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Ending Involuntary Commitments Would Shift Burden of Dementia Care to Strapped Communities


HELENA, Mont. — State lawmakers from both parties have shown support for a plan to stop the practice of committing people with Alzheimer’s disease, other types of dementia, or traumatic brain injuries without their consent to the troubled Montana State Hospital and instead direct them to treatment in their communities.

But a budget estimate attached to the proposed legislation raises questions about whether Montana communities, many of which are still reeling from past budget cuts and insufficient Medicaid reimbursement rates, will have the capacity to care for them by July 2025, when involuntary commitments would cease under the plan.

Health department officials essentially acknowledged as much in the fiscal note accompanying House Bill 29, sponsored by Republican state Rep. Jennifer Carlson. Health officials wrote in the unsigned fiscal note that 24-hour skilled nursing facilities are often the only appropriate settings for such patients, and that few of those facilities “are willing to take these individuals as an alternative placement to the Montana State Hospital.”

As a result, health department officials anticipate having to transfer patients with a diagnosis of Alzheimer’s, other dementia, or a traumatic brain injury from the Montana State Hospital to the state Mental Health Nursing Care Center, a long-term, 117-bed residential facility in Lewistown for people with mental health disorders, if the bill passes. The health department says the facility is for people who “require a level of care not available in the community, but who cannot benefit from the intensive psychiatric treatment available at Montana State Hospital.”

Department officials expect to move 24 patients from the state hospital to the Lewistown facility between fiscal years 2025 and 2027 if the bill passes. The cost of caring for those patients at the Lewistown facility would start at $181,062 per patient, per year, for a total cost of about $10 million over three years. The beds they vacate at Montana State Hospital would likely be immediately filled by other patients, so there would be no expected cost savings there, according to the fiscal note.

Department of Public Health and Human Services spokesperson Jon Ebelt did not immediately comment on the document outlining the expected transfers.

Carlson said she was surprised health department officials expected to relocate patients to another state-run facility when the point of the bill is to facilitate community treatment.

But, she added, that cost would be lowered if the state raised its Medicaid reimbursement rates. If the state raised its reimbursement rates to nursing homes to $300 per patient, per day, from its current $208 rate, those same 24 patients could end up costing the state a lot less, she said.

Carlson said some dementia patients are committed to the state hospital as a last resort because there are no other options for providing the intensive care they need.

“But that excuse is not good enough for me,” Carlson said. “There should be somewhere else for them to go.”

Carlson’s bill is just one of several measures to overhaul operations at the Montana State Hospital.

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