'Why didn't they tell my family?' Family impacted a third time due to nursing home closures

Two of the three moves were the result of closures and one move came when their placement at Eagle Cliff Manor wasn’t a good fit.

Spurred on by historical discrepancies in Medicaid reimbursement and an unprecedented reliance on expensive traveling staff, 10 rural Montana facilities have been forced to close in 2022, accounting for about 15% of the state’s nursing homes.

Though rural facilities tend to have far more bed space than long-term residents, the fact that those facilities exist means locals can stay in their hometown or near to their family and loved ones. Every time a facility closes, dozens of elderly and disabled residents scramble to find other places to live, often further away from family.

Jensen, who has some learning disabilities, and Grudzinski have been fortunate to land placements in the same facility and in the same room each time they’ve had to move. Their luck may be due to Debbie Grewell’s fierce advocacy for the two women. Grewell is Grudzinski’s sister, and while they aren’t biologically related to Jensen, they have taken her into their family — Grewell has even set to work teaching Jensen how to swear.

“I’m your big old pain in the, what?” Grewell asked, grinning at Jensen. After a couple moments Jensen retrieved the word. She yelled out “ass,” and they both exploded with laughter.

“We hug, we laugh and I pull them out of the dumps,” Grewell said. “I’m here to pick up the pieces.”

The unexpected evictions from nursing homes and a looming sense of uncertainty has brought on high levels of stress and many tears for Jensen, Grundzinski, Grewell and her husband.

Forced to leave

When historical flooding hit Red Lodge in June 2022, residents were evacuated from Cedar Wood Villas, the only nursing home in the community. When the residents evacuated, they never dreamed they would only return to pack up their belongings.

Even though the facility didn’t sustain any flood damage, a recent assessment of the building’s infrastructure led leadership to close the nursing home in July 2022. There was no extra money in the budget to pay for the repairs and updates that would need to be completed to safely serve residents.

Most of Montana’s rural nursing home administrators are familiar with this feeling, knowing a leaky roof or a failed boiler could spell financial ruin ending in closure. And once a closure is announced, turmoil follows.

After spending most of a decade at Cedar Wood Villa, Jensen and Grudzinski’s belongings had settled into the nooks and crannies of their shared room.

But with plans to move residents to Eagle Cliff Manor in Billings Heights, both would need to downsize.

Jensen had endless collections that bordered on hoarding, Grewell teased. Grewell facilitated the sorting and ultimately the disposal of a lot of items, a process that was distressing for Jensen.

Without some of their loved possessions, Jensen and Grudsinski eventually moved into Eagle Cliff Manor, but the facility wasn’t a good fit. Within two weeks Grewell had found them a new placement at a more intimate nursing home called Beartooth Manor in Columbus.

“I’ve pushed really, really hard that they keep being roommates,” Grewell said.

“The girls,” as Grewell calls them, need each other. Over the years Jensen has developed a knack for understanding Grudzinski’s speech, which is muddled due to cerebral palsy.

Grudzinski laughs often and sometimes shouts profanities, demonstrating that she shares her sisters’ love for creatively formulated curse words. But, to those who don’t know her well, the words spill out in an array of loudly slurred sounds.

While Jensen has some intellectual disabilities of her own, she is able to keep an eye out for Grudzinski and helps her communicate with the staff at each new facility.

They have sounded the alarm bells for each other when help was needed.

But just as they settled into a routine at Beartooth Manor, Grewell received a voicemail from the nursing home administration. With no other warning, a final closing date had been set for January 2023.

The announcement was made public on Nov. 7, and the administration was pushing to have all residents rehomed before the holidays. The women spent only three months and five days at the facility before it was time to pack up their belongings a third time.

“They got on it so fast it made our head spin,” Grewell said. “I called the nursing home to talk to (Grudzinski) and she had no idea.”

Parkview Care Center in Billings welcomed an influx of residents overnight, and in the rigmarole of moving some loose ends caused residents to unravel.

Jensen eventually called her cousin to tell him about her new living arrangements, but it quickly became apparent that no one had contacted her family about the move.

“That was the hardest thing,” Jensen said, doing her best to hold back the tears. “Why didn’t (they) tell my family where we were moving to?”

Grewell made her way across the cramped room and sat next to Jensen as she cried.

“I don’t want to move again,” she said, letting the sobs go when Grewell hugged her.

Health care

Each time Grudzinski and Jensen move to a new community they have to find a whole new set of doctors to manage their health needs.

On top of cerebral palsy, Grudzinski has an enlarged heart, congestive heart failure, she’s had countless pre-cancerous polyps removed from her colon and a third of her stomach is in her diaphragm, causing severe reflux.

She’s supposed to be on oxygen at night, but nearly five days into her stay at Parkview Care Center the room had not yet been set up with an oxygen tank.

