ALM's inspection grade is 58 / 100, an F — 25 points below the Iowa average for CMS-certified facilities (83/100) · A proprietary Assisted Living Magazine grade.A 0–100 score of a facility's regulatory inspection record, shown as a letter and compared with other facilities of the same kind in the same state. It is not a government rating.
1/5
CMS (the Centers for Medicare & Medicaid Services) is the federal agency that rates nursing home quality. Its Overall Rating runs from 1 to 5 stars, combining health inspections, staffing, and quality measures, with inspections weighted most heavily.
ALM's inspection grade is 58 / 100, an F — 25 points below the Iowa average for CMS-certified facilities (83/100) · A proprietary Assisted Living Magazine grade.A 0–100 score of a facility's regulatory inspection record, shown as a letter and compared with other facilities of the same kind in the same state. It is not a government rating.
1/5
CMS (the Centers for Medicare & Medicaid Services) is the federal agency that rates nursing home quality. Its Overall Rating runs from 1 to 5 stars, combining health inspections, staffing, and quality measures, with inspections weighted most heavily.
Bethany Lutheran Home provides skilled nursing and nursing home care, assisted living, and memory care in Council Bluffs, Iowa. Skilled nursing includes licensed nursing care on site around the clock, while nursing home care includes long term care and rehabilitation. Assisted living supports daily tasks such as dressing, bathing, and medication while a resident keeps an apartment. Memory care provides a secured setting with supervision for someone at risk of wandering.
The home opened in 1975 and has 112 beds. Its Rehab to Home program and rehabilitation services support a resident working toward returning home after a stay or treatment, when that goal is part of the care plan. A Walk Score of 77 places the area in the very walkable range, so most errands can be done on foot; shops, a pharmacy, and cafes can be reached by a short walk for a resident who no longer drives. Bethany Lutheran Home allows pets, so a resident can keep a pet with them during the move.
Medicare, Medicaid, and private pay are accepted, giving families payment paths for covered care or residence costs. Total nurse staffing is 4 hours and 39 minutes per resident per day, representing the daily hands on nursing time allocated per resident. Chandra Gustafson serves as administrator. Bethany Lutheran Home may be a good fit for someone whose needs could change over time because its assisted living, memory care, nursing home, and skilled nursing services are available within one community.
The Overall CMS Rating combines results from health inspections, staffing levels and quality measures. Health inspections carry the most weight. Staffing and quality scores can increase or decrease the final rating based on performance compared to state and national standards.
Based on the results of the facility's three most recent standard inspections and any complaint investigations. CMS reviews the number, scope, and severity of deficiencies, with more recent findings weighted more heavily.
Measures average nursing staff hours per resident per day, including Registered Nurses (RNs) and total nursing staff. Ratings are adjusted based on the level of care residents require and are compared to state and national benchmarks.
Based on clinical and physical health indicators reported to CMS, such as hospital readmissions, falls, pressure ulcers, and improvements in mobility. These measures reflect how well residents' health needs are being managed.
Data period: Q4 2025 (October 1 – December 31, 2025).
This nursing home is ranked 66th out of 225 nursing homes we track in Iowa for nurse hours. Total adjusted nursing hours per resident per day, combining RN, LPN, and aide time. CMS adjusts this for case-mix so facilities can be fairly compared.
4h 39mStandout metric: LPN / LVN is +113% above Iowa average
2 of 6 metrics below Iowa average
RNs hold the highest nursing license and can assess residents, interpret test results, and direct care plans. More RN hours per day often signals stronger clinical oversight and faster response to health changes. 23 total: 8 of the facility's own employees and 15 agency contractors.
23 staff · 7.9-hour shifts
Licensed Practical Nurses (LPNs) or Licensed Vocational Nurses (LVNs) deliver routine hands-on care — medication administration, wound dressing, and monitoring vital signs. They work under RN supervision and make up a large share of daily bedside care. 30 total: 23 of the facility's own employees and 7 agency contractors.
30 staff · 8.3-hour shifts
Certified Nurse Aides (CNAs) provide the most direct day-to-day assistance: bathing, dressing, feeding, and mobility. Nurse aide hours are typically the largest staffing category and directly affect residents' quality of life. 74 total: 70 of the facility's own employees and 4 agency contractors.
74 staff · 8-hour shifts
Hours per resident per day provided by licensed Physical Therapists (PTs) or PT Assistants. PT services help residents recover mobility after injury or illness and are especially important for post-acute (short-stay) rehabilitation.
Combined nursing hours (RN + LPN + Nurse Aide) per resident per day on weekends. Staffing often drops on weekends — this figure reveals whether the facility maintains adequate coverage outside of weekday hours.
RN + LPN + aide · Sat–Sun
Registered nurse hours specifically on weekends. Facilities sometimes reduce RN presence on Saturdays and Sundays — a low weekend RN figure compared to weekday hours can indicate reduced clinical oversight when most administrative staff are absent.
Sat–Sun
Every person who worked here at any point in the quarter, employees and contractors. It is not how many are on site at once: that is the "on an average day" figure.
