IowaWatch Forum: Critical Decisions About Elder Care

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Meghan Horihan/IowaWatch

IowaWatch elder care forum, April 29, 2014, in Des Moines.

IowaWatchConnectionsWithSponsorThe Tuesday, April 29, 2014, IowaWatch forum, Criticial Decisions about Elder Care, sponsored by Aging Resources of Central Iowa, focused on important decisions Iowans face about long-term elder care.

A panel of three distinguished experts spoke to an audience about the difficulty of improving the quality of long-term elder care and key issues to look out for when considering long-term care.


Clark Kauffman, Des Moines Register investigative reporter. Clark has reported extensively on neglect and abuse cases in Iowa nursing homes and systemic problems in the long-term care system.

Deanna Clingan-Fischer, Iowa’s long-term care ombudsman. Deanna’s office seeks to protect the health, safety, welfare and rights of people in long-term care.

John Hale, founder and owner of The Hale Group, an Ankeny-based consulting firm focused on long-term care public policy and service delivery issues. John is known at the Iowa Statehouse, and throughout Iowa, as a leading and passionate advocate for excellence in long-term care.

You may view here excerpts from that forum:

Video by Meghan Horihan,
Lauren Mills April 29, 20149:08 am

The IowaWatch forum, Criticial Decisions about Elder Care, will be held in Des Moines at 6 p.m. Hope to see you there!

Lauren Mills April 29, 20149:16 am

Check out this IowaWatch story about the use of stomach tubes in the elderly: Stomach Tubes to Feed Elderly Often Unnecessary, May Be Harmful

Lauren Mills April 29, 20144:58 pm

IowaWatch is on-scene in Des Moines, getting ready for the forum. We’ll be talking about the decisions that face Iowans looking at long-term elder care.

Lauren Mills April 29, 20145:12 pm

Clark Kauffman, investigative reporter at the Des Moines Register, is starting off the panel. Kauffman said he has covered long-term elderly care for around 16 years.

Lauren Mills April 29, 20145:15 pm

Last year, Iowa received an F rating for long term care. Five Iowa nursing homes were facing sanctions due to resident deaths and there were reports of sexual and physical assault, Kauffman noted

Lauren Mills April 29, 20145:17 pm

Kauffman: Just last year, at Prairie View Residential Care facility, four residents were arrested for assault. One man was arrested but later readmitted.

Lauren Mills April 29, 20145:19 pm

Kauffman: Regulation of long-term care is often lacking, impacting the quality of care patients recieve

Lauren Mills April 29, 20145:22 pm

Deanna Clingan-Fischer, Iowa’s long-term care ombudsman: “People living in these facilities have rights and we need to always keep that in the forefront of our mind”

Lauren Mills April 29, 20145:27 pm

Clingan-Fischer: We advocate for 53,287 people in 844 facilities in Iowa. We are starting a volunteer local ombudsman program, because as you can imagine with those numbers we can’t always be there.

Lauren Mills April 29, 20145:30 pm

Clingan-Fischer: The patient or resident should always be at the center of care and have a chance to participate in their treatment.

Lauren Mills April 29, 20145:32 pm

John Hale, founder/owner of The Hale Group: Most of us choose to deny that anyone we know or love will ever need long-term care.

Lauren Mills April 29, 20145:34 pm

Hale: “I brought a prop…[he rolls a pair of dice]…that’s my demonstration of long-term care in Iowa. There are some really good long-term care providers, there are some really lousy providers and there are a lot in the middle.”

Lauren Mills April 29, 20145:36 pm

Hale: Some keys to improve long-term care – Step 1.) Create minimum staffing standards for nursing facilities. Make sure at least a minimum number of people are on hand at all times.

Lauren Mills April 29, 20145:37 pm

Hale: Step 2.) Expand amount and type of training that front-line staff in every type of long-term care receive

Lauren Mills April 29, 20145:37 pm

Hale: Step 3.) Measure, report and publish data regarding staff turnover in facilities.

Lauren Mills April 29, 20145:38 pm

Hale: Step 4.) Create a recruitment and retention method in Iowa to attract and keep good people in the direct care workforce. Make sure they can make a decent living.

Lauren Mills April 29, 20145:40 pm

Hale: Step 5.) Change the incentives. Currently we pay for volume, not outcomes or results. And we need to increase the penalties and punishment for people and facilities who are responsible for violations.

Lauren Mills April 29, 20145:41 pm

Hale: We need to identify and evaluate who the good providers are and why they are able to do what they do in order to make significant progress.

Lauren Mills April 29, 20145:45 pm

Clingan-Fischer: Often residents of long-term care facilities are encouraged to go through arbitration if they have an issue with the facility. Once you agree to arbitration you have no other recourse and must abide by that decision.

Lauren Mills April 29, 20145:46 pm

Clingan-Fischer: Often that arbitrator is selected by the facility and often the decision sides with the facility.

Lauren Mills April 29, 20145:47 pm

Clingan-Fischer: Residents should always look at contracts before they sign to make sure they understand what it says.

Lauren Mills April 29, 20145:51 pm

Hale: If you are thinking about this issue from a rural Iowa standpoint, your choices are a lot more limited.

Lauren Mills April 29, 20145:54 pm

Joel Olah, executive director of Aging Resources of Central Iowa, the vast majority of older people are not in a long-term care facility. We often age-in-place, so it’s important to know what resources are available in our communities.

Lauren Mills April 29, 20145:55 pm

Olah: As you age, make sure you talk with your family so they know what you want in terms of care.

Lauren Mills April 29, 20145:57 pm

Clingan-Fischer: Whether you are there briefly for rehab or as a permanent resident and regardless of payment source, residents have the same rights while living in the facility

Lauren Mills April 29, 20145:58 pm

Kauffman: For each of the past two years, there was discussion of legislation to limit admission of sex offenders and violent offender into residential facilities

Lauren Mills April 29, 20146:04 pm

Today the Iowa Senate passed a law to define elder abuse and create a process for obtaining protective orders in the case of abuse. Here’s an article from the Des Moines Register: The bill goes on to Gov. Branstad for his signature.

Lauren Mills April 29, 20146:19 pm

Olah: The conversations you have on these issues are critical because you have to tell your family what you want. If you have selected a few places, visit them, multiple times. Don’t just look at the lobby or the garden, because those are window dressing. Look at the places where patients are.

Lauren Mills April 29, 20146:23 pm

Lyle Muller, Executive Director-Editor of IowaWatch, moderated the forum.

Lauren Mills April 29, 20146:25 pm

Hale: Once you hit the call light, how long do you think the nursing home should have to respond? No one has ever said anything more than 5 minutes. The reality is the nursing home has up to 15 minutes to respond.

Lauren Mills April 29, 20146:33 pm

Closing thoughts:
Hale: The demand that is occurring is occurring on the home-care side. Most of us want to stay in our own homes as long as we can. We need to give home-care licensing and regulations more of our time.

Lauren Mills April 29, 20146:35 pm

Closing thoughts:
Clingan-Fischer: Always remember you have advocates at the ombudsman’s office and you can reach out to us. Staying at home is not an option for everyone and we need to ensure that we have a quality system of care and protection of rights.

Lauren Mills April 29, 20146:36 pm

Closing thoughts:
Kauffman: More and more retirement communities hold themselves out as assisted living facilities but are not licensed as assisted living facilities. They are apartments where the assisted living is offered by a third party. It is getting harder and harder for people to tell what is an assisted living facility and so it is important to do your homework.