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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North Dakota
San Francisco plots risky socialist bank modeled after controversial experiment
San Francisco voters will decide whether the city should have a public bank after city supervisors this week approved such a proposal to appear on the November ballot.
The city would be the first in the nation to have a municipal government-owned bank. Only the state of North Dakota runs a major public bank in the nation.
But the city’s proposal gives no answer as to where the estimated $325 million in start-up costs will come from as the city faces a $643 million budget deficit.
“In a moment like this, asking voters to commit San Francisco to potentially running a financial institution is asking for trust the city has not yet earned,” said Supervisor Alan Wong, one of the two votes against placing the measure on the ballot.
“Our city’s track record shows that meeting those demands is harder than it sounds, even for institutions designed with the right intentions,” he added.
Socialist Supervisor Jackie Fielder, who just returned from a months-long mental health leave, indicated that future legislation would figure out a revenue steam. Supporters of a bank wanted to get ahead of a 2028 expiration date for a state law that gives cities the power to create their own public banks.
“It feels like an incredible tool to add to the city’s tool kit,” Misha Steier, a spokesperson for the San Francisco Public Bank Coalition, told the San Francisco Chronicle. The coalition was founded by Fielder.
“This is the culmination of years and years of movement effort,” Steier said.
A city bank, supporters say, would unlock financing for thousands of housing units that lack funding to address the housing crisis. It could finance climate goals or lend to small businesses in the area.
“This ensures we have an institution run by real bankers that is accountable, nevertheless, to public priorities and public policy priorities,” Fielder said.
“We can build a public bank that prioritizes reinvesting back into what we all need to sustain our local communities,” added Supervisor Chyanne Chen, who brought forth the measure. “Let us use every tool at our disposal to keep the city affordable and to drive an economic recovery that leaves no one behind.”
The bank would be run by qualified bankers appointed by an oversight committee whose members would be selected by local officials. While it does not establish a revenue stream, the ballot measure would at least enshrine the bank’s rules, structure and mission in the city’s charter — including a provision that it would never lend to fossil fuel corporations or weapons manufacturers.
How startup costs will be funded seems to be difficult to answer. Fielder in February attempted another ballot measure that would impose a higher tax on lending companies to help fund such a bank, though that effort was paused to focus on this new ballot proposal.
Any new taxes may be difficult in the current political environment; this past June, voters in the progressive city even voted down a tax hike on highly paid CEOs.
North Dakota’s bank sees deposits mostly from the state’s collections of taxes and fees and corporate accounts. A very small portion comes from residents as “it is the Bank’s policy not to compete with the private sector for retail deposits,” it said on its website.
The bank has mostly seen success and has turned a profit for many years, which can be returned to the state government’s general fund or used for economic development initiatives. A lot of the success can be traced to the the state’s fracking boom, according to research by University of Illinois Chicago professor Robert S. Chirinko.
But unlike commercial banks, deposits into the public bank are not insured by the federal government, which means North Dakota takes on all the risk. California’s law requires federal insurance, which will give the city more regulatory hurdles as no public bank has sought that approval before.
Chirinko said any success replicating North Dakota’s model will heavily depend on funding. San Francisco’s proposed focus on investing in climate-friendly technology or housing may also not pay off immediately.
“There could be a role there for government, but you have to recognize that you’re not going to get your money back,” he said.
Such banks also can face accusations of unfair political influence. In 2016, North Dakota’s bank financed local law enforcement’s militarized response to controversial protests against the Dakota Access Pipeline, sparking liberal backlash.
Already, critics in San Francisco are saying the same political favoritism could happen for how loans and other financial products would get issued.
“What do they want? An SF Public Bank staffed by cronies of absentee SF Supervisor Jackie Fielder,” claimed tech figure and Y Combinator CEO Garry Tan. “It’ll be a tremendous grift mill robbing the city blind.”
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North Dakota
Today in History, 1975: Earthquake rattles portions of Minnesota and the Dakotas, including Fargo-Moorhead
On this day in 1975, a moderate earthquake centered near Morris, Minnesota, shook parts of North Dakota, Minnesota and South Dakota, startling residents but causing no major damage or injuries.
