BILLINGS, MT — Federal health inspectors identified five deficiencies at Yellowstone River Nursing and Rehabilitation during a complaint investigation completed on November 19, 2025, including a citation for failing to provide required behavioral health care and services to residents.
Behavioral Health Services Found Lacking
The Centers for Medicare & Medicaid Services (CMS) cited the Billings facility under regulatory tag F0740, which requires nursing homes to ensure each resident receives necessary behavioral health care and services. Federal regulations mandate that facilities not only identify residents with behavioral health needs but also deliver appropriate, individualized interventions.
The deficiency was classified at Scope/Severity Level D, indicating an isolated incident where no actual harm was documented but inspectors determined there was potential for more than minimal harm to residents. This classification means that while no resident experienced a documented adverse outcome at the time of the inspection, the gap in care created conditions where harm could reasonably occur.
The behavioral health citation was one of five total deficiencies identified during the complaint-driven survey, signaling a pattern of regulatory non-compliance that prompted federal scrutiny.
Why Behavioral Health Care Matters in Nursing Homes
Behavioral health services in long-term care settings encompass a broad range of interventions, including mental health assessments, psychiatric medication management, counseling, and therapeutic programming for residents experiencing conditions such as depression, anxiety, dementia-related behavioral symptoms, and adjustment disorders.
Research consistently shows that nursing home residents experience higher rates of depression and anxiety compared to community-dwelling older adults. An estimated 50 to 60 percent of nursing home residents have some form of cognitive impairment, and many require specialized behavioral health interventions to maintain their quality of life and functional status.
When facilities fail to provide these services, residents may experience worsening psychiatric symptoms, increased agitation, social withdrawal, and a decline in their ability to participate in daily activities. Untreated behavioral health conditions can also lead to inappropriate use of psychotropic medications, which carry significant risks for older adults including falls, sedation, and cardiovascular complications.
Federal Standards for Behavioral Health
Under federal nursing home regulations, facilities are required to ensure that residents who display or are diagnosed with behavioral health conditions receive proper treatment. This includes conducting comprehensive assessments, developing individualized care plans, and coordinating with qualified behavioral health professionals when needed.
The standard of care requires facilities to:
- Screen residents for behavioral health conditions upon admission and on an ongoing basis - Develop person-centered care plans addressing identified behavioral health needs - Provide or arrange for appropriate psychiatric or psychological services - Monitor residents for changes in behavioral health status - Train staff to recognize and respond to behavioral health needs
Facilities that fall short of these requirements risk not only regulatory citations but also measurable declines in resident well-being and overall care outcomes.
Facility Response and Correction
Yellowstone River Nursing and Rehabilitation submitted a plan of correction following the inspection, and the facility reported that corrective measures were implemented as of December 14, 2025 — approximately 25 days after the inspection findings were issued.
The complaint investigation that triggered the survey suggests that concerns about care at the facility were raised by a resident, family member, or other party prior to the inspection. CMS conducts complaint investigations when it receives allegations of potential regulatory violations, and these surveys are unannounced to ensure inspectors observe typical facility operations.
Industry Context
Behavioral health deficiencies remain a persistent concern across the nation's approximately 15,000 Medicare- and Medicaid-certified nursing homes. Staffing shortages, particularly among mental health professionals willing to work in long-term care settings, contribute to gaps in behavioral health service delivery.
The five deficiencies cited at Yellowstone River Nursing and Rehabilitation place the facility among those requiring corrective action to meet federal minimum standards of care. Families and residents can review the facility's full inspection history, including all five deficiency citations, through the CMS Care Compare database or through the detailed inspection report available on this site.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Yellowstone River Nursing and Rehabilitation from 2025-11-19 including all violations, facility responses, and corrective action plans.
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