No nursing home for Pine Ridge

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PIERRE, S.D. - There will be no nursing home on Pine Ridge, the country's
second-largest reservation, any time soon.

A bill introduced in this year's South Dakota Legislature that would allow
for new construction of a nursing home on the Pine Ridge Reservation or
other reservations was deferred to the day after the session ends, thus
killing the bill.

Empty beds across the state and the state's growing inability to afford the
Medicaid funding for many nursing home residents prompted the state to
place a moratorium on the construction of new nursing homes in 1987.

Six years later, after much debate, the South Dakota Legislature made an
exception to the moratorium and allowed one nursing home to be built on the
Cheyenne River Reservation as a pilot.

"There was much discussion in the 2003 session that the construction and
operation of a nursing home on Cheyenne River would be a pilot project, a
landmark event," said Doneen Hollingsworth, secretary for the Department of
Human Services. "The state would hang a license on the nursing home on the
reservation, that's a first; the construction, that's a first. Will the
elders come back and use the facility? Let's see how it goes," she said.

Committee conversation also indicated that the Cheyenne River nursing home
will be watched to see if it can be staffed and how well it is run.

This issue is emotional to many people, especially Rep. Jim Bradford, who
wrote the bill. Bradford's district includes the Pine Ridge and Rosebud
reservations, and he has worked on this legislation for as many years as he
has served in the legislature.

"We now have a lot more elderly and we have a greater number of people who
are profoundly handicapped. There is a higher rate of accidents on the
reservation, and we have people in homes that are at a greater distance,"
Bradford said.

When nursing homes were being built in the state, not one was built on or
convenient to a reservation. For American Indians living in the United
States' poorest counties, it is difficult to afford a nursing home off the
reservation and visit frequently with elderly family members.

"You have to understand the whole cultural situation, our uniqueness.
People say, 'Why not put up an assisted living facility?' We have 2,000 of
them now. Everyone on Pine Ridge is doing assisted living. What we need is
a place within easy traveling distance for our profoundly unhealthy people.
Our reservation is the fastest-growing community in South Dakota and we are
living longer lives," Bradford said.

An impediment to new construction is the cost of operation. The state
contributes $587,000 in Medicaid funding for a 50-bed nursing home, and
spends $1.4 million per year on nursing homes statewide Meanwhile, there is
a 25 percent vacancy rate.

Some discussion has taken place to possibly transfer or sell empty beds to
other areas, such as reservations, but that is not considered viable at
this time, Department of Human Services officials said.

Deb Bowman, a senior policy advisor to the governor for the Departments of
Health, Social Services and Human Services, said the state is under
pressure to reduce the cost of Medicaid, or at least not escalate the cost.
She said there were more people qualifying for Medicaid and would assume
that most residents at Cheyenne River would be eligible for Medicaid.

Bradford told the Health and Human Resources Committee that a nursing home
may not be built for five years on Pine Ridge. There are no plans in place
now, and he said he didn't know if the tribe could gather enough funding,
but at least he wanted to know that it is a possibility in the future.

Bradford was praised by some committee members for his heartfelt passion
for this issue.

"I've been in and out of more nursing homes than anyone in this room. I
thought I knew a lot about nursing homes, but Jim [Bradford], you have
given me a whole new perspective on nursing homes. People pale in
comparison to your heart when it comes to care of the elderly," said Rep.
Tim Rave, Baltic. Rave voted to kill the bill.