154
110 employees · 44 contractors · 52 on an average day
154 total staff / 90 residents. Residents: CMS Long-Term Care Facility Characteristics (data as of Jun 2026); staff: CMS Payroll-Based Journal (Q4 2025).Residents and staff come from two different CMS releases, so the two counts can be a few months apart.
1.71 : 1
↓ 15% · IA 2.02This facility: 1.71 staff per resident, 15% below the Iowa average of 2.02 (among Iowa facilities reporting a recent figure).Green: 5% or more better than the state average. Yellow: within 5%. Red: 5% or more worse.
154 staff ÷ 90 residents
See full Iowa ranking →
Average hours one staff member works on a day they are on shift, across every role.
7.9 h
↑ 5% · IA 7.5 hThis facility: 7.9 h, 5% above the Iowa average of 7.5 h (among Iowa facilities reporting a recent figure).Green: 5% or more better than the state average. Yellow: within 5%. Red: 5% or more worse.
37,608 staff hours this quarter
See full Iowa ranking →91.8% of staff hours were worked by the facility's own employees
Iowa average: 92.3% · Contractors this quarter: Registered Nurse (15), Licensed Practical Nurse (7), Physical Therapy Assistant (5), Certified Nursing Assistant (4), Respiratory Therapy Technician (3), Physical Therapy Aide (3), Speech Language Pathologist (2), Medical Director (1), Occupational Therapy Aide (1), Qualified Social Worker (1), Occupational Therapy Assistant (1), Clinical Nurse Specialist (1)
Why it matters: employees work here week after week and get to know each resident's routines and needs. Agency contractors often rotate between facilities, so a higher employee share usually means more consistent care.
A mid-sized community that may balance personal attention with shared amenities and social activities.
112
Rank #14 / 235Bed count — State benchmarked This nursing home is ranked 14th out of 235 nursing homes we track in Iowa for bed count. Shows this facility's certified or reported bed count compared to other Iowa facilities. Larger communities may offer more amenities, programs, and on-site services for residents and families. Communities with the same value for a metric share the same rank. Rankings compare like with like: every nursing home we track in Iowa that reports data for that category. Nursing homes without available data are excluded, so the pool size varies from metric to metric.Medium-capacity home · Offers a balance of services and community atmosphere.
A longer operating history, which may indicate experience navigating regulations and delivering ongoing care. This is the number of years in operation under current management.
Rank #7 / 116Years in operation — State benchmarked This nursing home is ranked 7th out of 116 nursing homes we track in Iowa for years in operation. Shows how long this facility has been in operation compared to other Iowa facilities. Longer operating histories may benefit residents, families, and staff. Communities with the same value for a metric share the same rank. Rankings compare like with like: every nursing home we track in Iowa that reports data for that category. Nursing homes without available data are excluded, so the pool size varies from metric to metric.
Very walkable. Most errands can be accomplished on foot, and many essentials are within a short walk.
Rank #37 / 249Walk Score — State benchmarked This nursing home is ranked 37th out of 249 nursing homes we track in Iowa for walk score. Shows how walkable this facility's neighborhood is compared to the average walk score across Iowa facilities. Higher scores benefit residents, families, and staff. Communities with the same value for a metric share the same rank. Rankings compare like with like: every nursing home we track in Iowa that reports data for that category. Nursing homes without available data are excluded, so the pool size varies from metric to metric.
Occupancy lower than 85% suggests more openings may be available.
Rank #126 / 226Occupancy rate — State benchmarked This nursing home is ranked 126th out of 226 nursing homes we track in Iowa for occupancy. Shows this facility's occupancy rate versus the Iowa average, with its Statewide rank out of 226. Higher occupancy signals strong local demand and financial stability. Communities with the same value for a metric share the same rank. Rankings compare like with like: every nursing home we track in Iowa that reports data for that category. Nursing homes without available data are excluded, so the pool size varies from metric to metric.Based on 90 residents and 112 beds. Source: state inspection report (Oct 2025)
Similar to the Iowa average: 79.1%
Average number of days residents stay at this facility, based on CMS cost report data. Shorter stays often reflect post-acute or rehab care; longer stays reflect long-term care.
Bethany Lutheran Home is administered by Chandra Gustafson.
25 points below the Iowa average for CMS-certified facilities (83/100)
Category breakdown
136 severity-weighted points (43 deficiencies) · 4× higher than the typical CMS-certified IA facility (median: 38)
3 enforcement actions · above the typical CMS-certified IA facility (median: 0) · $46,914 in fines
35 days to fix issues · slower than the typical CMS-certified IA facility (median: 22)
97% corrected
42 of 43 citations corrected · 1 still open Latest inspection: May 21, 2026 · 1 citation (Abuse/Neglect, moderate), not yet corrected
Most cited category: Resident Assessment & Care Planning, 12 of 43 citations · 8 categories in total
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Health citations are formal notices following inspections when they fail to comply with safety and care standards.
16 of 43 citations resulted from standard inspections; 13 of 43 resulted from complaint investigations; and 14 of 43 came from combined inspections (standard and complaint).
Includes all CMS health inspection records for this property, which could include management/ownership changes.
Data sourced from CMS Health Deficiencies reports. Citation severity codes range from A (least serious) to L (most serious). Immediate Jeopardy (J-L) citations indicate situations where the facility's noncompliance has placed residents at risk of death or serious harm.
