Des Moines, Iowa — Iowa nursing homes are finally getting inspected on schedule after years of falling behind federal requirements, according to a new state audit that shows dramatic improvement in oversight timelines.
The report, released August 3 by State Auditor Rob Sand, found that Iowa facilities are now being inspected on average every 12 months — down from 17.1 months in 2024. That brings the state into compliance with Centers for Medicare and Medicaid Services (CMS) requirements for the first time in years.
The Numbers Behind the Turnaround
Federal rules require states to conduct nursing home surveys on a roughly 13-month average, with no individual facility going more than 15.9 months between inspections. Iowa had been missing both benchmarks.
In 2024, a staggering 85.4% of Iowa’s 403 nursing homes had missed the individual facility deadline at least once during the previous three inspection cycles. As of June 2026, that figure has plummeted to just 2.8% of the state’s 389 certified facilities — an 83-percentage-point improvement.
Sand, a Democrat who is currently running for governor, credited the Republican-led legislature and administration for investing in additional inspection staff.
“Because there’s more people doing it, because they’ve made that investment, that means we are increasing the number of inspections that are getting done, and we’re increasing how frequently they’re getting done,” Sand said.
What This Means for Residents
More frequent inspections matter because they determine how quickly problems inside a facility get caught by outside regulators. The shorter the gap between surveys, the sooner potential issues get flagged and addressed.
However, Sand was quick to note that inspection timeliness is not the same as care quality. Iowa still ranks 47th nationally in licensed nursing staff per resident, and the state’s nursing home workforce turnover rate sits at 44%.
The audit also found 17 fewer facilities operating in Iowa compared to 2024, with roughly 2,000 fewer beds available. Sand said those closures hit rural areas hardest, making it harder for families to find nearby care options.
A Dispute Over the Data
The Iowa Department of Inspections, Appeals and Licensing (DIAL), which conducts the surveys, disputes the auditor’s framing. In a statement, the agency said it maintains 46 long-term care surveyor positions — unchanged since 2024 — and claimed it has met CMS performance standards for the past three years.
The department also said the audit relied on outdated CMS data and that Sand did not contact the agency before publishing. The auditor’s office responded that it used updated publicly available data and calculated figures identically to the 2024 report.
Both sides agree on one point: Iowa’s current inspection intervals now meet federal requirements.
The Unfinished Business
While the inspection backlog has cleared, Sand identified staffing as the next crisis demanding attention. With nearly half of nursing home workers turning over annually, maintaining adequate care levels remains a challenge that inspection schedules alone cannot fix.
For families with loved ones in Iowa nursing homes, the improved oversight offers some reassurance that problems will be caught sooner. But as Sand’s report makes clear, timely inspections are only one piece of the puzzle.
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