, while suctioning equipment sat unused on a nearby dresser. Jacobs died on February 19, 2023, from a heart attack caused by oxygen deprivation. The caregiver, Becky Sue Manning, 70, was charged with felony wanton neglect, and her nursing license was suspended indefinitely in April 2023, according to state records. The state fined Care Initiatives $10,000, later reduced to $6,500.
Another case involves Debbie Thomas, 64, who was admitted to Centerville Specialty Care on December 19, 2022. As detailed by the Dubuque Telegraph Herald, Thomas' family discovered second-degree burns on her legs just two days after admission, caused by a heating element placed against her bed. Staff were reportedly unaware of the injuries. Thomas' condition deteriorated over subsequent weeks — she became malnourished and dehydrated, and by late January, staff informed the family she was dying but allegedly did not contact a physician or call an ambulance until the family insisted, according to the Telegraph Herald. Thomas died on February 1, 2023, from sepsis caused by an infected pressure wound roughly four inches in diameter. Iowa's Division of Inspections, Appeals, and Licensing substantiated four of seven complaints, and federal regulators imposed a $56,750 fine, as reported by the Telegraph Herald.
At Northcrest Specialty Care in Waterloo, which alone was the subject of 21 state complaint investigations over a 12-month period according to Nurse.org, four separate wrongful death suits have been filed. One involves Janice Schmitt, who fell just one day after being admitted in September 2022, sustaining brain hemorrhages, facial fractures, and a broken wrist, according to KCRG. Schmitt died four days later. That trial is set for February 17, 2026.
The first case expected to reach a courtroom involves former employee Kandus Jellison, who was fired from Oakwood Specialty Care in Albia in June 2022 after she helped a resident call 911, according to Nurse.org. Her whistleblower retaliation trial is scheduled for March 30, 2026.
CMS Inspection History
Federal inspection data maintained by the Centers for Medicare and Medicaid Services provides broader context for understanding nursing home oversight in Iowa. While Care Initiatives operates dozens of facilities statewide, CMS records for individual homes in the chain reveal varying levels of compliance.
As one example, Clarence Nursing Home, a 46-bed facility in Clarence, Iowa, currently holds an overall CMS rating of 5 out of 5 stars, with a health inspection rating of 4 stars, a staffing rating of 4 stars, and a quality measures rating of 5 stars. The facility has 13 total deficiencies documented across 8 inspections on record, with the most recent inspection conducted on January 4, 2024.
However, even facilities with relatively strong overall ratings can carry specific deficiency citations that raise concerns. During its January 2024 inspection, Clarence Nursing Home was cited for failing to timely report suspected abuse, neglect, or theft and report investigation results to proper authorities, as well as for failing to respond appropriately to all alleged violations — both classified at Severity Level D, indicating potential for minimal harm. The facility was also cited for failing to ensure accurate resident assessments and for failing to ensure services met professional standards of quality, the latter classified at Severity Level E, indicating actual harm that is not immediate jeopardy. A prior inspection in July 2022 cited the facility for failing to develop complete care plans within seven days of comprehensive assessment, also at Severity Level E.
These types of deficiencies — particularly those related to abuse reporting protocols and professional standards of care — mirror the broader categories of alleged failures described in the lawsuits against Care Initiatives facilities. Federal regulations require nursing homes to report suspected abuse or neglect promptly and to maintain staffing and care standards sufficient to prevent harm to residents.
Ownership & Operations
Care Initiatives, headquartered in West Des Moines, describes itself as a nonprofit organization and is one of the largest nursing home operators in Iowa. According to reporting by KCRG, the company operates 43 facilities serving approximately 2,800 residents statewide. Despite its nonprofit designation, CMS records indicate that individual facilities within the network may be classified under different ownership structures — Clarence Nursing Home, for instance, is listed in federal records as a for-profit corporation.
The concentration of 17 legal claims filed against a single operator within a 16-month window is notable. The allegations span at least seven different facilities and describe recurring themes: inadequate staffing, untrained caregivers, delayed emergency responses, and failures to report concerns to families and investigators. Care Initiatives has denied the allegations in all pending cases.
Resources for Families
Families with concerns about care at any Iowa nursing home are encouraged to contact the Iowa Long-Term Care Ombudsman at 1-866-236-1430. Ombudsman representatives can help investigate complaints, mediate disputes, and advocate for residents' rights at no cost to families.
The national Eldercare Locator hotline, operated by the U.S. Administration on Aging, can be reached at 1-800-677-1116 and provides referrals to local ombudsman programs and elder abuse reporting agencies nationwide.
Additional information about long-term care rights and how to file complaints is available through the National Long-Term Care Ombudsman Resource Center at ltcombudsman.org. Families may also file complaints directly with the Iowa Department of Inspections, Appeals, and Licensing, which conducts state survey inspections of nursing homes and investigates allegations of substandard care.
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