Daines wants timeline for nursing homes action, audits

Citing concerns for incidents reported at a state-run nursing home in Montana, Sen. Steve Daines on Friday asked the head of a federal agency overseeing these facilities when a review will be completed of nursing home regulations and guidelines.

And the Montana Republican asks Seema Verma, administrator for the Centers for Medicare and Medicare Services (CMS) if her agency will provide a list of audits and findings and what steps the agency is taking to improve its rating system.

“I am committed to shedding a light on the current systematic deficiencies that allow substandard care in nursing homes and fail to protect older Americans in Montana and across the nation from abuse and neglect,” he wrote.

He also asked what steps has CMS taken, or plans to take, to improve the star rating system used to rate nursing homes, and allows families to decide where family members should live.

Daines first brought up concerns about a state-run nursing home in Lewistown at a March 6 hearing of the Senate Finance Committee. Although he did not mention it by name during that hearing or in Friday’s letter, the facility is the Montana Mental Health Nursing Care Center.

It is the only one of its kind in Montana as it is certified as both a mental health and a long-term care operation. It is a 117-bed Medicaid-licensed facility. Its rating dropped from a five-star rating in 2017 to two stars, where it now remains.

Montana Department of Public Health and Human Services officials said in March, when Daines first aired his concerns about the Lewistown facility, that the nursing care center has been in ‘substantial compliance’ for nearly nine months and referenced a Sept. 21, 2018, letter from CMS that stated so.

State officials said one reason for the lower grade was due to a substantial change in nursing home requirements from CMS, and they have confidence in the facility’s administration.

Daines said the facility failed to protect patients from verbal, physical and sexually abusive behaviors of fellow patients.

“According to reports, on 13 occasions, officials were not notified of incidents that included abuse in the facility’s wing which houses dementia patients. This is unacceptable,” Daines said.

“The unfortunate reality is that this is not an isolated case,” Daines wrote. “This kind of abuse can happen to anyone. According to the Department of Health and Human Services Inspector General, one-third of nursing home residents experienced harm while under the care of their federally-funded facilities.”

He said nursing home residents are among the nation’s most vulnerable citizens, “and it should be a top priority to prevent them from being victims of abuse and neglect.”

CMS said at the March hearing it would review regulations related to the safety and quality of nursing homes.

Rose Hughes, executive director of the Montana Health Care Association, said it’s “reasonable” for Daines and others to be concerned if nursing home residents are receiving good care and are free from abuse and neglect.

But she said she is also concerned that what goes on in nursing homes is more complicated.

She said the evaluations of care in these facilities is complicated and changes all the time. There is not consistency from state to state and the evaluations  capture a day or two in life of a facility.

“The survey process is not the best way to figure out is how our facilities are doing,” ‘Hughes said. “If you have a good survey chances are you are doing a lot right.”

A bad survey reflects some problems.

“Everything in between doesn’t tell you much,” she said.

She said about 35, or half of Montana’s nursing homes, were surveyed in last six months. There were about a handful of citations that were low level and of no harm to anyone. She suspected the citations had to do more to do with policy and procedure.

Hughes said she would like people who are interested in good care for elderly to have the kind of commitment it takes to make that happen.

Hughes said the rate increase for providers OK’d in the Montana legislative session was not sufficient.

“I don’t feel like I saw a commitment from policymakers at the state level for senior services,” she said. “Senior care did not fare well in the Legislature. There was a lot that went undone.”