Here is the complete story as it appeared in the paper that day:
Earth Tremor Felt Across Wide Area Including F-M
An earth tremor at 9:56 a.m. today was widely felt in the Fargo-Moorhead area as well as other parts of North Dakota, Minnesota and South Dakota, but the National Weather Service here said it had no reports of damage.
The tremor lasted from two to five seconds, Keith Blessum of the Weather Service said, and ignited telephone reports from a wide area.
The earthquake measured 5.0 on the Richter Scale. Waverly Person of the National Earthquake Information Center in Denver, Colo., said: “The earthquake was moderate and was centered in the Morris, Minn., area. It could have caused much damage in a heavily populated area.”
The quake also was felt in northwestern Iowa. Carl Stover of the Earthquake Information Center said it affected an area 300 miles long and 180 miles wide in four states. He said the exact center of the quake was 10 miles west of Morris.
Person said the earthquake that struck California’s San Fernando Valley in February 1971, killing 54 persons and causing millions of dollars in property damage, measured 6.5 on the Richter Scale.
There were no injuries reported, but authorities in several communities in Minnesota and North and South Dakota reported that residents were startled, buildings shook, dishes rattled and books fell off shelves. Some residents in Alberta, Minn., and Wheaton, Minn., also reported cracked foundations.
Among the first to report locally was Mrs. Paul Dutt, 909 27th St. N., Fargo, who told the Weather Service pictures on the walls moved and a vase moved across the top of the television set.
Marjorie Henderson, who lives on a farm between Enderlin and Lisbon, N.D., reported that the house shook and windows rattled during the tremor, while Mrs. Wesley Belter, who lives south of Casselton, N.D., said that she and four neighbors had similar experiences.
Mrs. Earl Ernst, who lives eight miles east of Wolverton, Minn., also reported that the walls of her trailer home shook and dishes rattled.
Other reports received by the Weather Service at Hector Airport here were from Hankinson and Wahpeton, N.D., and Breckenridge and Ottertail, Minn.; Milbank, S.D., White Rock Dam on the South Dakota border and Canby, Minn.
The earth tremor shook much of northeastern South Dakota and parts of southeastern North Dakota and western Minnesota but apparently caused no injuries, the Associated Press reported.
Donald Johnson, Codington (S.D.) County Civil Defense Director, said the strongest tremors were felt in the South Shore area, about 12 miles northeast of Watertown.
Johnson said a school was evacuated in South Shore, but there were no injuries or major damage reported.
A University of Minnesota professor said that part of that state has a history of minor earthquakes, with about half a dozen reported since the mid-1800s.
Residents in the Willmar, Alexandria, Morris and Long Prairie areas all felt the tremor. It hit about 9:55 a.m., and lasted five to 10 seconds.
No major damage was reported, although the tremor startled many people and shook household furnishings. Some residents in Alberta, near Morris, reported cracked foundations.
Dr. Harold Mooney, professor of geophysics at the University of Minnesota, estimated the tremor would have measured 4 or 4.5 on the Richter Scale. Mooney’s seismograph wasn’t operating when the tremor struck, and he said his was the only such measuring device in the area.
“The motion of a fault in the western part of the state sent out seismic waves at thousands of feet per second, and that’s what the people felt,” Mooney said.
“There is a history of earthquakes in that area, so this one was not without precedent.”
The most recent was near Alexandria in 1950, he said. The most severe was near Brainerd in 1917; that one broke some windows and knocked things off shelves.
North Dakota
Trump visits TR library in North Dakota
President Trump traveled to North Dakota on Wednesday to visit the Theodore Roosevelt Presidential Library before its official opening on Saturday.
“He had a freakin’ wild life,” Trump told an audience at a Western-themed amphitheater, the Associated Press reported. “He didn’t want to be quiet. He wanted to be great.”
The library is expected to be a major source of tourism in rural western North Dakota.
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