Montana's Nursing Homes Are in Crisis

 

January 11, 2023



In the final week of 2022, the Havre Daily News carried a letter to the editor submitted by Valley County Commissioner Mary Armstrong on behalf of the County Commissions of 19 counties in Montana, including Hill and Phillips Counties. This letter was brought to the attention of the Sweet Memorial Nursing Home (SMNH) Board by Board President, Art Kleinjan, who wants to see Blaine County involved in the important mission outlined by Armstrong.

Administrator for the SMNH, Rebecca Shackelford, along with her governing board, wishes to get the word out to the community about the nursing home crisis in the state of Montana.

“Just this year, Montana has seen the closure of ten nursing homes. The pandemic has been hard on the industry, but what is killing us all now is sub-par Medicaid rates. Our costs per day have skyrocketed through the COVID years, and the Medicaid reimbursement rates are not much above even pre-pandemic costs,” Shackelford reports.

On a related note, in her letter Armstrong writes: “Our elderly neighbors who are on Medicaid benefits have served Montana well, and at this final stage in their lives, [they] seek the promise of compassionate, medically appropriate care. Most of them are out of money, have used up their care options with family members and loved ones, and cannot afford in-home care, which can cost more than $20,000 a month and is rarely covered by private insurance or Medicaid.”

Armstrong goes on to describe what she calls a “broken elder care economy,” citing as evidence the closure of more than ten per cent of Montana’s skilled nursing or rest homes. “And most of the facilities still operating, whether private or public, are teetering on the edge of closure,” Armstrong adds.

“The cancer in Montana’s elder care system is the low Medicaid reimbursement rate. The rate averages about $212 per day per patient, while the actual cost of care is well over $300 per day. No facility can remain financially viable under these circumstances, private or public. As a result, most facilities in Montana don’t accept Medicaid customers, leaving few options for those who need services the most.”

At their recent meeting, the SMNH Board decided that Kleinjan should schedule a conversation with Blaine County Commissioners after the first of the year to discover if they had been contacted to be part of this commission or whether they were just unaware. “If that is the case, hopefully they will want to join in the fight,” Shackelford said.

After receiving contact information for the committee members from Rose Hughes, Executive Director of the Montana Healthcare Association (MHCA) of which Sweet Home is a member, Shackelford wrote to the Joint Subcommittee for Health and Human Services. According to Shackelford, that group is a six-member subcommittee comprised of three representatives and three senators who develop recommendations regarding what should be included in the Department of Public Health and Human Services (DPHHS) budget, including allocations for nursing homes and assisted living facilities.

“I don’t normally do much in the way of lobbying, but I was compelled to at least try to write something because, in all reality, if something doesn’t change with the Medicaid rates, Sweet Home will be just like the other ten nursing homes that have had to close this year,” Shackelford responded.

Much to Shackelford’s surprise, she received a reply from the Committee Chair, Representative Bob Keenan, who desired more information. “He replied to my original email and asked for a few more specific details about costs and occupancy levels, but basically he said that the information would be helpful when they begin to work on the appropriations budget that they are tasked with.”

Keenan thanked Shackelford for the “interesting and thought provoking information” and added: “I would like to get that type of input from as many of your peers as we could.”

The County Commission, the MHCA, and the administration of SMNH all wish to send a strong message to the Montana DPHHS, to Governor Greg Gianforte, and to the 2023 State Legislature. Their plea targets these entities to do their part in saving Montana’s skilled nursing facilities by investing in a rate increase for nursing homes.

“We need their leadership now more than ever,” Shackelford stated. “I think our community needs to know that Sweet Home is not immune from things plaguing the other facilities in our state.”

The primary ‘thing’ to which Shackelford refers are the facilities’ financial challenges, which are due in large part to Medicaid rates for nursing homes being so low as to not come close to covering the actual costs of care.

“For much of this year—and possibly earlier—there has been a collective movement by the MHCA, Montana Hospital Association, and related groups to try to get DPHHS to increase the Medicaid rates. Even before COVID, the rates were not at a level they should have been to cover the daily cost of caring for residents. Then as costs increased, the Medicaid rates just became more of an important issue,” Shackelford explained.

She went on to say: “Sometime in 2020, I believe, Governor Bullock put in place an extra $40 per day per Medicaid rate for nursing homes. I think it was COVID money the state had received, so we got lump sum amounts based on the number of Medicaid residents we had. That ended with the change in administration at the state, though. Thankfully, we applied for and received a PPP loan in 2020 that was ultimately forgiven. The extra $40/day for Medicaid, the PPP loan, and federal Cares Act money that we received in 2020 and part of 2021 made it possible that we could continue to operate with reimbursement rates that are below our costs.”

According to Shackelford, community members can help to mitigate this crisis by reaching out to members of the 2023 Montana State Legislature, asking them to address the rate reimbursement for nursing homes. “The subcommittee members I wrote to are mostly from bigger cities in Montana, and I’m not quite sure that they realize the effect a facility closure has on a small, rural town. The rate that facilities are closing is scary and will impact the whole state.”

Shackelford’s original thought when she wrote to the subcommittee was to tell SMNH’s story, to outline the trials the facility has faced in the last couple of years, to explain the impact a closure would have on the community, and to describe the need for the state to do something to address the Medicaid rates. Shackelford reports that these rates “are literally $80 - $100 below what the current daily cost is. I have looked into our cost per day since 2019, and I really don't see how the costs will go back to pre-pandemic levels. I begged [the committee] to do something about the Medicaid rates, if not for our facility and the residents, then for the 50+ people that we employ that would be out of a job in the event that we had to close our doors.”

Anyone who wishes to support the SMNH in combatting this crisis is encouraged to contact any of the members of the Joint Subcommittee for Appropriations/Finance & Claims, which works with Health and Human Services, by using the following contact information:

Name Party District Town Email

Rep. Bob Keenan, Chair R HD 10 Bigfork bob.keenan@legmt.gov

Sen. Carl Glimm, Vice R SD 02 Kila carl.glimm@legmt.gov

Rep. Mary Caferro D HD 82 Helena mary.caferro@legmt.gov

Rep. Jane Gillette R HD 64 Bozeman jane.gillette@legmt.gov

Sen. Dennis Lenz R SD 27 Billings dennis.lenz@legmt.gov

Sen. Christopher Pope D HD 31 Bozeman christopher.pope@legmt.gov

Interested individuals do not need to wait for the legislature to reconvene in 2023. They can make their contacts before the members return to Helena.

Armstrong’s letter perhaps captures the situation best when it states: “We’re in this together. No group is more deserving of a safety net than our elderly Medicaid recipients. We urge Governor Gianforte, and members of the 2023 Montana Legislature, to please fix the rate reimbursement for nursing homes. The house is on fire and we need your help.”

 
 

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