IOWA
Iowa state officials devoted considerable attention in 2002 to reviewing coordination of home and community-based care services for senior citizens across multiple state agencies and the role of the Department of Elder Affairs. Another administrative action involved reorganizing the state's oversight system for assisted living facilities.
The Budget
Iowa's budget crisis caused the state to divert money from the Senior Living Trust Fund to help pay for the state's Medicaid program, which had lost $18 million through budget cuts in 2001. The trust fund pays for services such as home-delivered meals, adult day care and respite care and provides grants to nursing homes to convert beds into assisted living. The governor signed a bill in April 2002 requiring the state to repay the trust money when the state's rainy day fund was restored to its maximum level. (In June, 2002, $13.2 million was transferred to the fund, and another $6 million was transferred in September 2002.)
State Administrative Agencies
The U.S. Administration on Aging awarded Iowa's Department of Elder Affairs a $1.5 million grant in September 2002 to address the complex nature of Iowa's home and community-based service system for senior citizens. Funding for elderly services comes from as many as 17 different sources, with elderly clients required to make a separate application for each program. In addition, each program has specific and different eligibility requirements. Furthermore, the system is not equipped to share information in a confidential way among providers, Area Agencies on Aging, or the Department of Elder Affairs. The first year of the project will deal with research, analysis and development of an enhanced data management system that will address these issues.
Governor Tom Vilsack transferred authority for inspecting and regulating Iowa's 137 assisted living facilities from the Department of Elder Affairs (DEA) to the Department of Inspections and Appeals, the agency that oversees nursing home regulation in the state. The action followed newspaper reports that the Department of Elder Affairs failed to take action against a facility after complaints of numerous instances of resident neglect and allegations that the department created two sets of records on complaints, one with the actual complaints and another set for public release from which those details had been removed.
In July, the governor appointed a Task Force on the Department of Elder Affairs to review the department's mission. The task force issued a report on September 30, 2002, which included among its recommendations that the DEA develop standards and rules for assisted living and adult day care services, including establishing a consumer complaint investigation system. The Department of Inspection and Appeals would be responsible for inspection and regulation functions for those services. Other recommendations called for the DEA to review and streamline Iowa's case management system, focus on developing a seamless system for elders to gain information and a single point of entry system for access to home and community-based services, and allocate more resources to create consumer awareness of the continuum of the long-term care system in Iowa.
Assisted Living
Oversight of assisted living facilities raised another contentious issue during 2002, when the Department of Inspections and Appeals determined that a number of assisted living facility residents would have to leave certain facilities because the residents required greater care than the facilities were licensed to provide. Inspectors ordered the company that owned the facilities either to seek nursing home licenses for the facilities or to discharge those residents who needed assistance beyond that offered. The company filed a lawsuit, claiming the state was discriminating against people with disabilities by forcing them into nursing homes.
The lawsuit was dropped when the state issued regulations in July that more clearly defined the maximum level of care that could be provided in assisted living facilities. Also, any recommendation by the inspectors that an assisted-living resident might need care in a nursing home would have to be reviewed by a committee composed of a physician and the resident and his or her family. The state would be required to consider the recommendation of the committee before deciding whether a resident needed to be moved to a nursing home.
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