One State Tops the Nation in Nursing Home Short-Staffing Citations — and Residents Are Waiting Up to 90 Minutes for Help

Des Moines, Iowa — Iowa nursing homes collected more federal citations for short-staffing last year than any other state, and a new analysis of federal data suggests the problem runs far deeper than paperwork.

The review of Centers for Medicare and Medicaid Services records by the Iowa Capital Dispatch found Iowa led the nation with 87 insufficient-staffing citations across its 393 nursing homes. California, with nearly three times as many facilities, logged 59. Illinois reported 85 across 669 homes.

What the numbers look like on the floor

Citations only tell part of the story. Residents at one Carroll facility reported waiting 39 minutes for a nurse to answer a call light. At a Cedar Falls care center, some waited 60 to 90 minutes. When call lights didn’t work at all, residents at two other facilities resorted to calling the front desk from their personal cellphones, according to state inspection records collected since October 2025.

Regulators have flagged the pattern before. In 2023, 14% of Iowa’s nursing homes were cited for insufficient staffing — more than double the national average of 5.9% that year. The state ranked sixth-worst in staffing compliance then. It has since climbed to the top of the list.

A national problem, not just an Iowa one

The wider picture isn’t much better. A report this year from the Long-Term Care Community Coalition found that nine in 10 nursing homes fell below their expected staffing levels in the third quarter of 2025. On average, facilities ran understaffed by 24% daily, based on payroll records and federal assessments of resident needs.

And here’s the part that frustrates advocates: many of these violations carry no fine. In several states, short-staffing citations don’t trigger any financial penalty at all, which industry critics argue removes much of the incentive to fix the problem.

Lagging call-light response times are often the first visible sign of trouble. Federal rules require a registered nurse on duty at least eight hours a day, and Iowa homes were cited 16 times for violating that requirement alone.

Operators point to a labor market that hasn’t recovered. Recruitment remains difficult, agencies are expensive, and rural facilities struggle to compete with hospitals on wages. Whether Iowa’s worst-in-the-nation ranking prompts state lawmakers to attach real penalties to staffing failures — as Massachusetts did this month — is the question advocates are now asking. For residents waiting on a call light, the answer can’t come soon enough. The stakes are high: a New York jury recently hit an understaffed nursing home with a $6.8 million verdict after finding it short-handed every single day.