The party in power in Pierre has ignored South Dakota’s rock-bottom Medicaid reimbursement rates for years.
To refer to the cascading closures of South Dakota nursing homes as a “crisis” gives crises a bad name. Let’s call it what it is: a disaster unfolding in real time.
The pace is accelerating. The South Dakota Health Care Association reports that a Huron facility’s end marks the sixth such closure in three years, half of which occurred in 2019.
Two of the most recent facility closures, in Mobridge and Madison, were managed by Black Hills Receiver, LLC. The state-approved receivership still manages 16 of the South Dakota nursing homes orphaned when New Jersey-based Skyline Healthcare declared bankruptcy. The outlook for those facilities appears bleak.
The culprit is the financial loss long-term care facilities incur with residents who rely on Medicaid. The state’s funding formula falls far short of what it costs to provide them care.
We’ve seen this coming. The party in power in Pierre has ignored South Dakota’s rock-bottom Medicaid reimbursement rates for years. Their stubborn refusal to turn out their pockets and fix the problem has driven our nursing home system over the edge.
Governor Kristi Noem, who has called this situation a priority, proposed a mere 5 percent increase to Medicaid reimbursement. At first glance, the legislature doubling that amount to stanch the industry’s financial hemorrhage looks like a bold step in the right direction.
It is a step, but it’s hardly bold. It’s a band-aid on a gut shot.
Former Republican governor Dennis Daugaard proposed expanding Medicaid in the state, a move that would have netted South Dakota a windfall of federal funds. He was forced to abandon the effort due to resistance among the most conservative factions in his own party.
As Daugaard told the Argus Leader at the time, if legislators only crunched the numbers, they would have agreed to the expansion. But because such expansion was an element of the Affordable Care Act – Obamacare – it was a political non-starter. South Dakota is one of the 14 states in the nation that have not yet expanded Medicaid.
That’s Pierre in a nutshell: partisanship over practicality for our supermajority. In the case of nursing home closures, such intractable shortsightedness has dire consequences for elderly citizens.
These closures are not just an inconvenience for families who can’t visit loved ones as often because they now live hours away. Nor are they merely late-in-life instances of residents forced from towns where they have lived most, or all, of their lives.
One of its recent victims was Harold Labrensz, whose story was reported in the New York Times. The nursing home where he lived in Mobridge closed for good this January. Able to find no better option, Harold’s wife found a place for him 220 miles away in North Dakota.
Three days after he arrived, he was dead.
The critical state of our nursing homes is not unique to South Dakota, and the challenges facing the industry are many. Operational margins have fallen to around zero, which makes it hard to keep quality employees due to low pay. That makes it difficult to attract private-payer residents, whose fees are needed to bridge the Medicaid reimbursement gap.
Noem’s one-time $5 million grant to encourage innovation in care is a nice idea – in the long term. Innovating takes time, while implementing such measures can be costly.
We can certainly explore ways to keep our grandparents and great-grandparents independent longer, or in assisted living for longer. We might be able to find ways to lure more workers to such facilities – big breaks or even forgiveness on student loans for certified nursing assistants, LPN or RN degrees, for instance.
But all that innovation won’t help if there are no more nursing homes to benefit from the changes. Lawmakers need to be able to hit the ground running at the beginning of the next legislative session. We know our new governor hates the idea, but this is the perfect time to put smart people from stakeholder agencies and organizations into a room to knock this out.
Task forces aren’t the answer to everything, but they’re tailor-made to solve problems that we can get our arms around. It’s time for our governor and our lawmakers to take measure of their political will and take care of South Dakota.