(Iowa Capital Dispatch – Clark Kauffman) Iowa’s nursing home inspectors issued more citations for insufficient staffing last year than regulators in any other state in the nation, an Iowa Capital Dispatch review of federal data shows.
The Center for Medicare and Medicaid Services data show that 66 Iowa nursing homes were cited at least once for insufficient nursing staff during fiscal year 2026. With seven Iowa homes cited for the violation three times, and seven more cited twice, the total number of insufficient staffing citations issued in the state was 87, the data show.
That places Iowa — which has far fewer nursing homes than more populous states — at the top of the rankings for insufficient-staffing citations.
Lack of adequate staffing has long been considered the single biggest contributor to poor quality resident care in nursing homes. Attempts to impose more stringent federal requirements on nursing home staffing have been opposed by the Trump administration, Iowa Gov. Kim Reynolds, and Iowa Attorney General Brenna Bird.
The CMS data shows that the 10 states with the most nursing home citations for insufficient staffing in fiscal year 2026 were:
Iowa: 87 citations in a state with 393 nursing facilities.
Illinois: 85 citations in a state with 669 nursing facilities.
California: 59 citations in a state with 1,169 nursing facilities.
Michigan: 49 citations in a state with 424 nursing facilities.
Pennsylvania: 51 citations in a state with 657 nursing facilities.
New York: 42 citations in a state with 597 nursing facilities.
Ohio: 31 citations in a state with 926 nursing facilities.
Missouri: 23 citations in a state with 489 nursing facilities.
Minnesota: 16 citations in a state with 339 nursing facilities.
Wisconsin: 11 citations in a state with 323 nursing facilities.
The data show that Iowa also ranks high in the number of citations related to a more specific staffing requirement that calls for nursing homes to have at least one registered nurse on duty for at least eight hours each day.
Iowa nursing homes were cited 16 times for that nurse-specific violation. Only the states of Texas, Illinois, Ohio, California, Missouri and Oklahoma had more citations for violating the registered-nurse requirement.
The seven Iowa homes that were each cited three times during the year for insufficient staffing are Accura Healthcare of Carroll; Pinnacle Specialty Care in Cedar Falls; Ravenwood Specialty Care in Waterloo; Foxglove Wellness and Rehabilitation Center, aka Stone Cottage Care Center, in Sigourney; Harmony House Health Care Center in Waterloo; Iowa City Rehab & Health Care Center, and Southfield Wellness Community in Webster City.
The seven Iowa homes that were each cited twice times during the year for insufficient staffing are Hallmar Village in Cedar Rapids, Harmony Cedar Rapids; Bishop Drumm Retirement Center in Johnston, Exira Care Center, Garden View Care Center in Shenandoah, Parkridge Specialty Care in Pleasant Hill and Pine Acres Rehabilitation and Care Center in West Des Moines.
Typically, violations for short-staffing do not result in fines or any other financial penalties in Iowa, although short-staffing can contribute to issues of safety and neglect that do result in fines.
