North Dakota
Pressures could lead to more closures at ND nursing homes
BISMARCK — Federal requirements for nursing homes to have a registered nurse on duty 24 hours each day are expected to add pressure to an already challenging workforce situation for the 75 rural and urban facilities across the state.
A majority will have a hard time meeting the 24/7 requirement for RNs, according to the North Dakota Long Term Care Association.
Nikki Wegner, director of the NDLTCA, said most facilities across the state are currently well-staffed except for that RN requirement.
Cost pressures have already led to six facilities closing in the past 35 months, she said.
“We’ve never had that before in our history, and the majority of them were because of staffing issues,” Wegner said.
Urban facilities have until May 2026 to comply with the federal requirements, while those in rural areas have until May 2027.
Rules have also changed, with areas like Dickinson, Devils Lake, Jamestown, Valley City and Williston no longer considered rural, meaning they’ll need to meet requirements sooner.
“I worry about how many facilities might have to close because they can’t meet the standards,” said Reier Thompson, president and CEO of Missouri Slope in Bismarck, which has long-term care for over 250 residents.
“What’s that going to do to access to care, especially in the more rural area, where people are traveling 100 miles from their hometown to a nursing facility, and maybe a spouse is commuting that a couple times a week?” he said. “It’s going to be hard, especially in winter.”
Throughout the COVID-19 pandemic, staffing full-time nurses and nursing assistants at long-term care facilities became a huge challenge. Many turned to short-term contract nurses, and costs soared.
The situation has begun to turn around for Jill Foertsch, administrator at St. Gerard’s Community of Care in Hankinson. St. Gerard’s has added new certified nursing assistants while reducing the use of contract nurses from eight just a short time ago to two.
“We have improved significantly,” Foertsch said.
That being said, finding enough RNs to meet the new requirement is going to be tough.
“We are not able to meet the 24/7 staffing mandate,” she said.
The situation may mirror what happened during the pandemic, but contract RNs are in short supply and high priced, she said.
The one caveat is this time there’s no funding on the horizon.
“We will not be getting any help from the government like we did during COVID, and that’ll be what would most likely help us to shut down, because it’s just not sustainable that way,” Foertsch said.
The NDLTCA estimates contract nurses accounted for around $73 million of statewide nursing costs in 2023, up from around $24 million in 2020.
Staffing at nursing homes in the state is also now around 1,200 workers below what it was in early 2020 numbers, according to the NDLTCA.
The NDLTCA estimated that only 35% of urban facilities and only 14% of rural facilities would currently meet the future 24/7 RN staffing requirement.
Right now, most facilities rely on a mix of RNs, physician’s assistants, nurse practitioners or physicians through phone or telehealth if an RN isn’t on duty beyond the normal daytime shift. Finding RNs to fill overnight and other shifts is going to be difficult.
No funding is earmarked for those shortfalls, the numbers of RNs are just not available, and no pipeline is in the works to increase the availability of RNs.
“We’re still in a workforce crisis, we still rely on a lot of contract nurses, and it’s expensive, and then you add the mandate on there to increase even more,” Wegner said, adding that the state needs at least 80 if not more RNs to fulfill the mandates.
Several states have already met stringent requirements for waivers from the rule, but Wegner isn’t hopeful North Dakota will qualify.
Blake Kragnes, administrator at the 85-bed Knife River Care Center in Beulah, said his nursing home has been able to keep staffing at a good level, but the mandate of the 24/7 requirement for RNs is going to be tough to meet.
“When you look at the number of college grads graduating with a nursing and RN degree, it’s down, and that makes it complicated to meet a mandate that comes with no funding,” he said.
Kragnes is looking at how to increase recruitment and retention by connecting with area high schools to start people in a health care career that may lead them to full-time registered nursing status.
Foreign nurse visa freeze
One avenue most facilities are trying to use is immigration, but the U.S. State Department recently froze EB-3 visas used by foreign nurses for the rest of the fiscal year, leaving around 10,000 foreign nurses in limbo until resolved.
A cap of 40,000 visas for foreign nurses has been in place since 1990, and legislation to increase the cap stalled in the U.S. Congress after its introduction in November 2023.
According to the Migration Policy Institute, international nurses account for around 16% of the nursing workforce in the country.
National health care nonprofit KFF, formerly known as The Kaiser Family Foundation, estimates that 1 in 6 of the 3.2 million RNs in the U.S. is an immigrant nurse.
Amy Kreidt, administrator of St. Luke’s Home in Dickinson, which operates an 88-bed long-term care facility, echoed Foertch’s comments by saying the mandate coupled with the high cost of contract nursing could put more rural nursing homes out of business.
“Right now we’re not (in danger of closing), but if we can’t start getting nurses here, we have to keep that as an option and review,” she said.
St. Luke’s has had success with its foreign nurses, but the visa freezes and annual caps, along with the complicated immigration process, have led to it taking up to four years to get foreign nurses, Kreidt said.
“And that’s if it goes through relatively quickly, and it seems to always have taken that long, but now, with additional delays, it will continue to take that long and longer,” she said. “The contact is only three years long and it takes over four years to get them, so the numbers don’t add up.”
LeAnn Hokanson, vice president of resident services at Missouri Slope, said besides funding to cover nursing costs, there is a major need for both immigration and on expanding nursing programs.
