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Market Failure: South Dakota Can’t Keep Nursing Homes Open

One part of the market in South Dakota that shouldn’t be ailing is services for old people. The state has a growing number of old folks, especially in the smaller towns, so you’d think the demand those old folks create for services would keep the businesses serving them open.

Alas, not in Salem. Their nursing home got walloped by the wind storm in May, and corporate owner Avantara can’t make the business case for rebuilding:

Unfortunately, due to the damage Avantara Salem incurred during the May 12, 2022 storm, the facility has been left in an unrepairable and unsafe state. Thus, Avantara Salem has made the tough decision to permanently close its skilled nursing facility with no plans to re-open.

…Avantara Salem will continue to work with its residents and their families on permanent placement plans, to ensure that Avantara Salem’s residents’ well-being is maintained during this transitional period.

Additionally, Avantara Salem has already provided a formal written “Notice of Closure” to the South Dakota Office of Licensure and Certification, as well as notice to Avantara Salem’s residents and their families [Avantara, press release, posted in Renee Ortiz, “Nursing Home in Salem Permanently Closed,” KELO-TV, 2022.10.13].

Avantara has also closed old folks’ homes in Armour and Ipswich this year. We’ve got lots of customers, but we just can’t draw the workers.

Governor Kristi Noem has been trying to come up with a solution to the problem of dwindling care options for old folks in South Dakota. Letting coronavirus run rampant and wipe out the nursing homes’ customers evidently do any good. Hmmm… maybe the Governor could help the nursing homes save some money by repealing the sales tax they have to pay for food….


  1. scott 2022-10-14 06:56

    This is just a start of the health care crisis SD will be facing in the future.

    Medical workers are exiting this state because of how SD responded to covid. Expect to see small town hospital closures as these facilities cannot keep functioning with their present staff and paying traveling staff is cost prohibitive.

    EMS services have been struggling for years and we will be seeing more of these services have to shut down due to lack of workers.

  2. larry kurtz 2022-10-14 07:42

    By 2022,[3] the cumulative effects of overpopulation, pollution and an apparent climate catastrophe have caused severe worldwide shortages of food, water and housing. In New York City alone, there are 40 million people, and only the city’s elite can afford spacious apartments, clean water, and natural food. The homes of the elite are fortified, with private security and bodyguards for their tenants. Usually, they include concubines (who are referred to as “furniture” and serve the tenants as slaves). The poor live in squalor, haul water from communal spigots, and eat highly processed wafers: Soylent Red, Soylent Yellow, and the latest product, far more flavorful and nutritious, Soylent Green.

  3. John 2022-10-14 08:27

    Yet the voters in Salem, Ipswitch, and Armour will continue voting against their interests.
    Some rural consolidation of services is necessary as the frontier continues marching east in response to the rural ag business model to depopulate rural farms, towns, schools, and counties. Yet, the consolidation need not be as harsh as the market imposes.

    Scott is spot on – the closure of small EMS services, clinics, and hospitals will march across the nearly empty counties for the foreseeable future. These closures are the results of: a) lousy rural-ag economic model depopulating the plains; b) republicans anti-public health practices; and now c) criminalization of providing womens’ health, including abortion. One cannot recruit doctors in this environment. Watch rural life expectancy continue declining.

  4. Ryan 2022-10-14 08:57

    Nursing homes are going broke because nobody thinks they should have to pay for their own nursing care. So many people act like it should be free, somehow.
    Most people don’t have insurance that covers it. People who are broke can’t private pay so they go on medicaid and medicaid doesn’t pay enough to the nursing home to keep up with staffing and bills. South Dakotans who are wealthy avoid paying for the nursing home by hiding their money and farmland and business interests in special trusts so they can benefit from the money and pass it to their family when they die without having to use it for their own care. These people think the nursing home is going to “TAKE” their hard-earned life savings… when in reality the nursing home is just providing a valuable and needed service, but a service that very few people think they should be paying for.

