South Dakota Nursing Home Residents Need Less Help; Staff Need More Time

The Department of Justice says South Dakota is violating the Americans with Disabilities Act by failing to provide home- and community-based care that could keep thousands of South Dakotans form losing their ability to live in their own homes. The DOJ’s May 2 letter to Governor Dennis Daugaard cites multiple sources that identify further problems within South Dakota’s nursing homes.

Of particular interest is the Kaiser Family Foundation’s August 2015 report on “Nursing Facilities, Staffing, Residents and Facility Deficiencies, 2009 Through 2014.” Table 5 in the main report supports what DOJ is saying about South Dakota placing in nursing homes people who don’t need to be removed from their homes. That table rates the how much help nursing home residents need with eating, going to the bathroom, and moving from bed to chair to standing. South Dakota’s composite score on those scales is well below the national average; only three states—North Dakota, Iowa, and Kansas—have lower scores. That need score appears to reflect the thousands of residents the Department of Justice says could live in their own homes with less assistance.

Supplementary Tables 16–18 further support this conclusion. A significantly lower percentage of South Dakota nursing home residents receive ostomy care, injections, intravenous therapy, and tube feeding. On the contrary, Table 19 shows a higher percentage have bladder incontinence. However, Table 20 shows a lower percentage suffering from bowel incontinence. Overall, these needs suggest the effects of more residents who don’t require the round-the-clock care of a nursing home.

Table 6 shows nursing hours per resident-day—i.e., the amount of time that one staff member could be assigned to spend with each resident each day. In 2014, South Dakota’s nursing homes offered 1.19 licensed nurse hours per resident-day and 3.61 total nursing staff hours. Those are the lowest hours in the nation. The national averages are 1.60 and 4.03. The Kaiser report says experts recommend 1.30 licensed nurse hours and 4.55 total nursing staff hours to protect nursing home residents from jeopardy and harm.

According to Table 9, in 2014, South Dakota had the 14th-highest rate of certified nursing facilities receiving deficiencies for harm or jeopardy of residents; South Dakota’s deficiency rate has been higher than national averages in five of the last six years.

With the third-highest occupancy rate in the nation (91.74%, compared to the national rate of 82.28%), South Dakota nursing homes must stretch their staff more than facilities in other states, apparently lowering the overall quality of care. If state government reconfigured its policies and Medicaid reimbursements to support home- and community-based care, those thousands of residents committed to nursing homes in violation of the ADA could go home, getting better care, saving the state money, and allowing nursing home staff to provide more care to the residents who really need it.