Bohannan tours Park Place Long-Term Care nursing home in Mt. Pleasant

Rural health care facilities struggle with difficulty recruiting workers and with reimbursement from federal health insurance, local providers told a congressional candidate visiting Mt. Pleasant on Tuesday, June 16.

Christina Bohannan, the Democratic candidate for the House of Representatives from Iowa's First District, toured the Park Place Long-Term Care nursing home and met with staff. Her opponent, Republican U.S. Rep. Mariannette Miller-Meeks, did not respond to an invitation to join the tour.

The Rural Restoration Project, a nonprofit dedicated to building economic and social opportunities in the five counties of Iowa Senate District 44 through education and advocacy, organized the tour.

Park Place Director Tara Pope told Bohannan the facility is licensed for 49 beds but houses just 33 residents because of staff shortages. The facility often relies on workers from nurse staffing agencies, she added. "They're good to have available, but it doesn't provide the continuity of care" that full-time, core staff do, Pope said.

The situation has been worse: Pope said that in 2022, agency staff held most nursing positions at Park Place. Now, core staff hold most jobs.

Rural facilities like Park Place have an especially difficult time finding workers compared to urban care centers, Pope said. Certified nursing assistants (CNAs) and other staff often don't live in the area and are unwilling to drive long distances to get to work.

"There just aren't as many people wanting to be CNAs," Pope said. The COVID pandemic led many to quit, but hiring has improved recently, she added.

Carrie Gracey, a Doctor of Physical Therapy at Athletico Ltd. In Mt. Pleasant, said her company faces similar problems hiring therapists and assistants. Even with a government program that would pay up to $50,000 in student loans over five years — and with Athletico matching that amount — "it was hard to entice people" to join a rural practice, she said.

Staffing problems could worsen, Bohannan said, under provisions of the One Big Beautiful Bill Act passed in 2025. The law caps student loan amounts for many health care professionals, such as physician assistants (PAs), advanced registered nurse practitioners (ARNPs) and nurse anesthetists. That could lead to provider shortages, Bohannan said.

"That bill — I'm going to try to keep my temper even here — that bill was particularly bad for Iowa and rural states," she said. PAs, ARNPs and other professionals provide much of the health care in rural areas, she said. Nurse anesthetists, for example, deliver as much as 85% of anesthesia services in the state. Capping loans for those professions is "particularly hard for a state like Iowa that is so dependent on those (non-physicians) to provide that care."

Meanwhile, Gracey said, Medicare and Medicaid reimburse clinics at a lower rate when a physical therapy assistant provides care to a patient — even if that care is identical care to what a physical therapist would provide.

Bohannan said she's heard complaints about Medicare and Medicaid reimbursement rates "across the board … from hospital administrators, physicians themselves, to every person providing care."

Bohannan suggested enacting programs, such as travel reimbursement or extra pay, to help rural health care facilities, including nursing homes, survive and attract workers.

Pope said she would welcome incentives like those under Medicare's Critical Access Hospital program. Hospitals with that designation receive higher reimbursements "because they're a rural facility. The purpose is to keep them open," Pope said. "It would be nice if there was something equivalent for nursing facilities, because with the way reimbursement is and the way staffing is, it is difficult for rural communities to keep their nursing homes open."

"That's what I would like to see," Bohannan said, "is just a recognition of the unique challenges that rural health care faces."