Sen. Steve Daines told a Senate panel Tuesday that at worker at a state-run nursing home in Lewistown told him she resigned after believing her supervisors retaliated against her for raising questions about quality issues.
Daines, a member of the Senate Committee on Finance, made his comments about the Montana Mental Health Nursing Care Center during a discussion the panel had on “Promoting elder justice: A call for reform.” It was a discussion on the quality of care and safety for Medicare and Medicaid recipients.
He said when the former employee brought concerns to leadership she was excluded from meetings and ultimately resigned. Daines did not identify the employee.
The Montana Republican asked for assurances that when people who come forward with reports of mistreatment they are taken seriously.
Daines said fines have been levied against the nursing home and hundreds of thousands of taxpayer dollars funneled to this facility, but no one in a leadership position at Lewistown has been held accountable.
“When a Montanan brings a serious concern to me, it is one of my duties to look into it,” he said.
He asked Megan H. Tinker, office of counsel to the inspector general, U.S. Department of Health and Human Services, for help.
“What can be done to make sure that those coming forward with reports of mistreatment can be taken seriously?” he asked.
Tinker said she is committed to health and safety nationwide.
The Montana Department of Public Health and Human Services responded to Daines’ testimony.
“We take the health and safety of residents at the Nursing Care Center very seriously by working together as a team to provide the best care possible,” DPHHS Director Sheila Hogan said. “Further, management at the facility take great pride in fostering an environment that encourages staff and patients to come forward with any suggestions or recommendations to achieve our goal of continuous improvement.”
Residents at the nursing care center must meet the requirement for a nursing home, have a co-occurring mental illness and be denied entrance to at least three other nursing home facilities in the state or be transferred, due to need, by another state facility, officials said.
Senate Committee members were told that “abuse deficiencies” increased in nursing homes nationwide from 430 in 2013 to 875 in 2017, with the largest gains in severe cases. They said physical and mental verbal abuse occurred most often in nursing homes, followed by sexual abuse and staff were more often the perpetrators.
Much of Tuesday’s discussion was critical of the U.S. Centers for Medicare and Medicaid Services (CMS), which provides health coverage to more than 100 million people through Medicare, Medicaid, the Children’s Health Insurance Program, and the Health Insurance Marketplace, according to USA.gov. One senator noted that Medicaid covers two out of three nursing home residents.
The federal government has a website that compares nursing homes based on a health inspection database, a national database of resident clinical data and Medicare claims data.
Tinker said there are recommendations that CMS uses data to identify risk areas and do more training on reporting and how to address issues. CMS determines a facility’s eligibility to participate in the Medicare program based on the state’s certification of compliance and compliance with civil rights requirements.
Tinker said CMS, states and providers should use data to identify potential abuse and neglect, report it to proper agencies and states must ensure problems are fixed.
John E. Dicken, director of health care for the U.S. Government Accountability Office, said CMS’s data does not let the type of abuse or perpetrator to be identified by the agency. Officials said that state survey agencies are not required to immediately refer complaints or reasonable suspicions to law enforcement.
Dicken also said facility-reported incidents lack key information and CMS should come up with a standardized form.
Tinker said Medicaid claims are a powerful tool to fight against potential abuse and neglect, but CMS does not agree.
“CMS should make better use of the data at its disposal,” she said.
Tinker said in many cases abuse and neglect is hidden, noting a report of an 85-year-old woman beaten with a broomstick, taped to a chair and had her mouth taped shut. Another home had a manager who forced residents to fight each other.
“Fundamental common-sense safeguards are lacking,” she said.
The panel was told nursing homes in 13 states are not required to do national criminal background checks on potential new employees. Montana was not among those states.
Tinker said it was recommended to CMS to close that loophole, but that has not happened.
“Those 13 states that are outstanding, continue to raise concerns,” she said.
Sen. Ron Wyden, D-Ore., wanted to know if nursing homes are hiring people who could pose a threat to residents.
“There have to be robust background checks and it ought to be from sea to shining sea,” he said. “It is time to end this kind of lurching from one piecemeal approach to another …”
Wyden and Daines said the rating system used by CMS for nursing homes is “a mess” and confusing.
Dicken said there have been recommendations made to CMS. Wyden asked how to make reports of abuse more readily available.
CMS said Tuesday it never tolerates abuse and mistreatment of nursing home residents.
“All nursing home residents deserve to be treated with dignity and respect, and CMS requires nursing homes to report allegations of abuse, neglect, and mistreatment promptly to state survey agencies and other authorities,” a spokesperson said.
CMS has independently made significant changes since then since a 2013-1017 GAO review, officials said, adding they will continue to work with the GAO.
In 2017, CMS strengthened reporting requirements, and provided additional training to surveyors to help them identify and cite noncompliance.
“CMS isn’t finished: we are clarifying when abuse must be reported to state agencies and law enforcement, and setting clear timelines for the review of abuse and neglect allegations,” the spokesperson said.
In June, a report released by U.S. Sens. Bob Casey, a Republican, and Democrat Pat Toomey, both of Pennsylvania, showed one Montana nursing home listed as “underperform” on inspections, and listed five other facilities, including Lewistown, that could be added.
Lewistown 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-stars in 2017 to two stars, where it now remains.
A Feb. 22, 2018, inspection found the state-run facility failed to protect people from fellow residents who showed verbal, physical and sexually abusive behaviors in the Firefly Wing, which houses dementia patients.
The survey also found “immediate jeopardy” at the facility,” meaning, according to federal guidelines, that situations occurred in which the provider’s noncompliance with requirements “has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident.”
It was reported in August 2018, that the facility had been fined at least $535,000 since 2017 for failing to meet standards.
DPHHS officials said in June four deficiencies were found in the most recent Nursing Care Survey was in April and all have been corrected and “our plan of correction accepted by CMS.”
They said the department received a May 24 letter which found the facility has “achieved and maintained substantial compliance.”
They also said CMS notes in a recent release about Special Focus Facilities that nursing homes have some deficiencies, “with the average being 6-7 deficiencies per survey. Most nursing homes correct their problems within a reasonable period of time.”