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. 

SD awards $2M in grants for long-term care, but facilities sought $5M more

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.

by Ashley Murray, South Dakota Searchlight
November 15, 2024

WASHINGTON — President-elect Donald Trump continued his blitz of Cabinet and senior staff selections, closing the week Friday with the announcement that North Dakota Gov. Doug Burgum, a former presidential rival turned Trump surrogate, is his candidate to lead the federal department responsible for vast swaths of federal lands and U.S. relations with Native American tribes.

Burgum also will head up a brand new “National Energy Council,” Trump said.

In just 10 days since his decisive win, Trump from his Mar-a-Lago estate in Florida rapidly disclosed his picks to lead major U.S. policy areas, including relationships around the globe and the health and well-being of Americans at home.

The president-elect, who trounced Democratic nominee Kamala Harris on Nov. 5, has named roughly half of his intended nominees for the 15 executive departments that traditionally comprise a president’s Cabinet. If Trump follows through on his nominations, he’ll need the U.S. Senate’s approval for each.

That feat could be an uphill battle for Trump’s more controversial nominees — namely a Fox News host to oversee the entire U.S. military, a vaccine skeptic to administer health and science funding, and a recent Florida congressman who was investigated by the Department of Justice to wield the power of attorney general.

Trump has also drawn from his 2024 campaign staff, personal attorneys and pool of first-administration loyalists to fill several senior White House staff picks that do not require Senate approval.

Here are some of the president-elect’s latest choices:

Burgum as secretary of the Interior. Trump announced Friday he will nominate Burgum, a former 2024 Republican presidential hopeful, to lead the U.S. Department of the Interior. The $18 billion, 70,000-employee department oversees 11 bureaus that have a vast reach over relations with Native American tribes; control of hundreds of wildlife refuges and fish hatcheries; and the management of 245 million acres of public land, a third of the country’s minerals, and leasing for energy extraction from U.S. ocean waters. Trump said in a statement Friday that he will create a National Energy Council, with Burgum at the helm, “to oversee the path to U.S. ENERGY DOMINANCE,” he wrote. Burgum, a wealthy software executive turned governor, has filed a handful of lawsuits against the agency, including a challenge to open more oil and gas leasing in his state, according to the North Dakota Monitor. He dropped his 2024 presidential bid in January and endorsed Trump.

Former U.S. Rep. Doug Collins of Georgia as secretary of Veterans Affairs. Trump announced Thursday his choice of the ex-congressman from Georgia to lead the agency that distributes health care to 9 million veterans at over 1,200 facilities annually. The department, which asked Congress for a $369.3 billion budget for next year, also oversees veterans disability benefits and manages national veterans cemeteries and memorials. Collins, a lawyer, pastor and member of the U.S. Air Force Reserve since 2002, served in the U.S. House from 2013 to 2021, according to his congressional biography.

Robert F. Kennedy Jr. as secretary of Health and Human Services. The president-elect tapped Kennedy Jr. Thursday as his choice to lead the massive 80,000-employee Department of Health and Human Services that projects mandatory spending — think Medicare and Medicaid — will reach $1.7 trillion in 2025, and discretionary spending at $130.7 billion. Also under the huge HHS umbrella are the Food and Drug Administration, the Centers for Disease Control and Prevention and the National Institutes of Health. Kennedy Jr., a former 2024 presidential hopeful who dropped out and endorsed Trump, is well known for his spreading of vaccine misinformation. The former environmental lawyer and son of the late Attorney General Robert F. Kennedy also made headlines during the 2024 race for admitting he dumped a dead bear cub in New York’s Central Park nearly a decade ago, among other unusual revelations.

Trump attorney D. John Sauer as solicitor general of the United States. In his last staffing announcement Thursday, Trump said he intends to nominate his defense attorney in his federal election interference case to be the U.S. Justice Department’s litigator before the U.S. Supreme Court. Sauer successfully argued Trump’s presidential immunity case before the Supreme Court in April. Sauer made headlines at Trump’s federal January appeal hearing for appearing to argue that a president’s order for SEAL Team Six to assassinate a political rival would be covered under presidential immunity. Sauer, Missouri’s former solicitor general, was among those who filed friend-of-the-court briefs in support of Texas’ lawsuit to overturn the 2020 presidential election results.

Former U.S. Rep. Matt Gaetz as attorney general. Trump dropped a bombshell Wednesday afternoon when he revealed he will nominate the now-ex-lawmaker Gaetz of Florida as attorney general. Gaetz resigned from the U.S. House hours after Trump’s announcement, getting ahead of an anticipated ethics report on his alleged sexual misconduct and illicit drug use that could have been released Friday, according to several news outlets. Politico reported Friday that U.S. House Speaker Mike Johnson, R-La., does not want the report released, despite pressure from some in his own party. Gaetz, who if confirmed by the Senate would be the nation’s top law enforcement officer, was investigated by the Justice Department for two years, beginning under Trump’s first administration, for possible sex trafficking. The probe was dropped last year, as has been widely reported. Trump campaigned on meting out retribution from the Justice Department for his political foes following two federal investigations into his alleged stockpiling of classified documents at his Mar-a-Lago estate, and his alleged subversion of the 2020 presidential election. Gaetz is a staunch Trump ally and was among the nearly 140 House Republicans who objected to the 2020 election results. Trump has also tapped his personal criminal defense lawyer Todd Blanche to serve as deputy attorney general.

Within the past seven days, Trump also announced his plans to nominate former chair of the U.S. Securities and Exchange Jay Clayton to return to the post, former Democratic Congresswoman-turned-Republican Tulsi Gabbard as the director of national intelligence, Sen. Marco Rubio as secretary of State, Fox News host Pete Hegseth as secretary of Defense, South Dakota Gov. Kristi Noem as Homeland Security chief, GOP Rep. Mike Waltz as national security adviser, former head of national intelligence John Ratcliffe as CIA director, former Immigration and Customs Enforcement Director Tom Homan as “border czar,” former Trump White House adviser and immigration policy architect Stephen Miller as deputy chief of staff for policy, House Republican Conference Chair Elise Stefanik as U.S. ambassador to the United Nations, former Congressman Lee Zeldin as Environmental Protection Agency administrator, and his 2024 campaign manager, Susie Wiles as his chief of staff. 

The president-elect made waves as well when declaring this past week that billionaire campaign donor Elon Musk and former presidential hopeful, now a staunch Trump supporter, Vivek Ramaswamy will together run an ambiguous entity titled the Department of Government Efficiency. Shortened to DOGE, it is still unclear how the organization would operate and interact with the federal government.

Last updated 3:40 p.m., Nov. 15, 2024

South Dakota Searchlight is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. South Dakota Searchlight maintains editorial independence. Contact Editor Seth Tupper for questions: info@southdakotasearchlight.com. Follow South Dakota Searchlight on Facebook and X.