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Explaining the decades-old law that caps nursing-home beds in South Dakota

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Gov. George Mickelson announces his nursing-home bed moratorium in this screenshot from his 1988 State of the State address.

The attached interview above is from SDPB's daily public-affairs show, In the Moment, hosted by Lori Walsh.

The Lower Brule Sioux Tribe wants to build a new nursing home. The tribe doesn’t need any help from the state, except for one thing.

State Sen. Troy Heinert, D-Mission, explained the situation recently during a Senate floor debate.

“Now why do I bring this in front of this body? And it's not that they need permission to build a nursing home with their own money on their own lands. It’s about the moratorium that we have on beds.”

He was talking about a 34-year-old law that puts a cap — a moratorium — on the number of nursing-home beds in the state.

Mickelson proposes cap

The late Gov. George Mickelson proposed the moratorium in 1988.

“When I visit with senior citizens in centers and in nursing homes," Mickelson said, "the vast majority tell me that they are interested in remaining in their home as long as possible. It is time for South Dakota to adopt a new strategy to address the long-term care needs of the elderly.” 

Mickelson said South Dakota was too dependent on nursing homes for long-term care. At that time, 84 out of every 1,000 South Dakota residents lived in nursing homes. That was far above the national average of 50 per 1,000.

The state also faced ballooning costs for subsidized care of nursing-home residents. The state’s contribution to that care grew from $10 million in 1975 to $45 million in 1988.

Kitty Kinsman, now of Rapid City, was Mickelson’s secretary of health. She says the state’s contribution to the federal Medicaid program was driving the budget problem.

“People were in nursing homes that didn't need the level of care that nursing homes were providing, but they had no other alternatives," Kinsman said. "So people would oftentimes go into nursing homes and exhaust their resources and then they would become Medicaid-eligible, and that was really where the pressure from the state standpoint to look at alternatives came from.”

Progress noted

The Mickelson administration hoped a moratorium on nursing-home beds would spark innovative thinking about long-term care. Mickelson hoped other options like assisted-living centers and home-care services would spring into being. And he hoped those options would bring down the overall cost of the care, by keeping some people out of expensive nursing-home settings.

One year after signing the moratorium into law, Mickelson said it was working.

“One year ago the elderly of this state had little choice frankly except to accept nursing-home care as their only alternative," Mickelson said. "But today, I think you and I can be proud of the fact that our senior citizens can remain in their homes longer, receive some care in their homes and some other alternatives until they need nursing-home care.”

The moratorium was originally supposed to last three years. Lawmakers extended it four times and then extended it indefinitely in 2005.

Today, there are 104 nursing homes in South Dakota. There are also 27 home health-care agencies, 166 assisted-living centers, 32 residential living centers and a community living home.

Kinsman said the moratorium did what it was meant to do.

“I think if you look at the proliferation of assisted living facilities, residential care, other home care and assisted types of services, I think it was a huge success," she said. "Would it have happened otherwise? Perhaps, but I don't think in the timeframe.”

Exceptions allowed

Lawmakers have allowed some flexibility under the moratorium. The departments of Health and Human Services can reallocate unused beds or authorize new construction so long as the total number of statewide beds doesn’t exceed the maximum of 7,623.

Lawmakers have also passed legislation over the years to specifically authorize new nursing homes or extra beds for the Pine Ridge, Rosebud and Flandreau Santee Sioux tribes.

Sen. Troy Heinert’s district includes the Lower Brule Reservation. Besides his current bill seeking authorization for the construction of a tribal nursing home, he wants future legislation to change the process for tribes.

“Hopefully we can fix this problem in the code," he said, "so that tribes don’t have to come before the body to build a nursing home within their own homelands.”

Heinert’s bill to allow a new nursing home on the Lower Brule Reservation passed the state Senate and is pending in the House of Representatives.

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