Organizations representing South Dakota nursing homes are hopeful President-elect Donald Trump will halt a staffing rule they say could devastate their industry.

The organizations have said for over a year that a new staffing rule imposed by the U.S. Centers for Medicare and Medicaid under President Joe Biden will decimate nursing homes in the state. The price tag for South Dakota nursing homes will be just under $20 million, or $205,000 per facility, they estimate.

“I think we can look forward to different outcomes with those different policymakers in place, not taking that for granted or counting on it as we continue to pursue other strategies,” said Brett Hoffman, director of public policy and communications with the South Dakota Health Care Association. He spoke to the Legislature’s budget committee Thursday in Pierre.

The rule is aimed at increasing accountability and addressing chronically understaffed nursing homes, which can lead to low quality and unsafe care, according to the U.S. Department of Health and Human Services. 

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Urban areas of the state, such as Sioux Falls and Rapid City as well as midsize cities such as Aberdeen, Spearfish and Yankton, must meet requirements by May 2026. Rural areas have until May 2027.

The most controversial rules dictate that a registered nurse be on staff at all times and that nursing homes meet a staffing standard of 3.48 hours per resident day.

It would be “impossible” to implement the requirements in South Dakota, Hoffman said. He added that up to 600 nursing home residents — 12.5% of the statewide nursing home resident population — would be at risk for displacement.

After a sharp decline during the pandemic in staffing and slow recovery since then, the rule could cost significantly more if nursing homes must contract travel nurses, said Justin Hinker, vice president of post-acute care at the South Dakota Association of Healthcare Organizations.

About 5% of South Dakota facilities currently meet the hours per resident day requirement, Hinker added.

Two lawsuits are challenging the rule, including one involving South Dakota, and there are several federal bills that could overturn the rule, Hinker said. A potential U.S. Supreme Court decision in a separate case could impact federal agencies’ rulemaking authority.

“We’re not opposed to adequate staffing, but we’re not in favor of a one-size-fits-all,” Hinker said.

Hinker told lawmakers a withdrawal of the rule is not the only action needed to support nursing homes in the state. Lawmakers should continue to invest in the “health care continuum” for South Dakota seniors, he said, including assisted living, home health, hospice and palliative care.