This story was updated at midday* and a final time at midafternoon** after the meeting concluded.

PIERRE, S.D. (KELO) — Improving South Dakota’s approach to long-term care for older people and those with disabilities promises to be a big piece of the Legislature’s work next winter. That’s why a special committee of state lawmakers has started working this summer to develop recommendations for next January.

The Legislature’s Study Committee on Sustainable Models for Long-Term Care met for the first time Tuesday morning at the state Capitol. The panel is looking at the current situation and developing a 10-year forecast regarding the interplay between numbers, facilities, geography, services and workforce.

Republican Sen. Jean Hunhoff chairs the group. Now 69, and first elected in 2000, the registered nurse and small business owner is the current Legislature’s longest-serving member. “We’re all coming from varied backgrounds,” Hunhoff said about the committee members as she opened the meeting.

The panel will break into five subgroups focusing on regulations, workforce, community-based services, infrastructure and location, according to Hunhoff, and they will meet twice in the next few months. She said there also will be consideration of funding and potential incentives for the private sector.

The Legislature in 1988 capped the number of nursing-home beds in South Dakota. According to a memo to the committee from its Legislative Research Council staff, the purpose “was to help control the increasing cost of long-term health care; ensure the elderly received the most appropriate level of long-term care; and to spur further growth of home-based and community-based services such as home health care, assisted living centers, and residential living centers.”

The Legislature in 2005 extended the moratorium indefinitely. That current limit is 7,062 statewide. There were 6,038 licensed beds in 95 facilities across South Dakota as of April 6. A state Health Department official said there are approximately 1,200 beds available that can be transferred between facilities.

The LRC’s interactive map of nursing homes in South Dakota.

“The moratorium has proven effective in spurring the growth of alternative long-term care options,” the LRC memo said.

Among those options are 5,005 beds at 156 licensed assisted-living centers; four adult foster-care homes with eight beds; 25 registered residential-living centers with 571 beds; and six licensed community-living homes with 13 beds. There are also congregate housing facilities.

“I don’t think beds are the problem. It’s all of the other surrounding issues,” said Tim Rave, president for the South Dakota Association of Healthcare Organizations. He later added, “You have the financial pressures, but no one has seen the staffing crisis that we face today.”

*MIDDAY UPDATE: The committee also received a report from LRC staff regarding long-term care data. Among its take-aways:

Fiscal analyst Bill Douglas presented numbers on South Dakota’s population growth for age 65 and older. There were 115,815 65-plus South Dakotans in 2011 and 146,784 in 2021. He said Abt Associates for its 2007 report used a higher growth rate and Abt also wasn’t able to reflect the higher death rate among 65-plus during the recent COVID-19 pandemic.

Chief fiscal analyst Jeff Mehlhaff said assisted living centers tended to be smaller in bed numbers – 16 was most common – while nursing facilities tended to be larger. He said age of the two types of facilities varied, but the largest group of nursing homes fell in the range of 50-59 years old, while the largest group of assisted living centers fell in the 20-29 years old range.

Regarding workforce, Mehlhaff said nursing homes used contracted FTEs — traveling nurses — much more frequently than assisted living centers. He said nursing homes also tended to have higher employee-vacancy rates, including at rural nursing homes.

Nearly half of registered nurses and licensed practical nurses were located in five of South Dakota’s 66 counties – Minnehaha, Lincoln, Pennington, Meade and Lawrence — according to Mehlhaff.

**MIDAFTERNOON UPDATE: The committee received a briefing from SDAHO’s team in the afternoon. Among the highlights:

Many nursing care facilities date back to the 1960s and 70s and need to be replaced, Rave said. The current estimated cost of construction is $300,000 per bed space. “We’re talking about big dollars here,” he said.

Rave also said the state Department of Corrections needs to consider more options for long-term care of inmates. DOC currently tries to place elderly inmates in long-term care facilities in communities. “There’s not hundreds (of inmates), but every community that takes these folks, it provides a challenge to the community,” he said. Hunhoff noted there’s “a stigma” such as when a sex offender is placed.

Michele Snyders, a palliative care expert for SDAHO, said 17 states are working to provide more home-care palliative services, such as for anyone with a serious illness, including cancer or heart failure.

Rave said people move from a community that loses its long-term care facility. An example was Mobridge. “It just gives you pause, to think before decisions are made,” Rave said.

SDAHO’s Jacob Parsons said a recent survey of hospitals found they had 60 elderly patients in their care who had been waiting at least seven days to be placed in a long-term care facility — and 26 other patients who were waiting in emergency departments for rooms in those same hospitals. The hospitals weren’t receiving any government reimbursement for those elderly patients because they no longer had a reimbursable illness.

Republican Sen. Erin Tobin said that at the same time there were more than 1,000 nursing home beds that were available. “Where’s the disconnect?” she asked. Replied Rave, “Ninety-eight percent of it comes down to staffing.” He said nursing homes can’t take patients if they don’t have adequate staff.

Parsons said the primary reason cited by the hospitals holding those 60 patients waiting for long-term care was that beds weren’t available. Another reason in some instances was that long-term care facilities already had taken their maximum number of older people who were Medicaid patients. Medicaid reimburses at a lower rate than private pay in many instances. Said Rave, “These beds are open, the vast majority of them, because they don’t have the staff.”  

Hunhoff set the schedule for future meetings. They will be June 12, July 27, September 25, and October 18. She said the June and July dates would start with a joint committee meeting and all work groups would meet later those same days. The work groups are to bring preliminary recommendations to the September 25 meeting, and if they involve funding, that discussion would be held at the October meeting, she said.