Show Inspection Reports
Federal penalties imposed by CMS for regulatory violations, including civil money penalties (fines) and denials of payment for new Medicare/Medicaid admissions.
Source: CMS Penalties Database · Data as of Aug 2026
3 penalties in the past 3 years
Latest: Oct 2, 2025 · $16,588 civil money penalty
Serious action where Medicare and/or Medicaid temporarily stops payments for new residents until issues are fixed.
Fines imposed for noncompliance, which can be assessed per day or per instance of violation.
$16,588
Fines imposed for noncompliance, which can be assessed per day or per instance of violation.
$11,183
Fines imposed for noncompliance, which can be assessed per day or per instance of violation.
$19,143Totals count every penalty on record; the history lists the past 3 years. Iowa and US averages are among facilities with a penalty on record.
A civil money penalty is a fine for noncompliance, per day or per instance. A payment denial stops Medicare/Medicaid payments for new residents until issues are fixed.
How residents at this home fare on health outcomes and preventive care, compared with the Iowa average.
CMS star rating for the care of long-stay residents, who live at the home for 100 days or more. It is built from the long-stay quality measures below. 5 stars is the best.
3
/ 5
Average
↓ 8% · IA 3.3This facility: 3.0, 8% below the IA average of 3.3 (among IA facilities reporting a recent figure).Green: 5% or more better than the state average. Yellow: within 5%. Red: 5% or more worse.
CMS star rating for the care of short-stay residents, mostly people recovering after a hospital stay for under 100 days. It is built from the short-stay quality measures below. 5 stars is the best.
2
/ 5
Below average
↓ 22% · IA 2.6This facility: 2.0, 22% below the IA average of 2.6 (among IA facilities reporting a recent figure).Green: 5% or more better than the state average. Yellow: within 5%. Red: 5% or more worse.
Average of five long-stay measures: pressure ulcers, falls with major injury, unplanned weight loss, worsening ability to walk, and needing more help with daily activities. Each is the % of residents affected, so lower is better.
9.6
Score · lower is better
↑ 4% · IA 9.2This facility: 9.6, 4% above the IA average of 9.2 (among IA facilities reporting a recent figure).Green: 5% or more better than the state average. Yellow: within 5%. Red: 5% or more worse.
Average of three long-stay measures: needing more help with daily activities, worsening ability to walk, and loss of bowel or bladder control. Each is the % of residents affected, so lower is better.
20.1
Score · lower is better
↑ 2% · IA 19.8This facility: 20.1, 2% above the IA average of 19.8 (among IA facilities reporting a recent figure).Green: 5% or more better than the state average. Yellow: within 5%. Red: 5% or more worse.13 long-stay measures: 7 better, 3 worse, 3 near IA average
8 short-stay measures: 1 better, 4 worse, 3 compared with US only
People who live at the home · 13 measures
Percent of long-stay residents whose need for help with daily activities has increased
22.6%
↑ 32% · IA 17.1This facility: 22.6, 32% above the IA average of 17.1 (among IA facilities reporting a recent figure).Green: 5% or more better than the state average. Yellow: within 5%. Red: 5% or more worse.
Percent of long-stay residents whose ability to move independently worsened
12.2%
↓ 27% · IA 16.6This facility: 12.2, 27% below the IA average of 16.6 (among IA facilities reporting a recent figure).Green: 5% or more better than the state average. Yellow: within 5%. Red: 5% or more worse.
Percent of low risk long-stay residents who lose control of their bowels or bladder
25.5%
≈ 0% · IA 25.6This facility: 25.5, level with the IA average of 25.6 (among IA facilities reporting a recent figure).Green: 5% or more better than the state average. Yellow: within 5%. Red: 5% or more worse.
Percent of long-stay residents with a urinary tract infection
0.6%
↓ 74% · IA 2.4This facility: 0.6, 74% below the IA average of 2.4 (among IA facilities reporting a recent figure).Green: 5% or more better than the state average. Yellow: within 5%. Red: 5% or more worse.
Percent of long-stay residents experiencing one or more falls with major injury
3.1%
↓ 19% · IA 3.8This facility: 3.1, 19% below the IA average of 3.8 (among IA facilities reporting a recent figure).Green: 5% or more better than the state average. Yellow: within 5%. Red: 5% or more worse.
Percent of long-stay high risk residents with pressure ulcers
5.7%
↑ 37% · IA 4.2This facility: 5.7, 37% above the IA average of 4.2 (among IA facilities reporting a recent figure).Green: 5% or more better than the state average. Yellow: within 5%. Red: 5% or more worse.
Percent of long-stay residents who lose too much weight
4.3%
↓ 5% · IA 4.6This facility: 4.3, 5% below the IA average of 4.6 (among IA facilities reporting a recent figure).Green: 5% or more better than the state average. Yellow: within 5%. Red: 5% or more worse.
Percent of long-stay residents who have depressive symptoms
0.0%
↓ 100% · IA 4.2This facility: 0.0, 100% below the IA average of 4.2 (among IA facilities reporting a recent figure).Green: 5% or more better than the state average. Yellow: within 5%. Red: 5% or more worse.
