Ending Involuntary Commitments Could Shift Burden of Dementia Care to Communities

Health department officials anticipate having to transfer two dozen patients from the Montana State Hospital to another state-run facility if a bill to end involuntary commitments passes. By Keely Larson | KHN-UM Legislative News Service

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 Rep. Jennifer Carlson, R-Manhattan. 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...