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North Dakota Nursing Home Assoc Exec: Thank God We’re Not in South Dakota

Things are tough all over rural America for nursing homes recovering from losing lots of paying customers to coronavirus and now struggling even more than usual to hire workers for difficult caregiving jobs:

Patti Cullen, president and CEO of Care Providers of Minnesota, said it remains to be seen how damaging the pandemic has been to the financial health of nursing homes in the state. There’s a lot of uncertainty still with ongoing costs and the status of state and federal pandemic aid, she said.

Cullen cited a recent survey of long-term care providers by The American Health Care Association and National Center for Assisted Living, asking facilities about their financial condition. The results were grim and don’t bode well for the industry in the near term.

Only one in four nursing homes and assisted living communities are confident they can last a year or more, and more than half of those facilities are operating at a loss, according to the survey.

“The true implications of the pandemic impact aren’t going to be seen until next year,” Cullen said [Jeremy Fugleberg, “Covid-19 Detonates Long-Standing Financial Woes for Nursing Homes,” Bemidji Pioneer, 2021.07.09].

But one rural nursing home advocate says things could be worse—her people could be stuck in South Dakota:

South Dakota embodies how much Medicaid reimbursement rates shape the financial health of nursing homes, with 54% of residents covered by Medicaid, according to the South Dakota Health Care Association.

The all-important Medicaid reimbursement rates are set by state lawmakers, so states can vary in how much they reimburse via Medicaid for nursing home care. South Dakota’s reimbursement rates rank at or near the bottom of all states.

[Shelly] Peterson, of the North Dakota Long Term Care Association, minces no words when she compares South Dakota’s reimbursement rates with North Dakota’s more generous rates.

“When I look at South Dakota, I just thank God we’re not there, because you can’t provide good resident care with the amount of money they get,” she said.

The limited funding means South Dakota nursing homes face chronic financial issues, including low pay that exacerbates staff shortages, that can force them to close [Fugleberg, 2021.07.09].

Governor Noem could not be reached for comment on how she plans to address South Dakota’s nursing home funding crisis, as she was too busy traveling to Texas to get on Fox News again and criticize other governors for governing.


  1. John Dale 2021-07-13 21:26

    Did you try emailing Governor Noem about this issue? I’ve found her team to be insightful and responsive.

    Can you believe that Cuomo signed an executive order to put sick patients in nursing homes?

    This is some crazy stuff going down right now .. win at all costs is a mantra of both sides, but one side has a way more aggressive timeline.

    God help us.

  2. Mark Anderson 2021-07-13 21:36

    John is suffering from scomiting poor boy. Has he been in Colorado recently?

  3. grudznick 2021-07-13 22:25

    There is no god, Mr. Dale, but you are righter than right about the crazy stuff going on. And you are righter than right that if you email Governor Noem her team responds with good information. grudznick has emailed often and has rarely been disappointed in the alacrity of the response.

  4. M 2021-07-14 05:06

    God can’t help you if you have no brain.

  5. Cory Allen Heidelberger Post author | 2021-07-14 06:46

    “insightful and responsive”? John, check your email: I think you addresses it to some scammer, not South Dakota’s actual governor.

    John, I do better than email the Governor about public issues. I write about them publicly on a blog read by thousands of South Dakotans, including several who work in state government. Believe me, when I blog about an issue, Team Noem hears about it.

    And if Noem doesn’t hear about an issue until I blog about it, she must really be asleep at the switch. Let’s bring the subject back to the original topic, Joh, and not your inexplicable efforts to distract us and flack for Noem. Every Governor is keenly aware of the dire situation our nursing homes face. Noem simply has not addressed the problem with anything like the diligence she is applying tpo her cross-country travels, her national attention quest, and her 2024 Presidential campaign.

  6. Ryan 2021-07-14 08:10

    I have emailed noem’s office and never heard back. not surprised.

  7. Anne Beal 2021-07-14 09:25

    having worked for a temporary nursing staffing service I have worked in a lot of different nursing homes and have seen the problems up close.
    Staffing is best served if there is a college with a nursing program in the same town. This should be a no-brainer; I should not have to elaborate. Without a supply of college students in need of part-time employment, it’s hard to get staff.

    The big problem is the condition of the facilities themselves. The buildings are outdated.
    Start with climate control: by 21st century standards, there isn’t any. The residents have no control over the temperatures in their rooms.
    A central heating system makes some rooms too warm and others not warm enough. Central AC hasn’t been thought of yet, if the family provides a window unit that’s nice but since the wiring isn’t always up to code, extension cords are needed and then the circuits overload and trip off. Fortunately state inspectors seldom seem to show up in the summer and if they do, the staff hide the extension cords.
    Next: privacy. It seems that a standard design for these buildings in the 60s and 70s was two double occupancy rooms with a toilet in between. so four people share a toilet. (Private rooms are few and far between and nobody gets a choice of roommate.) The little room with the toilet in it does not have a sink to wash up in after using the toilet. Nobody gets a private bath/shower; everybody is taken down the hall to a communal tub/shower room. At least only one bath aide is on duty every day so she only takes only one at a time in there. I can’t imagine how this worked during the pandemic, everybody bathing in the same room with no time to clear or disinfect the air between clients.
    Ask yourself if you would stay in a motel like that for even one night?
    At three different facilities I worked in, residents and their families were so disgusted with conditions, they moved out after one night. Others left after a few days, in search of better accommodations. These were all private pay clients who, because they had money, had other options.
    The only people who stay are the ones on Title XIX who have no other choices.
    These are the nursing homes which want more of the state’s money, the ones in such bad condition that private pay clients won’t live in them. Should the state continue to prop up these failed businesses? Or would the money be better spent on more modern facilities?