Percent of long-stay residents who received an antipsychotic medication
16.2%
↓ 17% · IA 19.5This facility: 16.2, 17% below the IA average of 19.5 (among IA facilities reporting a recent figure).Green: 5% or more better than the state average. Yellow: within 5%. Red: 5% or more worse.
Percent of long-stay residents assessed and appropriately given the pneumococcal vaccine
97.8%
↑ 4% · IA 94.0This facility: 97.8, 4% above the IA average of 94.0 (among IA facilities reporting a recent figure).Green: 5% or more better than the state average. Yellow: within 5%. Red: 5% or more worse.
Percent of long-stay residents assessed and appropriately given the seasonal influenza vaccine
95.3%
≈ 0% · IA 95.3This facility: 95.3, level with the IA average of 95.3 (among IA facilities reporting a recent figure).Green: 5% or more better than the state average. Yellow: within 5%. Red: 5% or more worse.
Number of hospitalizations per 1,000 long-stay resident days.
2.42
↑ 64% · IA 1.48This facility: 2.42, 64% above the IA average of 1.48 (among IA facilities reporting a recent figure).Green: 5% or more better than the state average. Yellow: within 5%. Red: 5% or more worse.
Number of outpatient emergency department visits per 1,000 long-stay resident days.
1.18
↓ 44% · IA 2.09This facility: 1.18, 44% below the IA average of 2.09 (among IA facilities reporting a recent figure).Green: 5% or more better than the state average. Yellow: within 5%. Red: 5% or more worse.Rehab and recovery after a hospital stay · 8 measures
Percentage of residents at or above expected ability to care for themselves at discharge.
46.3%
↓ 14% · US 53.7This facility: 46.3, 14% below the US average of 53.7 (among US facilities reporting a recent figure).
Rate of successful return to home or community from a skilled nursing facility.
56.0%
↑ 11% · US 50.6This facility: 56.0, 11% above the US average of 50.6 (among US facilities reporting a recent figure).
Percentage of SNF residents who experience falls with major injury during their stay.
1.1%
↑ 45% · US 0.8This facility: 1.1, 45% above the US average of 0.8 (among US facilities reporting a recent figure).
Percent of short-stay residents who newly received an antipsychotic medication
3.9%
↑ 89% · IA 2.1This facility: 3.9, 89% above the IA average of 2.1 (among IA facilities reporting a recent figure).Green: 5% or more better than the state average. Yellow: within 5%. Red: 5% or more worse.
Percent of short-stay residents assessed and appropriately given the pneumococcal vaccine
69.0%
↓ 18% · IA 84.0This facility: 69.0, 18% below the IA average of 84.0 (among IA facilities reporting a recent figure).Green: 5% or more better than the state average. Yellow: within 5%. Red: 5% or more worse.
Percent of short-stay residents assessed and appropriately given the seasonal influenza vaccine
46.2%
↓ 37% · IA 73.3This facility: 46.2, 37% below the IA average of 73.3 (among IA facilities reporting a recent figure).Green: 5% or more better than the state average. Yellow: within 5%. Red: 5% or more worse.
Percentage of short-stay residents who were re-hospitalized after their nursing home admission.
31.4%
↑ 47% · IA 21.3This facility: 31.4, 47% above the IA average of 21.3 (among IA facilities reporting a recent figure).Green: 5% or more better than the state average. Yellow: within 5%. Red: 5% or more worse.
Percentage of short-stay residents who had an outpatient emergency department visit.
9.7%
↓ 26% · IA 13.1This facility: 9.7, 26% below the IA average of 13.1 (among IA facilities reporting a recent figure).Green: 5% or more better than the state average. Yellow: within 5%. Red: 5% or more worse.Arrows show whether a figure is above or below the average. Green is better for residents, red is worse, and yellow means within 5% of the average. Grey compares with the US average only, because CMS publishes no state figure. The line on each bar marks the average.
Quality measures are calculated by CMS from Minimum Data Set (MDS) resident assessments and Medicare claims.
75% of new residents, usually for short-term rehab.
23% of new residents, often for short stays.
2% of new residents, often for long-term daily care.
Source: CMS Long-Term Care Facility Characteristics (Data as of Jun 2026)
Total residents
90Residents meet regularly to discuss policies, care quality, and activities
Organized group of residents that meets regularly to discuss facility policies, quality of life, and activities.
Data sourced from CMS Long-Term Care Facility Characteristics quarterly report. Payer mix reflects the current resident census by primary payment source.
Bethany Lutheran Home’s finances from its CMS cost report for the fiscal year ending September 2024, compared with 223 Iowa nursing homes that filed a recent report. Includes all financial data for this property, which could include management/ownership changes.
Is it financially stable?
Losing money on care, but less than last year
−18.0% operating margin
+10.6 pts vs prior year
An operating loss in 8 of the last 8 reported years. Other income ($2.2M) turns it into a net profit to $0.2M. Watch for cost-cutting that reaches staffing.
Does it invest in staff?