“The (foreign nurses) that we’ve been interviewing most recently, they’ve been waiting and waiting and waiting,” she said. “Some of them wait for 10 years to get their call to have a facility interview them. It’s all stuck in that visa process.”
Contributed / Missouri Slope
Kreidt has previously tapped into the nursing program at Dickinson State University, but with its entire full-time nursing faculty resigning on July 10, the future of that program is uncertain.
The situation also adds further uncertainty regarding the nursing pipeline for health care facilities across the state and region.
North Dakota’s new Office of Legal Immigration is looking to pilot a cap-exempt H-1B visa program in the next several months specifically for foreign nurses, according to a study it released in late May.
This could help increase the numbers of RNs and nurse practitioners, though hurdles exist since the H-1B immigration process is more costly and facilities need to meet eligibility requirements.
This story was originally published on NewsCoopND.org
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FARGO — Health officials say influenza cases are surging across North Dakota, hitting hospitals and clinics earlier and more aggressively than usual this season.
The Centers for Disease Control and Prevention is tracking a rise in flu illnesses across the country, with roughly 8% of visits to health care providers labeled as flu-like illness, the highest in more than 25 years.
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DICKINSON — Property tax bills are arriving, and as inflation, taxes and property values continue to rise, many North Dakota homeowners are feeling the strain of higher household expenses.
Two state programs — the primary residence credit and the homestead property tax credit — aim to ease that burden by reducing, and in some cases eliminating, property taxes for eligible homeowners.
The primary residence credit provides a flat credit of up to $1,600 for qualifying homeowners, regardless of age or income. The homestead credit, meanwhile, reduces the taxable value of a home for seniors and individuals with disabilities, significantly lowering or eliminating their tax bill.
Eligible households may apply for both credits, further reducing the amount owed.
Primary residence credit: Who qualifies and how much is available
The primary residence credit was originally capped at $500 in 2023. In 2025, lawmakers increased the credit to $1,600 after Gov. Kelly Armstrong signed House Bill 1176 into law on May 3, 2025.
To qualify, a homeowner must own and occupy a home in North Dakota as their primary residence. Eligible properties include houses,
mobile homes
, townhomes, duplexes and condominiums. Homes held in trust also qualify. There are no age or income limits, and only one credit is allowed per household.
The credit may be applied up to the amount of property tax owed.
“We’re asking the public to take just a few minutes — please come to us, tell us who you are,” State Tax Commissioner Brian Kroshus said during a press briefing at the Capitol on Dec. 19. “That is the difference between applying the credit across the board and diluting it for everyone or having a larger credit amount of $1,600.”
Armstrong also highlighted the impact of the expanded credit in an
opinion column
.
“Since we more than tripled the credit to $1,600, the number of households paying no property taxes in 2025 has increased to 50,000,” he wrote.
Homestead property tax credit: Using health expenses to qualify
Unlike the primary residence credit, the homestead credit reduces the taxable value of a qualifying home.
To be eligible, applicants must be 65 or older or have a permanent or total disability, own and occupy the home as their primary residence, and have a household income of $70,000 or less. There is no age requirement for individuals with disabilities. Only one spouse may apply if a married couple lives together.
Households earning $40,000 or less may qualify for a 100% reduction in taxable value, up to $9,000. Those earning between $40,001 and $70,000 may qualify for a 50% reduction, up to $4,500.
Out-of-pocket medical expenses can be deducted when calculating household income. Eligible expenses include unreimbursed medical costs paid during the prior year for the homeowner, spouse or dependents. Subtracting those expenses may move applicants into a lower income tier or help them qualify.
Stark County Auditor and Treasurer
Karen Richard
said the credit has eliminated tax bills for many approved applicants.
“Out of the 725 approved homestead credit applications, there were 355 applicants who had a zero-dollar tax bill just from receiving the homestead credit,” Richard said.
She added that participation remains low.
“There are most likely many more seniors who qualify but do not realize the homestead credit exists,” Richard said. “Any way possible to get the word out could really help individuals living on fixed incomes.”
Applying for both credits
Some households qualify for both programs. The homestead credit is applied first, followed by the primary residence credit.
“By applying for and receiving both credits, an additional 149 applicants received a zero-dollar tax bill,” Richard said. “Out of 725 approved homestead applicants, 504 owed nothing for 2025 property taxes.”
It’s also important to note that either credit applies to special assessments, which may still result in a balance owed.
Applications for both credits must be submitted to a local assessor or county director of tax equalization between Jan. 1 and April 1 of the year the credit is requested. For 2026 taxes, the deadline is April 1, 2026.
Sarah Ruffin, who processes homestead and veterans credit applications for Stark County, encouraged seniors to seek assistance if needed.
“If you are over 65, own your home and earn under $70,000 per year, come talk to me about the homestead credit,” Ruffin said.
Homestead credit applications are available at
tax.nd.gov/homestead
.Primary residence credit applications must be completed online at
tax.nd.gov/prc
.
“The pen is mightier than the sword.”
As a professional writer with more than 10 years of experience, Kelly lives by these words. With a bachelor’s degree in communication, majoring in broadcasting and journalism, and a fiery passion for writing that began in childhood, she uses the power of words to make an impact in the community — informing, educating, and entertaining a wide range of audiences.
As a journalist, what Kelly loves most about her job is the ability to bring unique stories to the public and give people a voice that can be heard around the world. Whether through print or digital platforms, her goal is to share stories people enjoy reading while spreading valuable information that supports the welfare of southwest North Dakota and its people.
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