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Huron Nursing Home Closes; Where’s the Alarm in Pierre?

While Governor Kristi Noem fabricates a crisis out of protests that haven’t happened yet, a Huron nursing home is closing. The 36 residents who will lose their place to live by May 10 and the 45 workers who will lose their jobs do more clear and present economic damage than anything Governor Noem has substantiated about someday-maybe Keystone XL pipeline protests.

And this nursing home closure isn’t George Soros’s fault; it’s Kristi’s fault, and the fault of legislators who have taken no action:

In a press release, the Violet Tschetter Memorial Home’s board of directors said that the cost of resident care has greatly exceeded the state reimbursement under the state’s medicaid program that many of its residents relied on.

…”This news does not exist in isolation. Many facilities like ours are struggling in South Dakota and elsewhere,” the memorial home’s statement said. “Our seniors need — and deserve — quality care that provides dignity and comfort, but the programs many older people rely on do not cover the cost of that care. Our hope is that our elected officials will find in this announcement common cause to address this problem for the benefit of our state and its residents.”

The South Dakota Health Care Association distributed the news to outlets around the state, and said it’s the sixth nursing home closure in the last three years.

“We are in the midst of a long term care funding crisis,” SDHCA Executive Director Mark. B. Deak said. “For years, Medicaid has not been properly funded and we are unfortunately now seeing the consequences. It is critical that the legislature and governor act urgently to address this crisis” [“Huron Nursing Home to Close After 59 Years,” Mitchell Daily Republic, 2019.03.07].

Tyrant Noem and her Legislative stooges can pass a fake-emergency bill to please a corporate fascist pipeline builder in less than 72 hours. But they can’t muster any such ambition to rescue South Dakota’s old folks and their care providers from a real and long-standing financial crisis.

Maybe old folks should occupy the Governor’s mansion. Surely Governor Noem can find room.

28 Comments

  1. Kal Lis 2019-03-07

    This post seems to ignore the fact that one can safely ignore the elderly because folks in wheel chairs are not a threat to peacefully protest at a pipeline site. As a side question, if those who have walkers show up at a pipeline protest, will they be charged with rioting if they conceal carry while they protest?

    Snark aside, at least this session has shown that compassionate conservatism, if it ever existed, has gone the way of the dodo, killed by calloused individuals just for the heck of it.

    The nursing home situation should have been at the top of the legislative session’s priority list instead we got the wall resolution, concealed carry for anyone, and a metric crapton of other stupidity while those who need the social safety net see it destroyed.

  2. David Newquist 2019-03-07

    But the legislature has laid the foundation for gas ovens and has started designating its useless eaters.

  3. Scott 2019-03-07

    Our legislators seem to have no ideas of how to fix problems, so they spend time creating issues out of nothing or rehashing the same issues. Our legislators should be ashamed of themselves. Nursing homes are just a part of the health care crisis in this state. Rural EMS services are close to closing in many communities. Nurses are in short supply statewide.

  4. Roger Cornelius 2019-03-07

    This has been a total crappy day in terms of the news.
    First I just learned that Paul Manafort, Trump’s campaign manager, only received a 48 month prison term for all his financial fraud. Mueller’s team was asking for 19 to 24 years.
    Next I learn that South Dakota’s redneck legislature has all but stifled American Indian voices when it comes to protests.
    And finally there is another nursing home being forced to close, disrupting the lives of the elderly and disabled as well as many losing their jobs.
    John T. over at the Constant Commoner has properly called this legislative session a “dud”, truer words haven’t been spoken.
    The only good thing coming out of this legislative session is that everyone can now carry a gun, the old folks and Indian protesters may need them.

  5. Cory Allen Heidelberger Post author | 2019-03-07

    Stace and Kristi should hand out free guns to those old folks on their way out the door in Huron.

  6. Jenny 2019-03-07

    Roger, move to MN. I would be very depressed living in South Dakota and having this nut-filled legislature representing me. Cory, I still think you and Stace would work well together in Pierre. Who knows, you might even be able to calm him down with his gun obsession.

  7. Cory Allen Heidelberger Post author | 2019-03-07

    Not that I am trying to get rid of any of my friends, but Jenny, I will support any move that keeps my friend Roger happy and healthy. And it’s darned hard to be happy in a state run by Matt McCaulley and TransCanada.

    I would enjoy a chance to work with Stace in a professional setting. I will never convince him that guns are mostly useless and not worth all the time he has expended this Session on that topic instead of on nursing homes and other practical problem solving, but I get the sense I could find some common ground with him and his mugwumps and rally a few more votes to overturn Noem’s nuttiness than the current Legislature does.

