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
Vernon Krause
Vernon Dale Krause, 93, of Fargo, ND, formerly of Wahpeton, ND, passed away peacefully on Friday, July 10, 2026, at Heather’s House in Fargo, ND, under the care of HIA Hospice.
A Celebration of life will be held on Monday, July 20, 2026, at Vertin-Munson Funeral Home, Wahpeton. Visitation will be from 9:30 a.m. to 10:00 a.m., followed by a service at 10:00 a.m., with burial immediately following at Fairview Cemetery in Wahpeton.
Vern was born on February 16, 1933, in rural Wyndmere, ND, one of eleven children born to Theodore and Ella (Rohl) Krause. He grew up in Wyndmere and attended Wyndmere Public School, where he left his studies behind to volunteer for the United States Army. Vern proudly served from 1953 to 1956 before transferring to the Army Reserves. He was awarded the National Defense Service Medal and, throughout his life, carried great pride in his years of military service.
He married Jean (Carey) Krause, and together they built a life and raised their family in Wahpeton, where he would spend most of his years. They were blessed with two children. In his later years, after developing severe dementia, Vernon moved to Fargo so he could receive the care he needed and be closer to family.
For 41 years, he worked for the City of Wahpeton Water & Sewer Department, where he was highly regarded and known for knowing every inch of the city like the back of his hand. Even after retirement, he continued to volunteer his time and expertise whenever the City needed him. Among the accomplishments he was most proud of were his early years helping develop the Chahinkapa Zoo.
Above all, he cherished his family. He loved anything to do with his grandchildren — from crafting chairs out of tree trunks and splitting wood, to watching their sporting events and helping them grow into who they were meant to be. His great-grandchildren were a true blessing to him — even if their energy made him a little nervous, he always looked forward to their visits. His nieces and nephews brought him great joy as well especially in his later years and he loved being an uncle to them. When his brother Leyone “Spud” moved to town, Vern couldn’t wait to deliver him the daily newspaper and share a chat. He loved tinkering in the garage, always engineering new ways to drain water, and he was the biggest Green Bay Packers fan around — proud to call himself a team shareholder. After moving to Fargo, Vernon was grateful for the time he was able to spend with his sister, Carole Jean, who had always been his protector.
Vernon will be remembered for his steady hands, his quiet devotion to family and community, and the example he set of showing up — for his country, for his city, and most of all, for the people he loved. He will be deeply missed.
Vern is survived by his son, Mark Krause, Fargo; two sisters-in-law, Priscilla Krause and Donna Krause; two brothers-in-law, Ron Carey and Don Carey; eight grandchildren, Carey, Danielle, Margo, Jodi, Nikki, Kevin, Brad and Tracee; 13 great-grandchildren; and many nieces and nephews.
He was preceded in death by his parents; his wife, Jean Krause; his daughter, Deb Christopher; five brothers, Alfred, Donald, Willard, Kenneth and Leyone Krause; five sisters, Dorothy Peterson, Loretta Dable, LaVelle Odegard, Lucille Kruchek and Carole Jean Johnson-Bohlken; sisters-in-law, Viola Krause, Marleen Krause, Amy Carey and Linda Carey; brothers-in-law, Elroy Odegard, Robert Johnson, Willis Bohlken, Pete Peterson, Johnny Kruchek and Frank Dable; granddaughter, Robyn Krause; and grandson, Jack Bollman.
North Dakota
‘I think I was cheated’: Men speak out after birth switch discovery
GRAFTON, N.D. — Two North Dakota men are speaking out about a 38-year-long alleged mistake that altered their entire lives.
The men and their families are suing Unity Medical Center in Grafton, saying the hospital is responsible for
switching them at birth in 1988
. The hospital denies the allegations.
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North Dakota
Neighbors, not competitors
There are moments that remind us exactly who we are as a community, and the recent fire at Antelope Creek Bar and Grill in Mooreton was one of them. Many already know the awful loss that unfolded. It was a brutally hot day, the kind where the sun feels heavy and the air is so thick, and social media quickly filled with photos, videos, and comments documenting the devastation. Heartbreaking. Gut‑wrenching. A place that held memories for so many suddenly only visions smoke and charred remains.
But even in the middle of all that loss, something else rose up, something that always seems to show itself around here when life gets hard. Kindness. Pure, steady kindness.
The volunteer firefighters were the first reminder. They never cease to amaze me. They drop everything … work, family, whatever they were in the middle of and suit up in layers of gear despite the heat and humidity. They’re regular people with regular jobs, yet they show up like it’s the most natural thing in the world. No spotlight. No applause. Just service. Just heart.
Then came the folks who arrived with water, Gatorade, and anything they could think of to help ease the burden of those battling the blaze. Nobody organized it. Nobody asked. They simply showed up because that’s what people do here. That alone would have been enough to warm my heart.
But it didn’t stop there.
As the day went on, I saw posts from other regional businesses, specifically other bar and grills, reaching out with messages of support. These are places that could easily be seen as competition, yet there they were, offering help, extending care, and standing shoulder to shoulder with the owners who had just watched their livelihood disappear. “We are here. How can we help?” they wrote. No rivalry. No hesitation. Just neighbors being neighbors.
If you ever need a reminder of what makes this valley special, it’s moments like that. People who could have stayed quiet choosing instead to lift someone else up. Businesses that could have focused on themselves choosing instead to stand with another in their darkest moment. It’s the best of us. The part of small town life that doesn’t make headlines but makes all the difference.
We talk a lot about community, but this, this right here is what it looks like. It looks like firefighters sweating through their gear on a 90‑degree day. It looks like strangers handing out cold drinks. It looks like business owners reaching across the aisle to say, “You’re not alone.” It looks like compassion showing up before anyone has time to think twice.
Loss has a way of revealing character. And what I saw in the wake of that fire was a valley full of people who still believe in showing up, still believe in helping, still believe in each other. In a world that can feel divided and loud, this quiet, steady goodness is worth noticing. Worth celebrating. Worth holding onto.
Because when the smoke clears and the debris settles, what remains is the strength of a community that refuses to let anyone face hardship alone. And that, more than anything, is the story worth telling.
That is the true Best of the Valley. The people.
Bobbi Steffens resides in the Southern Valley and discovered her passion for writing through an unexpected path.
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