Payroll in line with Iowa homes
63.5% payroll share of revenue
IA average 60.9%Rank #63 / 223Payroll % of net patient revenue — State benchmarked This nursing home is ranked 63rd out of 223 nursing homes we track in Iowa for payroll % of net patient revenue. Shows payroll as a percentage of net patient revenue versus the Iowa average, among facilities reporting a recent fiscal year. Below 25% may signal understaffing or heavy agency use — read with Staffing ratings. Communities with the same value for a metric share the same rank. Rankings compare like with like: every nursing home we track in Iowa that reports data for that category. Nursing homes without available data are excluded, so the pool size varies from metric to metric.
Payroll rose $0.7M while revenue rose $0.6M. Check hours per resident in the staffing section to confirm it reaches the floor.
FY 2024 scorecard
Each row shows the FY 2024 figure, the change since the prior report, the trend, and how it compares with Iowa homes.
Losing money on care
| Metric | FY 2024 | vs prior year | Trend 2017 → 2024Trend | IA median | Compared with IA homesRank in IA | In short |
|---|---|---|---|---|---|---|
| Net patient revenue What the home earns from resident care, after discounts and bad debt. | $11.2M | +$0.6M | Trend 20172024 | IA median $6.3M | Rank in IA Rank #26 / 223Net patient revenue — State benchmarked This nursing home is ranked 26th out of 223 nursing homes we track in Iowa for net patient revenue. Shows this facility's net patient revenue compared to the Iowa average, among facilities reporting a recent fiscal year. Higher revenue generally means more resources for staffing and capital — read alongside Payroll %. Communities with the same value for a metric share the same rank. Rankings compare like with like: every nursing home we track in Iowa that reports data for that category. Nursing homes without available data are excluded, so the pool size varies from metric to metric. Higher than 89% of homes | Above IA median Higher net patient revenue than 89% of IA homes that filed a recent report. Revenue mostly follows how big a home is. |
| Operating expenses Everything it costs to run the home: staff, supplies, rent, admin. | $13.2M | −$0.5M | Trend 20172024 | IA median — | Rank in IA Not ranked | Exceeds revenue Operating expenses are higher than net patient revenue, so resident care runs at a loss. |
| Net patient income Revenue minus operating expenses. Negative means care loses money. | −$2.0M | +$1.0M | Trend 20172024 | IA median — | Rank in IA Not ranked | Loss, narrowing Resident care lost money this year, less than in the prior report. |
| Operating margin Net patient income as a share of revenue. The clearest health signal. | −18.0% | +10.6 pts | Trend 20172024 | IA median — | Rank in IA Not ranked | Loss A negative margin means resident care costs more than it earns. |
| Other income Money not from resident care: investments, grants, services. | $2.2M | — | Trend — | IA median — | Rank in IA Not ranked | Offsets part of the loss Income from outside resident care covers part of the loss on care. |
| Net income The bottom line after other income. | $0.2M | +$0.3M | Trend — | IA median — | Rank in IA Not ranked | Profit The bottom line is above zero after other income. |
Staff spending in line with Iowa homes
| Metric | FY 2024 | vs prior year | Trend 2017 → 2024Trend | IA median | Compared with IA homesRank in IA | In short |
|---|---|---|---|---|---|---|
| Payroll costs Salaries and wage-related benefits, not counting contract labor. | $7.1M | +$0.7M | Trend 20172024 | IA median $3.8M | Rank in IA Rank #28 / 223Payroll costs — State benchmarked This nursing home is ranked 28th out of 223 nursing homes we track in Iowa for payroll costs. Shows total staff payroll — salaries plus wage-related benefits — benchmarked to the Iowa average, among facilities reporting a recent fiscal year. Higher payroll relative to peers often signals better staffing and less reliance on contract labor. Communities with the same value for a metric share the same rank. Rankings compare like with like: every nursing home we track in Iowa that reports data for that category. Nursing homes without available data are excluded, so the pool size varies from metric to metric. Higher than 88% of homes | Above IA median Higher payroll than 88% of IA homes. Payroll in dollars mostly follows how big a home is, so this compares size, not staffing levels. |
| Payroll share of revenue Payroll divided by revenue. Higher usually means more staff per resident. | 63.5% | +3.0 pts | Trend 20172024 | IA median 59.0% | Rank in IA Rank #63 / 223Payroll % of net patient revenue — State benchmarked This nursing home is ranked 63rd out of 223 nursing homes we track in Iowa for payroll % of net patient revenue. Shows payroll as a percentage of net patient revenue versus the Iowa average, among facilities reporting a recent fiscal year. Below 25% may signal understaffing or heavy agency use — read with Staffing ratings. Communities with the same value for a metric share the same rank. Rankings compare like with like: every nursing home we track in Iowa that reports data for that category. Nursing homes without available data are excluded, so the pool size varies from metric to metric. Higher than 72% of homes | Near IA average The IA average is 60.9% of revenue. Within 3 points of it reads as near the average. |
What the home earned from resident care (net patient revenue), what it cost to run (operating expenses) and the difference between the two (net patient income), for each fiscal year it filed a CMS cost report.
USD, millions
Net patient revenue Operating expenses Net patient income
Both lines are a share of net patient revenue. Payroll share is what goes to salaries and wage-related benefits; operating margin is what is left after every operating cost (below 0%, resident care lost money). The dashed line is the Iowa payroll average.
