North Dakota
North Dakota long-term care providers call federal rule an 'impossible staffing mandate'
BISMARCK — North Dakota health care providers are scrambling to meet new federal standards set for long-term care facilities. Put in motion by a 2023
executive order,
the series of mandates go into effect Aug. 8 despite nationwide concerns — including a lawsuit filed in June by the American Health Care Association against the Department of Health and Human Services and Centers for Medicare and Medicaid Services.
The rule comes in response to high death rates during the COVID-19 pandemic, citing a Centers for Medicare and Medicaid Services, or CMS,
study
that links fatality rates to high turnover and chronic under-staffing in nursing homes.
Medicare- and Medicaid-certified facilities will be required to have a registered nurse on site 24/7 and increase the number of nurse aids available daily. Rural communities have a year longer to implement the standards than urban communities. Proposed last September and finalized in April, the rule received over 46,000 comments during the 60-day national comment period that closed in November.
“This rule does not only impact nursing facilities, it will impact all sectors of health care and the cost of care in our state,” Nikki Wegner, president of the North Dakota Long Term Care Association, testified in a state Health and Human Services committee meeting on Thursday, July 11.
The association is affiliated with two plaintiffs involved in the CMS lawsuit.
“This, for us and for the rest of the nation, is really an impossible staffing mandate. There are simply not enough RNs to fulfill this requirement. While the intent behind the rule is to improve care quality, it presents really significant challenges,” Wegner said.
Rep. Kathy Frelich, R-Devils Lake, responded to Wegner’s testimony, referencing her professional experience with long-term care as an outreach specialist at the
North Dakota School for the Deaf and Resource Center for Deaf and Hard of Hearing.
“I would say that quality of care generally isn’t related to your RN. It’s usually related to your CNA (Certified Nursing Assistant) on that level. So, I’m concerned that this is just adding a cost,” Frelich said. “Ultimately, that goes back to the residents.”
Long-term care residents pay an average of $403.19 per day — over
$12,000 monthly
— a rate Frelich said would “drastically” increase.
Since the height of the COVID-19 pandemic, the number of nursing homes across the state has been in decline. Six facilities closed in just under three years.
According to the
Bureau of Labor Statistics,
North Dakota would need to add 1,313 nursing home workers to return to pre-pandemic levels.
Data
from the Payroll Based Journal indicates 79% of the state’s facilities would not comply with the registered nurse mandate and only 17% would meet nursing requirements.
The same data shows rural communities in the state would be disproportionately impacted, where 86% wouldn’t meet requirements compared to 65% in urban areas. North Dakota would have to spend a minimum of $4.5 million per year to comply.
Individuals 65 and older make up over 16% of the state population with approximately
8,220 people
receiving care every day, according to the Long Term Care Association.
Some facilities could be considered exempt from the mandates. The
final ruling
states facilities would have to prove the local workforce is 20% or more below the national average and that administrators made “good faith” efforts to hire and retain staff.
Tanya Schnabel, administrator for the Wishek Living Center, said most rural facilities would have to apply for an exemption, including hers. She said the process would add to her already full plate of managing the already “concerning” worker deficit.
“We have housing issues here. So, even if somebody wants to move to town to come work for us, there’s no place for them to live that’s affordable. We wouldn’t be able to do it without contract companies right now, because they’re moving here and giving their time to help care for our residents,” Schnabel told Forum News Service.
“This will just probably be the straw that broke the camel’s back,” she said.
Rep. Kelly Armstrong, R-N.D., and 33 other Republicans cosponsored a joint resolution of congressional disapproval introduced by Rep. Michelle Fischbach, R-Minn., in May. Additionally, Sen. Kevin Cramer, R-N.D., sought to delay the rulings by introducing the VA Report on Proposed CMS Staffing Ratios Act, which would require the Veterans Association to study the risks to elderly veterans posed by the new requirements.
North Dakota’s Long Term Care Association is affiliated with the American Health Care Association and Leading Age. Last May, both entities joined four other plaintiffs in filing a
lawsuit
against the Secretary of the United States Department of Health and Human Services and CMS. According to the filing, CMS exceeded its authority by overriding congressional directives and employing “sweeping” new mandates.
“Hopefully they realize that this will probably kill off some rural facilities. If they close, then people would have to drive to Bismarck or Fargo or Jamestown to see their loved ones. That would be devastating,” Schnabel said.
North Dakota
Today in History, 1993: North Dakota-born astronaut leaves Fargo school kids starstruck
On this day in 1993, Jamestown native and astronaut Rick Hieb visited Fargo’s Roosevelt Elementary School, captivating students with stories of his record-breaking spacewalks and the daily realities of life in orbit.