  5. Richard Schriever 2022-10-14 09:40

    The Good Sam facility in Lennox closed in July and has since been demolished. This is all part of a prediction I made a point of expressing during my run for the SD Senate against Ernie Otten in 2012 during our town halls. It is related to the failure to expand Medicaid under Obamacare. As usual, SD will remain persistently late to the party – 10 – 15 years behind the times culturally and economically – when Medicaid expansion finally passes through the initiative process in a few weeks. Too little, too late, too conservative (yes – there is such a thing).

  6. SuperSweet 2022-10-14 09:41

    Virginia Mason Fransiscan hospital near me had to call the fire department for assistance this week because they were short staffed.

  7. All Mammal 2022-10-14 13:22

    Maybe we can come up with a system similar to our solid waste solution with the city dump. Set elderly folks on the curb for pickup on Wednesday mornings. Never have to see or deal with again. End of life is unsightly and makes us squeamish, just like the things we throw away and never want to see or touch again. Put it on someone else.

    However, it doesn’t just go away because we can’t see it. It still belongs to us and is a part of life. No exceptions. We all should have responsibility for our portion. Nobody wants to be left out on the curb when we complete our usefulness in society. Yet, EVERY person has something to teach. Death and birth are something too few people want anything to do with. In order for it to be done with dignity, we need to buck up and learn a good lesson about life and caring for others. There can also be positive outcomes when people have to deal with their own waste heap too. Wasteful consumerism would likely decrease and reusing and upcycling would increase. That is good.

  8. P. Aitch 2022-10-14 14:48

    SD can and probably will use the method the state uses to “help” those in need of financial assistance from time to time. i.e. A free bus ticket to Minneapolis. Let the damn liberals in Minnesota help ’em. South Dakota needs to increase its rainy-day fund more than it needs to give welfare to its citizens that aren’t pulling themselves up by their own damn bootstraps. Lazy bastards! Right, grudznichts?

  9. John 2022-10-14 16:21

    Ryan, let’s get real. Glance at the increases of compensation for nursing home / assisted living executives and board verses the hands-on nurses and care-givers.
    We, who cared for aging parents, understand “inflation”. We loathe executive, corporate, and board compensation that outpaces inflation or the CPI. Those greedy bastards grasp for every dollar of a family savings, the patient’s social security/MEDICARE. There is a strong case to nationalize the industry. Nationalization may be the only way to defeat the greed of executives and boards. After my mother passed, we gave “bonuses” of $500 each to the two lead nurses and a third for the general staff. Their feedback was they’d never seen that sign of appreciation and recognition. And Ma was an easy, elder.)

    We agree that the vile banksters who created means to “hide” and “protect” family wealth for purposes of end-of-life-care need to be undone. One of the purposes of savings is to protect ones family from ones end-of-life bills. So use (or take) those funds.

    We disagree on insurance. Insurance is a bankster racket. Insurance is a racket between jacking up costs above the CPI and the end-of-life-caresters and the insurance banksters — with the patient / family caught in the middle. Sometimes the medical banksters and well-intentioned family allow themselves to get caught up in the middle by unreasonably using extreme measures to minimally extend a poor quality of life. Let’s glance at this medical-bankster cabal for a minute. Diabetics – persons with a life-threatening, debilitating disease, outlive the general population. Why? They receive the drug metformin. Metformin is an over-the-counter drug in Europe and many nations — but not in the US. It’s likely its not available OTC in the US because the medical-bankster cabal want to use the drug to prolong diabetic life in care facilities as opposed to facilitating longer lives for those outside of care facilities. Consider:

  10. Arlo Blundt 2022-10-14 18:03

    I think this break down in public policy is appalling, another example of total negligence by the Republicans. South Dakota is an older, graying and getting grayer state, especially in rural, farming areas. My home town is very proud of the work done daily in the nursing home by, largely, the women of the community. It is an anchor for that town, and the care provided our friends and neighbors, is first rate. That Salem has lost its facility, while the state sits on millions of Covid money is a tragedy, and reflective of the numbskulls serving in Pierre. If we can’t provide for the elderly, who’ve paid taxes and supported their communities all their lives, we have failed in our responsibilities.

  11. Dc 2022-10-14 20:05

    Yes, as someone who paid his brother’s bills for last 8 years, spending life savings of over $3/4
    Of a million. To local nursing home, while others shift their money and assets to avoid payment! Doesn’t seem quite right??? Should be some help from state, he has been a productive member of society for over 70 years!

