Caregivers are battling new rules that advocates say will help prevent dependent adult abuse. The proposed rules stem from a 2008 law that directed the Iowa Department of Inspections and Appeals to define and investigate abuse in hospitals and nursing homes.

But Cindy Kramer, a consultant for Healthcare of Iowa in Cedar Rapids, says the standards are so strict an accidental injury could land a caregiver on the state’s dependent abuse registry.

"You may have a nurse aide that is walking down the hall and she may have a resident sitting in a wheel chair that usually self-propels — they move themself down the hall — and that resident says, ‘Would you take me to the activity?’ and the nurse aide pushes them in the wheelchair and doesn’t put a foot pedal on; the person catches their leg and sustains an injury — that is potential dependent adult abuse," she says.

"And, you know, I think that’s unreasonable and to hold C.N.A.s and nurses to that standard is higher than what we hold our physicians to." Kramer says the rules may make it harder for nursing homes to find staff.

"People are shying away from that because they’re afraid if they get caught up in something like this where they could end up with a dependant adult abuse allegation against them it could ruin their career as far as going on into nursing, medical school or any health profession," she says.

Kelly Meyers, an attorney for the Iowa Health Care Association, says the agency’s proposed definition of sexual exploitation is very problematic. "The definition involves kissing and oftentimes we have caregivers who will give someone a supportive hug or a kiss on the top of their head or on the cheek and we think that that is a positive, supportive action and we would never want that misconstrued as any type of abuse," Meyers says.

Legislators on the Administrative Rules Review Committee are sympathetic to the industry’s concerns. The panel has directed the Department of Inspections and Appeals to consider redrafting the proposed rules one more time. But an attorney for the agency warned many of the definitions that are drawing fire were taken directly from the law legislators passed.