% of net patient revenue
Payroll share Operating margin IA payroll average
| Metric | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 |
|---|---|---|---|---|---|---|---|---|
| Net patient revenue | $10.0M | $10.1M | $10.7M | $10.2M | $8.4M | $8.8M | $10.6M | $11.2M |
| Operating expenses | $10.5M | $10.5M | $11.3M | $11.7M | $10.4M | $11.8M | $13.6M | $13.2M |
| Net patient income | −$0.5M | −$0.4M | −$0.6M | −$1.5M | −$2.1M | −$3.0M | −$3.0M | −$2.0M |
| Operating margin | −5.0% | −3.8% | −5.8% | −14.3% | −24.8% | −34.4% | −28.6% | −18.0% |
| Net income | −$0.3M | −$0.7M | −$0.5M | $1.2M | $0.5M | −$3.7M | −$0.1M | $0.2M |
| Payroll costs | $7.2M | $7.2M | $6.7M | $6.3M | $5.4M | $5.1M | $6.4M | $7.1M |
| Payroll share of revenue | 72.2% | 70.7% | 62.5% | 61.6% | 64.6% | 57.5% | 60.5% | 63.5% |
| Beds | 121 | 121 | 121 | 121 | 121 | 121 | 121 | 121 |
| Gross revenue | $10.5M | $10.6M | $12.2M | $11.7M | $10.3M | $10.4M | $11.8M | $12.8M |
| Salaries | $6.0M | $6.0M | $5.7M | $5.4M | $5.3M | $4.6M | $5.8M | $6.2M |
| Wage-related costs | $1.2M | $1.2M | $1.0M | $0.8M | $0.1M | $0.5M | $0.7M | $0.9M |
| Contract labor | $0.5M | $0.4M | $1.4M | $1.9M | $1.6M | $3.5M | $3.3M | $2.2M |
| Other operating costs | $3.3M | $3.4M | $4.6M | $5.4M | $5.0M | $6.8M | $7.2M | $6.1M |
| Net patient revenue per day | $241 | $244 | $257 | $277 | $282 | $295 | $327 | $366 |
| Cost per day | $253 | $253 | $272 | $317 | $352 | $396 | $421 | $432 |
| Average length of stay | 211.4 days | 419.3 days | 133.4 days | 201.0 days | 151.3 days | 159.2 days | 152.1 days | 214.6 days |
Showing 2024–2022 · scroll sideways for 5 earlier years
Earlier and partial years are in the download. Download CSV
Most residents typically stay for a few weeks or months before returning home or moving on.
Most new residents arrive under Medicare (75% of admissions), and a typical Medicare stay runs around 17 days.
Coverage residents most often arrive under.
Coverage residents most often leave under.
0.0 miles from city center
Estimated distance in miles from Council Bluffs's city center to Bethany Lutheran Home's address, calculated via Google Maps.
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The facility name. Click to view the full profile page on Assisted Living Magazine, including photos, services, and contact info.
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CMS (Centers for Medicare & Medicaid Services, the federal agency that regulates nursing homes) Overall 5-star rating — a composite of Health Inspection, Staffing, and Quality Measures scores. 5 stars = top 10% nationally. 1 star = bottom 10%. The single most important number to start with when comparing facilities.
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Care Types in This Table
AL (Assisted Living):
Housing with help for daily activities like bathing, dressing, and medication, without 24-hour skilled nursing.
NH (Nursing Home):
24/7 skilled nursing care for residents with complex, ongoing medical needs.
SNF (Skilled Nursing Facility):
Round-the-clock nursing care, often for recovery after surgery, injury, or illness.
MC (Memory Care):
Secured, specialized care for people living with Alzheimer's or dementia.
RC (Respite Care):
Short-term temporary care that gives family caregivers a break.
IL (Independent Living):
Community living with dining, activities, and transportation for active seniors who need little personal care.
HOS (Hospice Care):
Comfort-focused care for those with a terminal illness, prioritizing quality of life over treatment.
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Neighborhood or city area where the facility is located. Proximity to family, hospitals, and green space matters for both quality of life and ease of visitation. Consider drive time and transit access when evaluating location.
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Licensed bed capacity. Larger facilities (300+ beds) often have more specialized programs but can feel institutional. Smaller homes (under 150 beds) tend to deliver more personalized care. Compare with Avg Res/Day to understand how full the facility typically runs.
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A 0–100 score of a facility's regulatory inspection record, shown as a letter and compared with other facilities of the same kind in the same state. This is a proprietary Assisted Living Magazine grade. It is not a government rating. A dash means we have no inspection data for that facility.
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Percentage of licensed beds filled on an average day. Color indicates financial health: green (90%+) = operationally strong, typically profitable. Amber (80–89%) = stable but leaving revenue on the table. Orange (70–79%) = financial strain likely, may struggle with fixed costs. Red (<70%) = significant distress, closure or ownership change risk increases sharply.
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This facility's occupancy rate compared to the statewide average for similar facilities. A positive number means above-average demand. Facilities running 5%+ above the state average are typically the most sought-after in their market — a strong proxy for reputation.
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CMS-adjusted total nurse hours per resident per day (RN + LPN + CNA combined). The national average is approximately 3.5 hrs. Higher is better — more direct care time per resident. Below 3.0 is a red flag. CMS weights RN hours more heavily because RNs handle complex clinical decisions that CNAs cannot.