  8. Jenny 2019-03-07

    There you go, SD Dems, focus on winning the next elections on fixing the nursing home crisis as your number one issue. Since the Republicans obviously don’t care about the elderly, make that part of your platform. Those elderly are the biggest group of voters.

  9. Kal Lis 2019-03-07

    I hate to go all realist, but before we start handing out Coca Colas and teaching everyone to sing Kumbaya in perfect harmony, there are a few inconvenient facts.

    The same people will be in Pierre in January 2020 because the next election isn’t until 2020. The concealed carry issue will morph into eliminate all gun free zones issue.

    Another 5 or 6 nursing homes will be in trouble or have closed before the next election. The 2020 election will be about redistricting and little else unless the economy goes totally south. If that happens, Noem will still see to it that no money goes to nursing homes.

  10. Debbo 2019-03-07

    I live in old people housing in Minnesota. You have to be 63+ and low income to move in. Among most of my neighbors there is a fear of nursing homes and massive denial about someday living there. “I’m never going to one of those. I’ll die first.”

    Maybe that denial plays a role in why oldies vote SDGOP. But I’d think the middle aged children who are faced with moving their parents into a nursing home would be more demanding.

    When the nursing homes have all closed due to SDGOP indifference, they’ll be looking for ice floes to put the oldies on. Problem is, due to SDGOP enabled global warming, the ice will be melted. Now that’s a self-inflicted wound.

  11. leslie 2019-03-08

    Trump—emergency to privatize imprisoned immigrants—Kristi—emergency against protestors of tar sands pipeline.

    Trump—illegal campaign funding (you name it)—Kristi—illegal campaign funding (Sioux Falls Trump event costs)

    Trump—ignoring welfare of most vulnerable (kidnapping children)—Kristi—ignoring welfare of most vulnerable (elderly in nursing homes).

    Trump—nepotism—Kristi—nepotism—Rounds—nepotism—Daugaard—nepotism—McConnell—nepotism.

    Trump—comb over orange dye job—Rounds—comb over brown dye job.

  12. Jenny 2019-03-08

    kal, I don’t expect the Republicans to do anything about the nursing home crisis next year in the legislature either. Potty bills and gun bills will be more important instead to the super majority.

    Aren’t you so proud of your legislators, South Dakota.

  13. jerry 2019-03-08

    Ms. Debbo, gave a whimsical post on the way it is. NOem and her blind faith legislators, have the perfect solution to the nursing home crisis…die quickly. Dennis Daugaard started this hateful trend with the nursing homes when he was first anointed governor. His Protestant reasoning was that old folks just live too cushy of lives in these homes and by golly, he was gonna take away their applesauce. NOem and her cronies saw his success to keep the pressure up and here we are.

    Here is an idea, make nursing homes CAFO like. Put all residents under one central location, say Pierre. Bring in a bunch of Mexicans to take care of the residents (while paying them much less than you would white folks from South Dakota) and collect the money from the federal government. The State could also get into the funeral business as well with this steady stream, by forcing residents to buy Final Expense Plans (sold under the banner of the Mike Rounds agency) to have economic development, with the state as the beneficiary. Also, in the Protestant mind, there is no reason these residents should not have to work. We are so flush with work here that they can be trucked to fast food places to earn their keep that would again be economic development.

  14. Cory Allen Heidelberger Post author | 2019-03-09

    Jenny, would lifting the cap on nursing home beds by part of the solution? I have heard that the state has an interest in limiting the number of beds so that we don’t overbuild capacity and increase costs to the state… but would some more market competition bring costs down? Or are Medicaid reimbursement rates and low wages the overarching problems?

    The latter two items will require money to solve, plain and simple. Do Democrats dare make some revenue and spending increase the central part of their campaign? Is the nursing home crisis sufficiently intense to motivate voters to accept a tax hike the way they did in 2016 for a half-assed teacher pay solution?

    Actually, the 2016 tax increase for teachers and the 2015 tax increase for roads should be instructive for the majority party. Republicans can do whatever they want in Pierre and not get voted out… or at least they haven’t hit the threshold of hypocritical action that makes voters change their habits. The fact that SD Republicans have suffered no ballot-box implications for their actions suggests that if Republicans really wanted to solve the nursing home funding crisis, they would.

