State-Run Nursing Home Not Meeting New Federal Guidelines

Report says Lewistown facility failed to protect patients from verbal, physical and sexually abuse of fellow dementia patients

By Associated Press

GREAT FALLS — The state health department has paid more than $277,000 in civil penalties as the Montana Mental Health Nursing Care Center in Lewistown works to meet new federal documentation requirements for facilities that care for older adults with mental illness.

The federal Centers for Medicare and Medicaid inspected the state-run facility in February and found it failed to protect patients from the verbal, physical and sexually abusive behaviors of fellow dementia patients, the Great Falls Tribune reports . Three residents had suffered physical and mental harm from the aggressors, inspectors said.

The state Department of Public Health and Human Services is paying about $70,000 a month for a consultant to guide the center in meeting the new requirements. Officials hope that work can wrap up in June, after four months. The hired consultant has placed a temporary manager at the center.

Steven Chickering, associate regional administrator for CMS, said there are times “we feel the oversight of a facility by the administrator is not effective.”

Administrator Dianne Scotten declined to comment.

Zoe Barnard, administrator of the health department’s Addictive and Mental Disorders Division, said residents are receiving the same good quality of care, but with a different set of regulations and expectations. Much of the issue, she said, is with documentation.

“Oftentimes with certification it’s about how you document the incident, how it gets reported and who it gets reported to,” she said.

One of the issues is with reporting incidents to Montana Adult Protective Services, which was not previously required by the state, Barnard said.

The states were given ample time to prepare for the new federal regulations, Chickering said.

If the state does not comply with the new regulations it could lose Medicare and Medicaid reimbursements.

The February investigation, based on a complaint, found on 13 occasions the administrator and other officials were not notified of incidents that included physical, mental and sexual abuse in the dementia wing.

It’s common for patients with dementia to display inappropriate sexual behavior, Barnard said.

“It’s a constant challenge from a supervisor standpoint to make sure residents are not inappropriately touching each other,” she said.

The Montana Mental Health Nursing Care Center is a 117-bed Medicaid-licensed facility that has about 80 residents. More than 70 percent of them are over age 65 and all have a mental health diagnosis. They have been determined to be a danger to themselves and others, require long-term care, cannot benefit from care at the Montana State Hospital and must have been turned away from three nursing homes or other community placements.

The Centers for Medicare and Medicaid fined the state $12,759 for each day from Feb. 22 to March 13, when it considered residents of the Lewistown center to be in “immediate jeopardy,” for a total of more than $255,000. The civil penalty was lowered to $505 per day from March 14 to April 26, for a total of $22,220.

After an April 26 visit, the daily fine was reduced to $105 and will continue until the facility is in substantial compliance with all requirements, state officials said.

There will be a follow-up visits 45 to 90 days after the facility comes into compliance with federal regulations, Chickering said.

“Our desire is to have every nursing home (be in compliance) and to provide good care to everybody,” he said.

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