  8. Ryan 2021-07-14 09:40

    anne, i think the point that cory is making would address your complaints. the premise of this article is that the state is underpaying for services, and thus the infrastructure necessary to keep those facilities and services adequately maintained is failing. you ask, “would the money be better spent on more modern facilities?” but you miss the point that the money is not adequate to support the industry as it stands now, much less to modernize anything.

    one major revelation above is that more than half of SD residents who are in these long term care facilities are on medicaid. how in the world does that jive with the local mantra of self-reliance and anti-socialism? funny how those principles go out the window when your income stream dries up and you need to ask for help.

  9. Dicta 2021-07-14 09:54

    I worked at national campus for Good Sam. The problems with long term care facilities are numerous:

    1. Americans are unhealthier than ever but also living longer than ever due to technological advancements. What does this mean? People, usually with government payors, are living a long time while needing a lot of care. This means little money with expensive care requirements for long periods. It is a losing battle, monetarily. This is why rehab beds are so, so valuable: they are usually private payors with shorter stays.
    2. Orgs like Good Same simply can’t afford to pay CNA’s what they deserve because their current business model has them hovering near insolvency. So, if you are a younger person with no college education, are you gonna get paid 12 dollars an hour to change diapers and other provide other care that is emotionally trying and, at times, a bit icky? No, you are probably gonna go flip burgers for the same money.
    3. Due to lack of funding, many facilities are in various states of disrepair. How are you going to pay for it?

    The problem that I have with Anne’s critique, even though much of it is dead on accurate, is that who pays for these more modern facilities? We are squeezing blood from turnips as is. Simply turning to the market for a solution is not really workable as so much of the available funding is public.

  10. bearcreekbat 2021-07-14 10:39

    Ryan’s observes that:

    . . . more than half of SD residents who are in these long term care facilities are on medicaid. how in the world does that jive with the local mantra of self-reliance and anti-socialism? funny how those principles go out the window when your income stream dries up and you need to ask for help.

    Those principles not only go out the window when your income stream dries up, for many folks those principles only apply to other people, as evidenced by modern estate planning. As an elderly person ages a key element of estate planning is how to avoid having to spend that elderly person’s assets on his or her future needs by a timely transfer of assets in anticipation of long term care. It seems to be a common estate planning goal in SD to get grandma on Medicaid as soon as possible so her heirs can enjoy her assets and life savings instead of using them to pay for grandma’s long term care. The sooner the heirs can impoverish grandma by taking control of her assets the sooner she will have to rely on the so-called “socialism” of Medicaid, while the heirs can add her assets to their individual nest eggs.

    “Self-reliance and anti-socialism” slogans do not trump individual personal greed in SD. Typical heirs of grandma want her property and her life savings and will engage in whatever necessary steps they can to make sure grandma doesn’t have to use up these assets paying for her own care. Estate planning in SD is big business

    see e.g.,

    and for those families with elderly members that have accululated substantial assets, taking steps to avoid spending those assets for grandma’s future care is often a key, and sometimes the only, objective.

  11. Ryan 2021-07-14 10:53

    bcb – i know all too well about medicaid being the goal of some estate planners as I previously worked in the industry. it’s incredible that nobody has put a stop to that type of planning like they have in some neighboring states. in my experience it was almost always the grandma or grandpa themselves looking to squirrel away their own assets rather than the family encouraging them to do it. of course, the family would rarely object. That type of “planning” is one of the reasons attorneys get a bad reputation, in my personal opinion.

    That list you posted is funny because several attorneys listed on their are retired, deceased, or no longer practice in the state or the field of EP. Oh well, but it’s worth a laugh.

  12. Porter Lansing 2021-07-14 17:07

    Problems with lower income anything in SD is because the overwhelming majority are mean to Mexicans, even those fully legal with green cards.

    It’s that mean spirit backbone that puts your elderly in a public home when your family home is where they’d best be.

    I’ve been told numerous times that I’ll never be put in a public home, no matter what. Unless, I choose to be and I’m still able to make lucid decisions.

  13. Mark Anderson 2021-07-14 17:48

    Bearcreekbat, your spot on on this one. My mother was only in a home for a couple of years but it ate up pretty much all the savings. It all had to be gone at that time before any federal or state aid kicked in. Before we put her in we had her funeral costs taken out first about the only allowance. This was over 15 years ago in South Dakota, don’t know what has changed.

  14. Ryan 2021-07-15 19:12

    Some people seem to think “the nursing home took all my money” instead of the correct version, “the nursing home provided me with services I asked for, but I don’t want to pay for it because what I asked for is expensive.”

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