    For a moment I thought that maybe strategy here will be like the Republican strategy on teacher pay: let the problem linger for a couple generations, see if it goes away. One would think that the nursing home crisis will go away once the baby boomers die off… but it would seem that even after that demographic transition, our low birth rate will still leave us with a larger proportion of old people requiring care and not enough young workers to provide that care, leading to higher costs and an ongoing need for better Medicaid reimbursement.

  15. happy camper 2019-03-09

    Heck yeah, this is something that would pass if given a vote by the people, or maybe if everyone started calling their representatives. It’s egregious. Are they looking away on purpose? In a cold view wealthy people are less affected cause they’ll remain private pay someone told me Sandford or someone is building more are they exempt some way from the moratorium? Maybe they’re only adding private pay but it takes private pay to support the deficit even the most responsible people can run out of money given the cost 50 grand a year or so. It just seems unexplainable why they haven’t addressed this issue (although it is in Noem’s budget).
    “Governor Noem’s proposed budget does include a boost in the reimbursement rate for nursing homes, as well as grants for the facilities. Nursing Home officials have said those actions are encouraging, but not a full solution to the state’s crisis.”
    https://kelo.com/news/articles/2019/mar/07/south-dakotas-nursing-home-crisis-worsens/

  16. bearcreekbat 2019-03-09

    Spoiler alert – long comment ahead.

    The financial inability of private providers to survive because of inadequate public funding for indigent elderly is certainly a pressing problem. Under current SD law, however, counties still have the statutory obligation to provide adequate care for indigents, which would obviously include the indigent elderly.

    See SDCL 28-13-1:

    Every county shall relieve and support all poor and indigent persons who have established residency therein, as that term is defined in §§ 28-13-2 to 28-13-16.2, inclusive, and who have made application to the county, whenever they shall stand in need. Each board of county commissioners may raise money by taxation for the support and employment of the poor. If a person is receiving benefits from the Department of Social Services, the board of county commissioners may determine if he is eligible for county relief.(emphasis added)

    Several statutes authorize a variety of methods for a county to meet this statutory obligation to provide for the elderly indigent. See, e.g., SDCL , 28-5-24 and 28-18-6.

    For many years Medicaid nursing home funding has helped counties avoid spending local property tax dollars to meet these obligations. If Medicaid reimbursements have now become inadequate to cover the cost of private nursing homes, it would seem the counties have one of at least two options:

    First, a county is specifically authorized by statute to provide supplemental funding to the nursing home in an effort to cover the shortfall. State authorized funding, however, appears to be limited to $20,000 per year (SDCL 28-18-6), hence the county would need to look to increasing or repurposing existing property tax revenue to make up any further shortfall to comply with the statutory mandate imposed by SDCL 28-13-1.

    Second, a county could fund and build public facilities designed to comply with its statutory obligation to “relieve and support all poor and indigent persons . . ., whenever they shall stand in need.” I think these facilities used to be be refered colloquially to as the “poor house” or the “old folks’ home.”

    As for private nursing homes, the immediate solution would seem to be to stop accepting any patient that cannot pay the necessary cost of care.

    Private nursing homes that have built their business models on anticipated adequate Medicaid funding would still seem to have another option before closing: Seek a judicial remedy (perhaps a writ of mandamus) against a county on behalf of any indigent elderly who lacks sufficient personal resources to pay the cost of necessary nursing home care.

    A private nursing home likely has standing to pursue the 1st option, just as hospitals have standing to sue the counties for the cost of medical care, and if enough pressure is placed on counties, perhaps that pressure might actually transfer to local legislators to address the problem by bringing Medicaid funding back to the level sufficient to again keep counties off of the financial hook.

    Of course none of these remedies would assist either spouses or children who have the financial resources needed to pay the cost of care for a spouse or parent in need of nursing home care. See, SDCL 25-7-1 and 25-7-27. In other words, healthy spouses or children could no longer use planning strategies to obtain Medicaid eligibilty by impoverishing a sick spouse/parent by transferring or selling his or her property and resources to the adult children.

  17. happy camper 2019-03-09

    That is very interesting BCB, the problem may be laws on the books are not always enforced. Our county had a comprehensive drainage ordinance they never followed, for example, fast forward and they are completely repealing them and telling the farmers to fight it out in court. This being a state law perhaps they can’t get around it if someone takes them on unless this law is so antiquated the state needs to change it, after all they’re the ones who restricted how high property taxes can go. It’s odd none of these nursing homes have pursued this option thus far. Financial clawbacks follow Federal law the two you referenced have no specifics. If a family’s estate can support the parents they are likely to keep assets in the parent’s name rather than gift early but now that estate tax exemptions are so high people of moderate wealth may find it beneficial to give away assets before death and nursing care to avoid any risk of losing it to nursing home costs (although they won’t get stepped up value). People are doing the math you can bet on it, and their lawyer helping them make the decision that’s in their family’s best interest. Long term coverage has turned out not to be a great answer. The vulnerable are already suffering it will probably get worse unless the state steps up and takes responsibility.