Because of the reflux, she can’t have chocolate, a dietary restriction listed in her chart. But during the interview with The Gazette, employees delivered afternoon snacks, leaving behind chocolate pudding for Grudzinski.

When Grewell noticed, she followed the employees down the hall, pudding cup in hand.

“It’s exhausting, making sure everyone’s needs are met,” she said. “No orders have been sent, no appointments have been made for a doctor to get to know Sharon.”

And the transition trauma has pushed Jensen to seek mental health support once again. Prolonged stress and heartache of being herded from one facility to another has prompted her to talk to a doctor about starting anti-depressants.

“All this and our governor (Greg Gianforte) doesn’t care,” said Karen Shelhamer, another of Grudzinski’s and Grewell’s sisters. “I voted for the fool, but I wouldn’t do it again.”

The governor’s administration has pointed to families to help care for elderly loved ones with in-home care services, as most Montanans would prefer to age in place, according to an AARP survey.

Difficult for administrators

The closure of Beartooth Manor came unexpectedly to everyone, even to Wendy Soulek, COO of the parent company Lantis Enterprises. When a handful of employees handed in their resignations, the loss of staff was enough to permanently close the doors.

Since the start of the pandemic, most health care facilities have had to rely on expensive agency workers, also known as travelers, more than ever before. It has become a necessary evil as it’s the only solution to the shortage of health care workers. Price gouging by these agencies and no Medicaid reimbursement for the expense has resulted in huge financial loss in nearly every medical sector in Montana.

In Columbus, housing prices are sky high, making it difficult to attract permanent workers, Soulek said. But there is no money in the budget for any more traveling staff, leaving Soulek with no choice but to close the facility.

When the paperwork for a voluntary closure is filed with the state, administrators are tasked with notifying staff, then families, helping them identify next steps. They’re expected to schedule informational meetings with residents and their loved ones and then help everyone pack-up their belongings and make dozens of arrangements.

The process is both hectic and emotional, said Christy Preece, administrator at Beartooth Manor.

“There’s not a lot (of residents) moving in with families because once you get to this point, it’s usually the point where families can’t take care of them,” Preece said.

Residents with dementia especially struggle to understand the flurry of changes that follow a voluntary closure, and the process can be traumatizing for the resident and heartbreaking for those devoted to caring for them.

In an effort to manage the dementia behaviors in one resident in particular, all of the staff at Beartooth Manor developed a special relationship with her.

The woman was one of the first to be transported to a new facility, and as Preece was getting ready to head back to Columbus she passed the resident’s window.

“She called me in to where she was eating lunch…and she told me she was done eating, she’s ready to go home now. She wanted me to take her home,” Preece said. “Several of them wanted to just go (home). That’s the most heartbreaking because then you have to tell them no and it’s like telling a little kid.”

The Parkview Care Center is nearly twice the size of Beartooth Manor. The thought of removing vulnerable residents from a comfortable environment and placing them in the hands of strangers borders on unconscionable for Preece, but there are no other options.

“It’s heartbreaking to watch them,” Preece said. “And yet it all could have been avoided, potentially.”

Disappointment

The first day residents were moved from Beartooth Manor to Parkview Care Center in Billings, the scene at the sidewalk’s edge was a poignant one.

“When I went to leave that day, the bus was unloading boxes and there were some people sitting in wheelchairs and the look on their faces was total confusion, total despair,” Grewell said.

Both Grewell and Shelhamer have turned to Gov. Gianforte, their candidate of choice in the 2020 primary elections, hoping he’ll make nursing homes a priority. Instead, Shelhamer and Grewell’s disappointment grows, fearing Gianforte’s administration will squeeze Medicaid services.

“Old people aren’t (Gianforte’s) concern. He’s got money. He’ll never have to be in one of these nursing homes. We’re on social security, my husband and I, that’s it. That’s a limited income. How can you make ends meet with what’s going on right now?” Shelhamer said. “And then these people are treated like this, I mean, where’s the dignity?”

While it’s true most Montanans would prefer to age in place, Grewell cannot care for Grudzinski in her home. Grudzinski is wheelchair bound and immobile, meaning she requires a lot of physical support from getting into bed to toileting. Not only is Grewell’s home not wheelchair accessible, but Grudzinski’s needs are more than Grewell can manage safely.

And the same is true for Shelhamer.

In a recent email exchange with the governor’s office, The Gazette requested an updated comment on his perspective on the future of nursing homes. Gianforte’s press secretary, Brooke Stroyke, responded.

“With more and more folks electing to age-in-place in their communities, Gov. Gianforte continues to believe that the State of Montana, and the long-term care industry, must adjust to meet aging Montanans where they’re at,” she wrote. “To ensure there is not a gap in services as the industry shrinks due to falling demand, DPHHS is working to build up services for Montanans who choose to age-in-place.”