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CMS Health Inspection star rating (1–5 stars), based on the 3 most recent annual state surveys plus any complaint investigations. This is the hardest rating to manipulate — it reflects real surveyor findings on-site. 5 stars = fewest deficiencies found. 1 star = most. It carries the heaviest weight in the Overall CMS rating.
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CMS Staffing star rating (1–5 stars), based on daily nurse staffing hours submitted to CMS via verified payroll data. Compares RN, LPN, and CNA coverage relative to resident acuity level. 5 stars = well above expected staffing. Weekend staffing is evaluated separately, as that's where many facilities quietly reduce coverage.
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CMS Quality Measures star rating (1–5 stars), based on 15 clinical outcome metrics including fall rates, pressure ulcers, antipsychotic drug use, and hospital readmissions. Captures actual resident health outcomes, not just compliance. High QM combined with low Health Inspection scores can indicate a facility with strong care but weak documentation practices.
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Registered Nurse hours per resident/day compared to the statewide average. RNs are the highest-skilled nursing staff — they assess residents, manage medications, and respond to emergencies. A value of +50% means RN coverage is 50% above the state norm. Negative values are a concern for residents with complex or acute medical needs.
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Total nursing staff hours (RN + LPN + CNA combined) per resident/day vs. the statewide average. A broader measure than RN vs State — it captures the entire care team. A facility can have high total staffing but low RN hours, meaning more aides and fewer nurses. Read both columns together for the full picture.
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Total dollar amount of federal monetary fines (civil money penalties) issued by CMS in the past 3 years. Fines are only levied for serious violations — typically actual harm to residents, repeated uncorrected deficiencies, or systemic non-compliance. Even a single fine is noteworthy. Multiple fines strongly suggest a pattern, not isolated incidents.
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Total health deficiency citations from the most recent standard inspection cycle. Minor citations (scope A–C) are common and often administrative in nature. Higher counts aren't always disqualifying, but should be read alongside Severe Citations to understand actual harm levels. Under 10 is strong for a large facility; 30+ warrants a closer look.
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Average deficiency citations per CMS inspection (survey) in the reporting window — total citations divided by the number of inspections. Lower is better; compare alongside total Citations and Severe Citations for context.
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Citations at CMS scope/severity level G or higher — G–I means actual harm occurred; J–L means residents were placed in immediate jeopardy. (D–F is potential for harm only). Examples include unaddressed falls, medication errors causing injury, neglect, or abuse.
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Average number of residents in the building on any given day, derived from annual census data. Reflects true operating scale — a 400-bed facility running 200 residents/day operates very differently from one at 390. Higher resident counts generally mean more funded staffing hours.
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Better Business Bureau rating (A+ to F). Reflects complaint history, business transparency, and how family disputes were resolved. A+ means no significant unresolved complaints. A blank (—) means the facility isn't BBB-accredited, which is common for healthcare providers and not necessarily a negative signal.
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Walk Score® (0–100). Measures walkability of the surrounding area. 90–100 = Walker's Paradise. 70–89 = Very Walkable. 50–69 = Somewhat Walkable. Below 50 = Car-Dependent. Higher scores benefit family visitors, resident outings, and staff commuting.
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The licensed owner or operator of record filed with CMS — the individual or organization legally accountable for the facility. Searching the operator name across other facilities can reveal chain or multi-site ownership, which matters: chain-operated homes tend to have more variable quality outcomes than independently run facilities.
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What the home actually collects for resident care, after contractual allowances, bad debt and discounts — not gross billings. Taken from the latest complete annual cost report, so it is comparable across homes reporting the same period. Revenue alone doesn't indicate care quality, but it funds staffing and capital reinvestment. Pair with Payroll %. Figures are from each facility's most recent complete fiscal year — hover a value for the exact year; a * marks homes that report an older period than most facilities.
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Staff salaries plus wage-related benefits from the latest complete annual cost report. Contract and agency labour is counted separately, under other operating costs, so a home leaning on agency staff can show a low figure here. Payroll is the cost most directly tied to care quality — compare with Payroll % for full context. Figures are from each facility's most recent complete fiscal year — hover a value for the exact year; a * marks homes that report an older period than most facilities.
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Payroll as a share of NET PATIENT REVENUE (not gross revenue). Both figures come from the same cost-report year. A higher figure means more of each revenue dollar goes to staff pay. Read with the Staffing star rating to judge whether spend translates into coverage — and note that homes whose patient revenue covers only part of their operation can read implausibly high. The Iowa average is: 60.9% Figures are from each facility's most recent complete fiscal year — hover a value for the exact year; a * marks homes that report an older period than most facilities.
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CMS Certification Number: the unique federal identifier for this skilled nursing provider.