  18. mike from iowa 2019-03-09

    Medicaid is a federal/state program, mostly funded by federal taxes and is dying a slow deliberate death due to Russia red pols from Russia red states who are doing their damndest to kill this and other “indigent friendly” programs.

    Without allowing poor and elderly people to die without care, pols will have to put on their big boy britches and collect necessary tax revenues to fund the government as per the constitution. If they refuse, they need to be put out to pasture with no pensions so their golden parachutes can help fund the government they refuse to fund.

  19. bearcreekbat 2019-03-09

    happy, arguably if Medicaid took care of the cost of a nursing home there would be no need to look to County Poor Relief laws, and it appears that in the past this was the case. As lack of state funding for Medicaid needed to keep up with the cost of nursing home care becomes more of a reality, implications for our counties have changed.

    I too am surprised that nursing homes haven’t resorted to the courts to enforce county obligations. During the 1970’s, 80’s and 90’s local hospitals started suing the counties for reimbursement of the costs of medical care and were, for the most part, apparently successful.

    In the 1980’s a class of poor indigents sued Pennington County commissioners to require even handed and proper dispensation of County Poor Relief assistance to indigents and obtained a satisfactory settlement of the litigation. This resulted in the adoption of enforcable, meaningful written guidelines for relief. Not long afterwards Minnehaha and some other larger counties decided to adopt written guidelines, perhaps to avoid another class action lawsuit, and sometime after that the state adopted state-wide eligibility guidelines.

    I haven’t found anything to confirm this history on Google, but to the best of my recollection of the times I believe this is an accurate representation of some of the more recent history of the Poor Relief program. As always, I am open to, and invite, correction if I have erred in some way. Bottom line, this history indicates that this law is not dormant or dead from non-use.

    It is my understanding that a frequent selling point for estate planners is the idea of developing a plan to transfer assets out of an elderly person’s estate to shift the cost of long term care to Medicaid. Such estate planning doesn’t seem to affect or weaken the statutory family obligation to support a spouse or parent. Nevertheless we don’t seem to read or hear a lot of public news or information about that oibligation from estate planners, nor public reports of enforcement. This may be because many of the families that hope to use Medicaid would be unable to meet other expenses, such as college costs for kids, retirement savings, vacations, newer cars, mortages on mid-range housing, etc, if they had to devote a substantial portion of their income and resources to supporting a parent. I assume more wealthy individuals often don’t look to Medicaid, although I again could be mistaken.

  20. happy camper 2019-03-09

    There might be reasons nursing homes are not using the law. Perhaps they don’t want to alienate their own county by insisting they pay more taxes, especially when residents are not always from within their own county. As it is nursing homes need charitable support to survive, or so I am told, but with for-profit nursing homes entering South Dakota, why should they receive grants and additional support? How much does Medicare Planning affect nursing home costs? Does the Legislature feel too many families are giving away assets and refusing to pay their own way, so they feel justified in not raising the daily rate? It seems there are some dynamics we do not understand, but these direct questions are entirely valid to be directed toward our representatives.

  21. jerry 2019-03-09

    South Dakota has a look back period to see if assets were transferred to be able to go on the Medicaid. South Dakota also put into place Partnership programs https://ltcpartnership.sd.gov/ that cover long term care for a period certain to protect assets before utilizing Medicaid. Most generally the life expectancy for nursing homes is a 3 year average, unless the person has cognitive impairment or Alzheimer’s Disease, then they can last for years. Many folks now in nursing homes are mental patients and disabled that the state should be taking care of in the first place. It seems the Daugaard outfit came up with the plan to put these folks in nursing homes rather than in state run facilities.

  22. happy camper 2019-03-09

    So what is that thing Jerry? A Long Term Policy usable only in the state of South Dakota? So they want to get the burden off their back, but what about these people who have worked at the grocery store their whole life, or whatever, been responsible, but don’t have the money for long term care???
    “Currently, Partnership policies are available from the participating insurance companies which are authorized by the South Dakota Division of Insurance to market and sell these policies. The State of South Dakota does not sell Partnership policies, they administer and monitor the Long-Term Care Partnership Program.”
    “While the South Dakota Long-Term Care Partnership Program allows for the exchange of policies, it is still up to each insurer as to whether they offer exchanges to their insureds.”

