Iowa nursing home responsiveness requirements

Any staff member who suspects dependent adult abuse must immediately tell the person in charge, who must then notify DIAL within 24 hours or the next business day; if the person in charge is the alleged perpetrator the staff member reports directly to DIAL on the same clock, and "immediately" is defined by rule to mean within 24 hours.

"Immediately," for purposes of mandatory reporters' reporting of suspected dependent adult abuse, means within 24 hours. ... a. If a staff member or employee is required to make a report pursuant to this rule, the staff member or employee shall immediately notify the person in charge or the person's designated agent, who shall then notify the department within 24 hours of such notification or the next business day. b. If the person in charge is the alleged perpetrator of dependent adult abuse, the staff member shall directly report the abuse to the department within 24 hours or the next business day.

The nursing facility chapter itself bars mental, physical, sexual, and verbal abuse, exploitation, and neglect, and routes all abuse allegations to the Iowa Code ch. 235E / 481—Chapter 52 reporting and investigation machinery.

481—58.43(135C) Resident abuse prohibited. Each resident shall receive kind and considerate care at all times and shall be free from mental, physical, sexual, and verbal abuse, exploitation, neglect, and physical injury. ... 58.43(9) Allegations of dependent adult abuse. Allegations of dependent adult abuse shall be reported and investigated pursuant to Iowa Code chapter 235E and 481—Chapter 52. (I, II, III)

For Medicaid-participating nursing facilities, all alleged violations involving mistreatment, neglect, or abuse — including injuries of unknown source and misappropriation of resident property — must be reported immediately to the administrator or other officials including DIAL, and the results of the facility's investigation must be reported within five working days of the incident.

(2) The facility shall ensure that all alleged violations involving mistreatment, neglect or abuse including injuries of unknown source and misappropriation of resident property, are reported immediately to the administrator of the facility or to other officials (including the department of inspections, appeals, and licensing) in accordance with state law through established procedures. ... (4) The results of all investigations conducted by facility staff shall be reported to the administrator or the administrator's designated representative or to other officials (including the department of inspections, appeals, and licensing) in accordance with state law within five working days of the incident

A nursing facility must have arrangements in place for a physician to be available to furnish medical care in an emergency.

Arrangements shall be made to have a physician available to furnish medical care in case of emergency. (II, III)

The person in charge must immediately notify the physician of any accident, injury, or adverse change in a resident's condition, and a roster of physician names and telephone numbers must be kept readily available to nursing staff so the on-call physician can actually be reached.

58.14(5) The person in charge shall immediately notify the physician of any accident, injury, or adverse change in the resident's condition. (I, II, III) 58.14(6) A schedule listing the names and telephone numbers of the physicians shall be readily available to nursing staff. (III)

Iowa sets its own licensed-nurse coverage floor: facilities of 75+ beds need a qualified nurse on duty 24/7 and an RN health service supervisor, facilities under 75 beds with an LPN supervisor must buy at least 4 hours per week of on-site RN consultation, and every facility must keep at least two people capable of rendering nursing service awake, dressed, and on duty at all times.

e. A nursing facility of 75 beds or more shall have a qualified nurse on duty 24 hours per day, seven days a week. (II, III) ... g. Facilities with 75 or more beds must employ a health service supervisor who is a registered nurse. (II) h. There shall be at least two people who shall be capable of rendering nursing service, awake, dressed, and on duty at all times. (II)

Telephone orders may be received only by a qualified nurse, must be written into the resident's record and signed by the person taking the call, and must go to the physician for signature within 48 hours — this is the closest Iowa analog to a nurse's duty to handle telephone contact from a prescriber.

Telephone orders shall be taken by a qualified nurse. Orders shall be written into the resident's record and signed by the person receiving the order. Telephone orders shall be submitted to the physician for signature within 48 hours. (III)

Each resident may communicate, associate, and meet privately with persons of the resident's choice and send and receive unopened mail, and telephones must be available and accessible for residents to make and receive calls with privacy, with staff assistance for residents who need help using the phone.

481—58.47(135C) Communications. Each resident may communicate, associate, and meet privately with persons of the resident's choice, unless to do so would infringe upon the rights of other residents, and may send and receive personal mail unopened. (II) ... 58.47(4) Telephones shall be available and accessible for residents to make and receive calls with privacy in accordance with 42 CFR 483.10(g)(6) and (7). Residents who need help shall be assisted in using the telephone. (II)

The administrator must maintain a written emergency plan for fire, tornado, explosion, or other emergency, must post the plan, and must in-service all employees on it.

58.28(2) Safety duties of administrator. The administrator shall have a written emergency plan to be followed in the event of fire, tornado, explosion, or other emergency. (III) a. The plan shall be posted. (III) b. In-service shall be provided to ensure that all employees are knowledgeable of the emergency plan. (III)

Medicaid-participating facilities must keep detailed written plans and procedures for all potential emergencies and disasters including fire, severe weather, and missing residents, train every employee at hire, periodically review procedures with existing staff, and run staff drills.

h. Disaster and emergency preparedness. (1) The facility shall have detailed written plans and procedures to meet all potential emergencies and disasters, such as fire, severe weather, and missing residents. (2) The facility shall train all employees in emergency procedures when they begin to work in the facility, periodically review the procedures with existing staff, and carry out staff drills using those procedures.

Iowa imposes a hard numeric answer-time on the nurse call system: qualified staff must respond promptly to a resident's use of the call system, and the rule defines prompt as no longer than 15 minutes.

58.18(4) The facility shall provide prompt response from qualified staff for the resident's use of the nurse call system. (II, III) (Prompt response being considered as no longer than 15 minutes.)

Iowa adopts the federal physical environment rule by reference for Medicaid facilities and, for construction, requires compliance with the FGI Guidelines for Design and Construction of Residential Health, Care, and Support Facilities (2018 edition) rather than writing its own nurse-call hardware spec.

81.11(18) Physical environment. In accordance with 42 CFR 483.90 (as amended to August 1, 2024), the facility shall be designed, constructed, equipped and maintained to protect the health and safety of residents, personnel and the public.

Iowa has no QAPI rule of its own in the licensure chapter — it incorporates the federal quality assessment and assurance committee requirement by reference, and only for Medicaid-participating nursing facilities.

j. Quality assessment and assurance. A facility shall maintain a quality assessment and assurance committee in accordance with 42 CFR 483.75(g) through (i) (as amended to August 1, 2024).