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|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Midlands Living Center LLC | NH HOS RC SNF | Council Bluffs | 94
Facility
94
IA AVG
66
Rank
#28 / 235 | A- |
70.2%
Facility
70.2%
IA AVG
79.1%
Rank
#179 / 226 | -11% | 4.85
Facility
4.85
IA AVG
4.49
Rank
#110 / 225 | -23% | +8% | $0
Facility
$0
IA AVG
$53.2k
Rank
#1 / 230 | 16
Facility
16
IA AVG
20.7
Rank
#109 / 226 | 3.2
Facility
3.2
IA AVG
3.8
Rank
#95 / 226 | - | 66 | A+ |
77
Facility
77
IA AVG
50
Rank
#37 / 249 | North Crest Living Center(Free Standing Nf/Snf) | 780853 | $8.0MFiscal year ending 12/2024
Facility
$8.0MFiscal year ending 12/2024
IA AVG
$7.4M
Rank
#74 / 223 | $4.7MFiscal year ending 12/2024
Facility
$4.7MFiscal year ending 12/2024
IA AVG
$4.5M
Rank
#76 / 223 | 58.2%Fiscal year ending 12/2024
Facility
58.2%Fiscal year ending 12/2024
IA AVG
60.9%
Rank
#123 / 223 | 165447 | ||||
| North Crest Living Center | NH SNF | Council Bluffs | 62
Facility
62
IA AVG
66
Rank
#100 / 235 | C |
91.9%
Facility
91.9%
IA AVG
79.1%
Rank
#40 / 226 | +16% | 4.91
Facility
4.91
IA AVG
4.49
Rank
#66 / 225 | -32% | +9% | $0
Facility
$0
IA AVG
$53.2k
Rank
#1 / 230 | 34
Facility
34
IA AVG
20.7
Rank
#180 / 226 | 5.7
Facility
5.7
IA AVG
3.8
Rank
#183 / 226 | - | 57 | - |
77
Facility
77
IA AVG
50
Rank
#37 / 249 | Midlands Living Center LLC(Free Standing Nf/Snf) | 780508 | $6.1MFiscal year ending 12/2024
Facility
$6.1MFiscal year ending 12/2024
IA AVG
$7.4M
Rank
#118 / 223 | $2.8MFiscal year ending 12/2024
Facility
$2.8MFiscal year ending 12/2024
IA AVG
$4.5M
Rank
#158 / 223 | 46.8%Fiscal year ending 12/2024
Facility
46.8%Fiscal year ending 12/2024
IA AVG
60.9%
Rank
#210 / 223 | 165290 | ||||
| Bethany Lutheran Home | NH AL MC SNF | Council Bluffs | 112
Facility
112
IA AVG
66
Rank
#14 / 235 | F |
80.4%
Facility
80.4%
IA AVG
79.1%
Rank
#126 / 226 | +2% | 4.65
Facility
4.65
IA AVG
4.49
Rank
#66 / 225 | +28% | +4% | $46.9k
Facility
$46.9k
IA AVG
$53.2k
Rank
#196 / 230 | 43
Facility
43
IA AVG
20.7
Rank
#196 / 226 | 4.8
Facility
4.8
IA AVG
3.8
Rank
#160 / 226 | 5 | 90 | - |
77
Facility
77
IA AVG
50
Rank
#37 / 249 | Diana Roberts | $11.2MFiscal year ending 09/2024
Facility
$11.2MFiscal year ending 09/2024
IA AVG
$7.4M
Rank
#26 / 223 | $7.1MFiscal year ending 09/2024
Facility
$7.1MFiscal year ending 09/2024
IA AVG
$4.5M
Rank
#28 / 223 | 63.5%Fiscal year ending 09/2024
Facility
63.5%Fiscal year ending 09/2024
IA AVG
60.9%
Rank
#63 / 223 | 165524 | ||||
| Prairie Gate | - | NH AL IL MC SNF | Council Bluffs | 36
Facility
36
IA AVG
66
Rank
#217 / 235 | ? |
94.4%
Facility
94.4%
IA AVG
79.1%
Rank
#27 / 226 | +19% | - | - | - | - | - | - | - | - | - | - | 34 | - |
6
Facility
6
IA AVG
50
Rank
#241 / 249 | Natasha Urinko | $1.9M*Fiscal year ending 05/2022These figures are from this home's most recent complete cost report — an older period than most facilities report. Compare with that in mind. | $3.1M*Fiscal year ending 05/2022These figures are from this home's most recent complete cost report — an older period than most facilities report. Compare with that in mind. | 160%*Fiscal year ending 05/2022These figures are from this home's most recent complete cost report — an older period than most facilities report. Compare with that in mind. | 165789 |
Rank badges are statewide and care-type specific: each nursing home is ranked against every other IA nursing home we track that reports that metric, not just the 4 on this page. See how we rank facilities
Bethany Lutheran Home is located in Council Bluffs, Iowa.
Here are the financial assistance programs available to residents in Iowa.
Bethany Lutheran Home has a walk score of 77. Very walkable. Most errands can be accomplished on foot, and many essentials are within a short walk.
According to IA state health department records, Bethany Lutheran Home's license number is 780207.
According to IA state health department records, Bethany Lutheran Home's license expires on May 1, 2027.
Bethany Lutheran Home's occupancy is 80.4%.
Bethany Lutheran Home has been operating for approximately 51 years, based on available licensing and registration records.
Yes, Bethany Lutheran Home allows residents to bring their pets.
The team at Bethany Lutheran Home can be reached at info@blhs.care.
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