Nursing home closures requires a serious solution

In mid-December 2022 the media reported “Miles City Nursing Home Closing, the 11th One in Montana This Year,” implying a gloomy future for seniors without political leadership from the Montana Legislature and Gov. Greg Gianforte. It’s time we stand up for seniors instead of asking them to stand at the back of the line.

Currently, Montana has a $2 billion budget surplus thanks largely to an infusion of federal money intended to help our state during the Public Health emergency and providing a safety net for our state’s most vulnerable residents.

Charlie Brereton, Director of Montana’s Department of Public Health, and Human Services acknowledges the nursing home closure problem is real. Mid-January he testified before a legislative committee, sharing he’d been asked during this biennium by the industry to find the money, and the money simply doesn’t exist.

Gianforte is quick to brag about a healthy state budget balance, but he and his staff have taken the position that our state coffers are empty to address this pressing and growing problem. That’s a fake argument because there is money available. What’s lacking is the will to make deserving seniors and their families a priority by investing in and shoring up the continuum of care for Montana’s aging population.

State budgets signal our priorities and values. This administration apparently is telling seniors that their health and safety, particularly in their final years, are not a priority nor valued.

Can you imagine receiving an eviction notice at any age? Now imagine receiving one at age 70 or 80 or even 90, and learning that you’re being kicked out of your home?

Nursing facilities play a vital role. They are essential to Montana’s health care system, providing on-site services for medically compromised residents. With closures, many elderly residents with significant medical needs must be relocated, sent home, or find alternative accommodations. In small towns, such as Red Lodge, Hardin and Malta, where nursing homes already have shuttered, there are few choices available.

While many seniors prefer to “age in place” the challenges of finding adequate medical and support care is are daunting. Home health aides are scarce and usually unaffordable for seniors (or their families) to hire for around the clock care. For many, family members no longer live nearby. The few senior-citizen apartments have long waiting lists. With 11 nursing home closures this past year alone, these tragic effects ripple throughout every community in Montana.

Is this issue going away? No. Montana’s fastest growing population demographic is the 65 and over age group.

Are there commonsense solutions? Yes. Nursing home costs of doing business along with reimbursements are complicated. Presently, Medicaid is the largest payer for nursing homes as well as at-home care in Montana. Nursing homes are subject to extensive government regulations to ensure quality care, adequate staffing levels for residents — directly impacting operating costs and the bottom line.

The state sets the Medicaid reimbursement rates for nursing home beds and it’s well documented that the current reimbursement rate falls significantly short of covering the actual costs of providing services. Covid added more costs along with inflation, workforce shortages, and the need to pay competitive wages for clinical care providers.

Right now, the Montana Legislature is making funding decisions for the next two years. A recent study commissioned by DPHHS recommended increasing Medicaid rates for nursing homes to close the gap between current reimbursement and actual costs of providing services. This gap cannot be tackled exclusively through “addressing inefficiencies,” nor can we afford to postpone responsible action until the next legislative session, as suggested the Gianforte Administration.

Now is not the time for reckless gambling with the well-being of Montana’s seniors and the worries of their families. The Legislature with the administration’s leadership should significantly increase Medicaid rates to ensure access to these critical health care services.

Kicking the can down the road is really a kick in the gut for Montana seniors and their families facing one of life’s most difficult decisions.

Kim Gillan is a former legislator from Billings (1997 to 2012). She served as Regional Director for U.S. Department of Health and Human Services, Region 8 and has worked in health care for many years.