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The five Montana nursing homes on a list of candidates for a federal program meant to improve facilities with a “persistent record of poor care” have been found by inspectors to put residents at risk of harm and to fail to stop physical, emotional and sexual abuse.

The nursing homes are among more than 400 nationally that are candidates for the federal Special Focus Facility program, meant to improve care. The program is part of the Centers for Medicare and Medicaid Services (CMS), which funds nursing homes and inspects them for health, safety and other criteria.

The names of the 88 nursing homes around the country that are part of the SFF program were public before Monday. What was released this week in a report issued by U.S. Sens. Bob Casey, D-Pa., and Pat Toomey, R-Pa., are the 435 candidate facilities that also have problems but are not a part of the program because of limited resources at CMS, according to the report.

The five nursing homes in Montana on the candidate list have all had at least one finding of immediate jeopardy in inspections going back to 2015. Immediate jeopardy is a situation where a facility's problems caused or are likely to cause serious injury or death to a resident.

Federal reports show nursing homes make corrections to address the problems found in annual inspections and inspections triggered by complaints. But the inspectors continue to find deficiencies in subsequent inspections. Some nursing homes pointed out federal regulations changed significantly in recent years, which has made compliance more difficult.

Still, inspections show serious lapses in care. At Big Sky Care Center in Helena, a resident who was on oxygen died in May 2018 several days after catching on fire while smoking and receiving second-degree burns. An inspection found the resident was not supervised by staff when she caught fire.

The facility, which has 108 certified beds, has had 21 complaints over the last three years resulting in a citation. In the last year, inspectors found 30 deficiencies; the average in Montana is 8.4 per inspection. 

In an email, the corporation that operates Big Sky Care Center and Heritage Place, another facility in Kalispell that is on the candidate list for the Special Focus Facility program, said it is working to improve care. Kismet took over both facilities in the fall of 2018. 

“It was a rapid transition due to the imminent bankruptcy of the prior operating company. At this time, our facilities have cleared their surveys with all corrections approved,” the email reads. “We are working with the medical community and communities at large to improve and create sustainable quality of care.”

The email says Kismet has hired new regional and local administrators and clinical leadership, and is working to improve facilities, provide additional training and more.

“It is not an easy road, but we will get it done. We appreciate the support and guidance we have received to date. Turnaround situations are never easy yet we believe we have the right teams in place to make it happen!” the email reads.

The 140-bed Heritage Place in Kalispell had 15 deficiencies in the last year. One report said a resident told inspectors they were called "wicked" by a staff member for having to go to the bathroom often during the night. An inspection also shows residents suffered weight loss because employees did not adequately intervene.

“Resident #15 had lost 45 pounds in six months, with no preventative interventions implemented, to include interventions to assist with pressure ulcer healing,” the inspection reads.

One of the most severe findings at Heritage Place was during an August 2017 inspection, which found a resident sexually abused four others who lived there, including one who cried loudly after being groped.

The Montana Mental Health Nursing Home in Lewistown is also on the candidate list for the SFF program. It is run by the Department of Public Health and Human Services. The facility is home to residents who have a co-occurring mental illness and have also been denied entrance into at least three other nursing home facilities or transferred from another state facility.

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A February 2018 inspection, as reported by the Great Falls Tribune, documented a serious situation involving verbal, physical and sexual abuse among residents that resulted in a finding of immediate jeopardy for the facility.

A total of 22 deficiencies were found at the facility from May 2018-April 2019. The most recent survey at the facility in April found four deficiencies, which have all been addressed in a plan of correction accepted by CMS, the department said Tuesday. Montana Mental Health Nursing Home is licensed for 117 beds, which would require double occupancy. It typically is home to 80-95 residents.

“High-quality patient care is the No. 1 priority for the patients we serve at the Montana Mental Health Nursing Care Center. We are committed to immediately addressing deficiencies and continually improving the quality of care,” department Director Sheila Hogan said in a statement Tuesday.

Starting in 2016, CMS began to phase in revised requirements for long-term care facilities. It is the most comprehensive set of rule changes in 25 years, with most of the revisions made to abuse and grievance policies. For part of 2018, the state paid a consultant $70,000 a month to help it navigate the new rules, the Great Falls Tribune reported last year.

The Awe Kualawaache Care Center in Crow Agency is also on the list of candidates for the SFF program. A 2018 inspection found the facility hired a staff member with a criminal record including assault who was accused of sexually abusing a resident. The facility had seven deficiencies in the last year.

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A person who answered the phone Tuesday at Awe Kualawaache Care Center said the facility had no comment.

The fifth Montana facility that's a candidate for the SSF program is listed only as "Deer Lodge" in CMS records. Genesis HealthCare is listed at the address provided in CMS documents, 1100 Texas Ave., in the town of Deer Lodge. The facility at that address did not return a message asking for clarification or comment Tuesday.

The facility at 1100 Texas Ave. had five deficiencies in the last year. Findings of immediate jeopardy were found in two 2017 inspections, including a failure to assess signs and symptoms of a resident's medical condition and pneumonia that led to a hospitalization and death.

A sixth Montana facility, Crest Nursing Home in Butte, is already a part of the Special Focus Facility program. A CMS document shows it has been a part of the program for 23 months and categorized it as a facility that has not improved.

Staci Bercier, administrator for Crest, said Tuesday she has been frustrated with news coverage of the Special Focus Facility program. She said there's a lack of clarity about what puts a nursing home in the program and how to get out of it. Bercier became administrator after Crest was put into the program, and pointed to a lack of any complaint inspections at the facility, which are triggered by residents, their families or others, in the last two years as a sign of improvement.

Crest had nine deficiencies in the last year, all at either a level one or two out of a possible four. The last time the center had a finding of a level three was in 2017 and unlike the five nursing homes on the candidate list in Montana, it has not had a finding of immediate jeopardy since at least 2017. Results from a May 2 survey were not available Tuesday, however.

"We are doing way better," Bercier said Tuesday.

Bercier said it's unclear to her why some nursing homes are put in the program and others aren't. "There is no strict criteria anybody can find. It's subjective," she said. "If you look at nursing homes that are scoring far worse than us in the surveys ever year, it's not cut and dry."

Bercier said the new regulations CMS has phased in are "extremely burdensome" and more punitive than before.

"I think it's very frustrating to be in a role where we're responsible for peoples' lives and well-being, and get accused of not doing well and it's unclear how to get off the list," Bercier said.

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