  23. Kal Lis 2019-03-09

    Thanks for the legal research BCB.

    The point you touched on about paying for kids’ college or parents’ nursing home care is something that elected officials at all levels in SD want to overlook because it totally destroys the “everything is rosy and we all live the great life” narrative that they use when they try to bring businesses to the state by touting low wages and low taxes.

    Meanwhile, South Dakota workers do an honest day’s work for a less than honest day’s pay and then have to worry about their kids trying to get out from under a mountain of college debt and deal with their parents being in a nursing home. The thought of actually being able to enjoy a few golden years of their own becomes an ethereal dream.

    btw Jenny, I am jaded enough to expect the South Dakota legislature to pull the rug out from under the worst off, so I’m not sure what emotion I feel when I see them ignoring important issues.

  24. jerry 2019-03-09

    Partnership plans are available in several states under this federal program http://www.aaltci.org/long-term-care-insurance/learning-center/long-term-care-insurance-partnership-plans.php “Here’s an example. Stephanie buys a PQ policy and needs care one day. Her policy pays out $150,000 of insurance claim benefits. Stephanie earns a Medicaid asset disregard that allows her to keep an additional $150,000 over the asset level she would otherwise have to meet in order to be eligible for Medicaid coverage. The Partnership Program also protects those assets after death from Medicaid estate recovery.”

    South Dakota has a very very effective estate recovery program. If you receive Medicaid for nursing home coverage, you can bet when you give up the ghost, the state recovery boys will be making damn sure you didn’t transfer anything within the look back period.

    The folks who cannot afford long term care, qualify for Medicaid…after they impoverish themselves. You cannot receive Medicaid without a financial statement of need that you file with the State of South Dakota. At that time, they see if you have assets of any kind, including life insurance that has cash value. Getting Medicaid is like getting disability, it is not easy to do. All the crap you hear about welfare queens was pulled out of Ronald Reagan’s lying arse.

    So now, these folks in Huron are not all Medicaid patients. Many are private pay that have a long term care policy. For them, they might be able to find another home of choice. For the poor, who knows what the benevolent republican has in mind. Medicaid patients have to go where there is a bed available in the state. If there are none available, then they go to their loved ones care. One thing for sure, the governor and her legislators, all hope they die quickly.

  25. mike from iowa 2019-03-09

    Private insurance is even more unsustaionable than government run healthcare and hella more expensive.

    People have to decide do we throw everyone but the koch bros under the too expensive bus or do we bite the bullet and disabuse wingnuts of the notion that helping the poor and promoting the general welfare of the people is not dreaded socialism.

    Let’s get real. Americans already save less than other nations simply because there is less for the majority to save. How can people put money in savings for retirement, college or long term care when they have none to spare? You know wingnuts are going to propose taxcredits for [people to save money they don’t have. They always do and that is basically all they do.

  26. happy camper 2019-03-09

    Some things should be socialist or at least lean that way. Education, health and nursing home care. The lack of compromise is the problem a little bit of each would go a long way.

  27. jerry 2019-03-09

    Don’t forget clean water and clean, un-chlorinated food, and adequate, safe shelter. Those are starters, then we work on equality. Now, we are dealing with typhus in our country because of the filth people are living in. Put these poor souls that are being neglected and put on the streets for lack of care and this will become the normal here in South Dakota. If the fascists in Pierre think they cannot pay their obligations for nursing homes, wait until they get the bills for hospitalization. https://www.theatlantic.com/health/archive/2019/03/typhus-tuberculosis-medieval-diseases-spreading-homeless/584380/

  28. happy camper 2019-03-10

    In the old days, like the 20s, Fire Departments were not municipal but private entities hired by your insurance company. Only the fire company contracted by your insurance company would come put out your fire else it burn to the ground people decided certain municipal services were worth sharing. The word “socialism” is being overly demonized and we forgot how many shared services have become normalized. It also wasn’t that long ago the mortician provided ambulance service though he had no specialized medical knowledge today nursing homes simply do so many things that can’t be done at home by relatives in a mobile society. Maybe we should have more home health care and keep people home longer when possible, but there is definitely a time when Libertarian ideology (any ideology) gets taken too far and some other way of doing things is more suitable. This should not be a liberal or progressive cause but a concern of all South Dakotans.

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