10/21/2022: This story has been updated with responses from Governor Kristi Noem’s office.

SIOUX FALLS, S.D. (KELO) — Another nursing home is closing in rural South Dakota this year with November being the last month for residents at the Country View Assisted Living Center in Florence.

The Florence facility joins care centers in Salem, Lennox, Clear Lake, and Ipswich in the growing nursing home crisis in the state. Aside from Salem, which closed following damage from the May derecho, all of the facilities cited two common factors in their closure: staffing shortages and a lack of Medicaid reimbursements in order to keep the facilities open.

The Department of Health Services says that there are currently 13 facilities in the state considered “Access Critical.”

Vicky Maag has been the owner and RN Administrator at the Country View Assisted Living Center since 1999 when they opened the nursing home. Maag’s vision was to provide assisted living care to the small, rural community and those surrounding it in order to keep residents close to their families.

“And, you know, it was working fairly well, there was the long-term care insurance that was available and quite a few of our residents in the early years had that,” Maag said. “Now, that’s really impossible, just about impossible to get long-term care insurance, unless you’re in your 30s and then you have to pay you know, a pretty hefty premium and young families probably can’t afford that, is kind of what I’m hearing.”

With Medicaid reimbursements returning so little, and Maag wanting to retire, she’s been unsuccessful in finding an investor to keep the facility open for residents.

“Any investor who looked at our profit margin just said, ‘Nope, this isn’t a moneymaker,’” Maag said.

Now, residents are looking to move to Wilmot, Milbank, Groton, Redfield and even Brookings for assisted living care as facilities in nearby Watertown are full and not taking residents.

Santee Sioux Tribal Community opening in Flandreau

While Florence is joining a growing list of nursing home closures, a new facility is opening 94 miles south of the community that is anticipating residents coming from all over.

The Santee Sioux Tribal Community had a ribbon cutting ceremony Thursday in Flandreau. The new facility hopes to house up to 42 people and is already hearing from interested residents according to David Kills A Hundred, the Santee Sioux Tribe’s public relations and communications specialist.

“I think the first residents, just by virtue of their location, will probably be from here. But I think the more and more people hear about this place, I think more will come from the surrounding area to be closer to their families,” Kills A Hundred said.

Kills A Hundred said the closure of other nursing facilities could cause the Flandreau one to fill up quickly. And like many small communities, Flandreau is seeing a need for care for the elderly.

“So, for this area, what you don’t really have a lot of is place for the elderly, the infirm, to go maybe aside from the clinic downtown, at the Avera clinic,” Kills A Hundred said. “This place will provide housing for those who can’t live independently who need a place and they can be close to home as well.”

The Flandreau facility has a cultural element to it as it’s on tribal land, Kills A Hundred said. And while that will be important to its Native residents, non-Native residents are welcome as well.

While the opening of facilities like the Santee Sioux Tribal Community is helpful for residents being displaced by closures, it still separates them from their families and the communities they have likely spent their whole life in.

“And then they have to start, you know, really looking at unfamiliar facilities and communities. So, it’s a hardship all the way around,” Maag said.

Maag added recently she’s been receiving three to five calls a week from people looking for memory care facilities for their relatives on Medicaid from as far away as Rapid City.

The struggle to find staff

Medicaid reimbursement is just one piece of the puzzle of the recent nursing home closures. There’s also a struggle to find and maintain staff.

For Country View, most of the staff travel from Watertown or Webster, which can be a tricky drive during the winter months. Add in the fact that not many people are interested in going into the memory care field and Maag says smaller communities can struggle to find workers.

“It’s hard work, it’s difficult,” Maag said. “And, you know, we’re a small business and, you know, can’t afford to offer benefits to our employees. So, when they can make as much at Walmart or McDonald’s and get benefits, you don’t have to take a course, you don’t have to pass a test, a state test, you know, it’s kind of a no brainer. Why do this?”

“I just personally feel it’s really kind of disgraceful that we can’t do better for our veterans and our elderly.”

Vicky Maag

Additional assistance from the state and higher Medicaid reimbursement could aid these small nursing homes, Maag said.

“You know, a lot of facilities don’t take Medicaid reimbursement, when they run out of money, they have to find another place to go. And so, we as owners decided from the get-go that we just could not do that. You know, if they ran out of money, we would just let them stay on Medicaid,” Maag said.

But with the low reimbursement rates, there just isn’t enough money to provide competitive pay and benefits.

The Good Samaritan facilities in Clear Lake and Lennox cited similar issues with Medicaid reimbursement and staffing shortages when talking about why those facilities closed.

“I just personally feel it’s really kind of disgraceful that we can’t do better for our veterans and our elderly,” Maag said. “I mean, this group of people that we’re serving now, you know, they fought in a couple of different wars. They came back, they built South Dakota up again; our farms and our industry. And, you know, these aren’t people that haven’t been without money all their life, they just ran out of money. And now we just say, ‘I’m sorry, I can’t take care of you.’”

In Flandreau, Kills A Hundred said they’re still working to staff the new care facility, but he’s not worried about finding employees.

“We’ve had folks come through, toured the facility, and they really, really want to work here. The pay scale is going to be very competitive; it’s going to be very good. And I think it’s just going to be a great environment for people to be in,” Kills A Hundred said.

‘It’s a crisis’: Nursing homes ask for state assistance

Earlier this year the South Dakota Legislature passed one-time funding of $30 million to aid nursing homes. Governor Kristi Noem also provided facilities with a 6% reimbursement rate increase.

“It helped some, sure. But, yeah, but it’s not sustainable. It doesn’t sustain us, you know,” Maag said.

Aimee Middleton with Good Samaritan expressed a similar statement following the closure of the Clear Lake and Lennox facilities saying they were thankful for the funding, “…but the reality is that we need permanent funding solutions to support and address our workforce and resident care needs now and in the future.”

Maag wishes there was more assistance from the state and elected officials to prevent facilities like the one in Florence from closing.

“It’s a crisis situation, and it’s not being looked at that way by the people who can help financially,” Maag said.

Thursday, gubernatorial candidate Jamie Smith announced a plan to address the nursing home crisis at the ribbon cutting of the Flandreau facility.

“On day one of a Jamie Smith administration, we’ll develop a blue-ribbon task force that will be headed by Lt. Governor Jennifer Keintz here, and she has her own expertise regarding this very subject,” Smith said. “This task force will focus its attention towards studying the proven methods to keeping our nursing homes open.”

A spokesperson with Governor Kristi Noem’s office told KELOLAND News that when facilities close, the Department of Human Services meet with providers to explore other options and work with residents and families to find a new home.

“The Noem Administration knows that nursing homes are an important part of the continuum of healthcare options,” Tony Mangan said via email on Friday.

Noem’s office added that during her tenure as governor, DHS has expanded the Access Critical Nursing Facility Program to, “…help ensure that geographically-isolated nursing facilities remain operational with the help of enhanced reimbursement.”