Blaming deep budget cuts, the state agency that advocates for the elderly and people with disabilities in Iowa nursing homes has eliminated virtually all staff visits to those facilities.

The change at the office of the Iowa Long-Term Care Ombudsman comes at the same time the office has lost its top administrator, Deanna Clingan-Fischer.

Her former office, which is run out of the Iowa Department on Aging, employs eight regional ombudsmen to advocate for residents of nursing homes and assisted-living centers, investigate complaints of abuse and neglect, and provide training for care-facility workers.

That job got tougher after the office's annual budget, which includes $1.3 million from the state and $400,000 from the federal government, was cut by roughly $500,000 in the fiscal year that began last month.

“It was quite a massive cut,” Clingan-Fischer said. "I made a decision to not lay off people, partly because we were severely understaffed as it was.”

With 82 percent of the Iowa ombudsman’s budget consumed by salaries, Clingan-Fischer eliminated the agency’s next largest expense: in-state travel, which costs $65,000 to $85,000 annually.

According to data from the ombudsman’s office, the staff there made more than 5,000 visits to Iowa care facilities in the 2015-16 fiscal year.

The budget cutbacks have prompted protests from advocates for seniors, including John Hale, an Ankeny consultant who specializes in issues affecting the elderly.

In a recent column for The Des Moines Register, Hale said the budget cuts must be reversed.

“The Iowans charged with protecting the health, safety and rights of residents in Iowa nursing homes can no longer go to these places in person to thoroughly investigate complaints and fully advocate for residents,” Hale wrote. “I refuse to accept that there is no money available to fund such essential services.”

Dean Lerner, who under former Gov. Chet Culver headed the state agency that inspects nursing homes, said the budget cuts are not a surprise.

“This is just part of an overall scheme to reduce state oversight of these care facilities,” he said. “This is deliberate. It’s intentional.”

Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care in Washington, D.C., said residents' lives may depend on restoring the ombudsman's budget.

Without facility visits, it's difficult to build relationships with residents to get the information needed to thoroughly investigate complaints, she said.

"A regular on-site presence allows them not only to respond quickly to complaints but also to identify some concerns early, before they become big or serious," Smetanka said.

The most recent data from the Administration for Community Living indicates that in 2015 only nine other states had a higher ratio of long-term care ombudsmen to nursing home residents.

The data also show that Iowa's ombudsman's office ranked last in the percentage of nursing homes visited at least once per quarter. In Iowa, 12 percent of nursing homes were visited quarterly, while the national average was 67 percent.

Clingan-Fischer recently resigned her post and accepted a new job as the ombudsman for Iowa State University.

She pointed out that whoever is appointed to take her old job could decide to restore some of the funding for travel and shift the spending cuts to other areas of the budget.

But Cindy Pederson, the interim long-term care ombudsman, says the office is currently relying on telephones and other technology to connect with Iowa's nursing home residents. She said it's impossible to say what might prompt the office to conduct an on-site visit using money from other areas of the budget.

Clingan-Fischer said one factor in her decision to leave the ombudsman’s office was the uncertainty surrounding the funding for the agency’s work.

“I just needed to find a position where I didn’t have to worry about budget cuts year after year,” she said.

In years past, the office’s regional ombudsmen would conduct on-site visits to speak with residents, their family members and care facility workers.

Almost 700 visits made in the 2015-16 fiscal year were in response to specific complaints of poor resident care or violations of residents’ rights.

Regional ombudsmen also participated in 99 heath-and-safety inspections of care facilities, which are conducted by the Iowa Department of Inspections and Appeals.

The staff also provided more than 100 training sessions for “volunteer ombudsmen” throughout the state, each of whom is tasked with helping to oversee care in one specific care facility in their community.

An additional 30 training sessions were aimed at care-facility staffers.

There are roughly 53,000 Iowans living in 850 nursing homes and assisted-living centers.

Under state and federal law, the ombudsman’s office has the legal authority to enter Iowa care facilities without notice, access records related to resident care and conduct interviews.

But the laws do not require the office to perform all of those functions; they merely require that the ombudsman’s office be accessible to Iowans.

The Long-Term Care Ombudsman's Office is not affiliated with the Iowa Office of Ombudsman, which handles citizen complaints dealing with state and local government.