  12. Marie 2022-10-15 08:11

    Requiescat in pace.

    Remember Gov. Noem’s 2020 “More Hunting–less Covid!” Pheasant Opener video taunt–
    as Covid began tearing through SD s nursing homes—including my town’s home?
    Less Covid? Surely, things didn’t work out that way for SD’s nursing home residents and staff.

    While the SD DOH Covid Dashboard has recently stopped displaying nursing home
    resident Covid cases and deaths, the SD DOH furnished these totals–(Mar. 9, 2020 through Oct.12, 2022):

    Nursing Home Resident Covid Cases—5,467.

    Nursing Home Resident Covid Deaths—1002—a new milestone.

    SD has the #1 nursing home Covid death rate in the country, AARP’s Covid Nursing Home Dashboard reports.

    SD nursing home occupancy and available beds are lower, with more closures likely.
    Pre-Covid (1/30/2020) SD DOH reported that 84%–5422 of 6438—of SD nursing home beds were occupied.
    A year later (1/28/2021), occupancy dropped to 69%–4471 of 6487 beds. Today (10/13/2022),
    only 75%–4695 of 6256 beds—are occupied.

    Gov. Noem does not acknowledge any hand she may have had in this needless tragedy.

  13. All Mammal 2022-10-15 12:17

    Only a couple weeks of not being allowed into Avantara to see MY DAD, he was Dead. $7,000 a month was never complained about. But when I had to report them for kidnapping when they wouldn’t let me take MY FATHER home with me, and when they shoved all the patients into the cafeteria where I would come squeegee the window and put pots of spruce trees I illegally dug up, and when they purposely kept MY DAD away from me to ensure they collected as much of his good insurance they could get, it isn’t clear if COVID killed him, or Avantara’s sick greed. But he died of a lonely, broken heart. They hated my guts because I told my pappy and that sh!t hole everyday my dad was way too good for that place. Makes me shake thinking about who my dad was and how hard he worked and how giving he was and how much he did for every person in need to have to die in squalor, not understanding why I was outside the window in the bushes and why he was laying in a room filled with beds and people coughing, wheezing, crying and dying. And never once did they open a goddamn window for any air! Sorry. He tested negative for covid, but it gave them their privacy to kill so many people. I want to pull the fire alarm and see if they even attempt to evacuate people.

  14. P. Aitch 2022-10-15 12:39

    My heartfelt condolences, All Mammal. Your assessment is in sync with my observations and those of my hospice nurse daughter.

  15. All Mammal 2022-10-15 13:11

    I appreciate that, P. Aitch. I feel like immigrants are in dire need to help our people working with our elderly, since I don’t foresee the facilities paying their staff any better, anytime soon. I hope your daughter gets a much earned reward everyday. The kind that can be felt.

    You know what, P? You just gave me an idea to make sure those people who showed up to work today do get that appreciation. Plus, I will feel better too. My dad woulda gotten on me for moping around. He would say something like, “Ain’t nothin but a step to a stepper.” And knuckle my arm. I would of course say ouch. And get to it(:

  16. Mark Anderson 2022-10-16 18:56

    Ryan, when I helped my brother put our mother in the nursing home in Highmore, first, all her money in savings was used. That was first, then the government would have stepped in. She only lasted one year so I’m not sure what the government part of it would have been. She could no longer live by herself but “I’ll never forget her saying “goodbye house” as we left our home.

  17. Loti 2022-10-16 22:14

    It is so scarey to get old as i think about having another BD. Meanwhile, our Native mom left us 5 years ago at nearly 97yo. We were fortunate to keep her in her own home. Luckily, as a retired health care worker, i did my best assisting her the last 3 years+ of her life. It was so nice sharing my life with her, but oh so sad now.

  18. larry kurtz 2022-10-21 08:04

    As Emperor Schoebeck bleats screw the poors! it looks like Florence is the latest community with a nursing home that’s too cheap to raise wages for staff just like the State of South Dakota is too cheap to hire people that might help slow the spread of invasive species like zebra mussels.

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