Here is the complete story as it appeared in the paper that day:
Students have blast with astronaut
By Tom Pantera, STAFF WRITER
Like some astronauts, Rick Hieb downplays the importance of the profession. “We have an astronaut office; there’s a hundred of us in there,” he said. “My office-mates are astronauts. My neighbor one street over is the commander of my last flight. The next street over is the commander of the previous flight. We’re kind of a dime a dozen around where we all live” in Houston, he said.
“We sort of realize that if we make a mistake, it’s going to be of historic proportions,” he said. “But you don’t really think of yourself as being some kind of historic figure.”
But the 37-year-old Jamestown, N.D., native said his importance as a role model comes home when he speaks to children, as he did Thursday at Fargo’s Roosevelt Elementary School.
He kept the kids spellbound with a description of the May 1992 space shuttle mission in which he was one of three astronauts who walked in space to recover an errant satellite — the largest and longest space walk in history. He illustrated his talk with slides and film of the mission, including the capture of the satellite.
But he drew perhaps his biggest reactions when he explained how astronauts handle going to the bathroom during long spacewalks — adult-size diapers — and the peculiar cleanup problems that come with getting nauseous in a weightless environment.
Hieb already has started training for his next mission, when he will be payload commander aboard the shuttle Columbia in July 1994, although he noted the schedule “might slip a little bit.”
It will be an international spacelab mission, meaning a pressurized laboratory containing 80 different experiments will be housed in the shuttle’s payload bay.
“Every one of those scientists wants to teach us their science we’ll be doing on that flight,” he said.
About 40 percent of the experiments will be done for Japanese scientists, about 50 percent will be for Europeans, 5 percent for Canadians and the rest for Americans. The flight will last 13 days, and the shuttle will carry enough astronauts for two work shifts.
Hieb and others in the crew spent much of December in Europe for training and will be going to Europe and Japan for more training until about June.
He said he could have put in for a flight that featured another spacewalk, but he wanted to be a payload commander of a spacelab instead.
A 1973 graduate of Jamestown High School, Hieb earned degrees in math and physics from Northwest Nazarene College in Nampa, Idaho, in 1977 and a master’s degree in aerospace engineering from the University of Colorado in 1979. He joined NASA right out of graduate school, becoming an astronaut in 1986.
His first mission was in spring 1991 as a crew member of the shuttle Discovery.
Hieb would not say Thursday if the 1994 mission would be his last.
“I’m not promising anybody anything beyond this,” he said. “A spacelab flight is not nearly as sexy as putting on a spacesuit and going outside and grabbing onto satellites and stuff like that. But for me, it’ll kind of fill out the checklist of all the kinds of things that mission specialists can do. I’ll have kind of done everything that we do. I’m not for sure going to quit, but I’m not for sure going to stay either.”
Kate Almquist is the social media manager for InForum. After working as an intern, she joined The Forum full time starting in January 2022. Readers can reach her at kalmquist@forumcomm.com.
North Dakota
Plain Talk: ‘You’re talking over 4,000 more victims every year than was the case in 2014’
MINOT — “I just didn’t get it prioritized to get out the door.”
That’s what Attorney General Drew Wrigley said on this episode of Plain Talk when asked about the state’s annual crime report, which is typically released over the summer, but this year wasn’t made public until New Year’s Eve.
The delayed report comes amid an intense debate over crime in North Dakota. The most recent report, covering the year 2024, showed some declines from recent peaks in serious crime categories, but they’re still significantly up over the last decade.
“Violent crime and robbery crimes against the person … came down 2%,” Wrigley said, “but that 2% … makes last year the 10th highest of the last 11 years. You’re talking over 4,000 more victims every year than was the case in 2014.”
Wrigley said he plans to continue his push for stricter sentencing policies in next year’s legislative session. He was unsuccessful in winning enough votes among lawmakers for his proposed reforms during the first two legislative sessions of his tenure in office.
Wrigley also addressed delays in his office in responding to open records and open meetings complaints filed by the public, and the news media — “the number of requests is quite robust,” he said — and said that he planned to address a legislative request for an opinion on Retirement and Investment Office bonuses in “weeks” not months.
Also on this episode, co-host Chad Oban and I react to my story about top executives at the F5 Project giving themselves personal loans out of the nonprofit’s revenues, as well as my report about Legislature’s potentially preempting, during their upcoming special session, a ballot measure for universal school meals with a proposal of their own.
If you want to participate in Plain Talk, just give us a call or text at
701-587-3141.
It’s super easy — leave your message, tell us your name and where you’re from, and we might feature it on an upcoming episode. To subscribe to Plain Talk, search for the show wherever you get your podcasts or use one of the links below.
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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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