On October 6, at the south end of White Clay, Nebraska, a town not known for healing and care, the Oglala Lakota Nation dedicated its new Oglala Lakota Nursing Home, a $16.5-million, 80-bed nursing home for the care of their elderly. The official opening of the facility caps nearly two decades of regulatory and political struggle.
Mary Jo Tapio, a social worker at the home, said the facility has four residents with many more on the way, pending accreditation. “We have 72 people we’re getting ready to move in,” said Tapio. The social worker provided a tour of the facility that includes a theater, library, private gathering rooms for celebrations, a barber and beauty shop, physical therapy room, a large theatre-style multi-purpose room, and four common areas with two sunrooms.
Tapio said staffing is currently at 25 full-time employees, but will approach 100 when the facility is fully up and running. Further expansion may be in the works with the possible addition of an Alzheimers unit.
“When they brought in our first resident, I was with him walking down the hall. I became very emotional,” said Administrator Susan Pourier, “I thought: Finally, they’re coming home. How can you not have that feeling?”
Kathy Janis, the home’s advisory board chairwoman, said, “Early on, when we were trying to get this done, we went to a home in North Dakota. There was an elderly Lakota man who was sitting there, looking out the window. He says to me in Indian: ‘Did you come after me?’ I looked back at him, and said: ‘Not yet.’”
Janis and Pourier have been in contact with nursing homes “all over the country” in their efforts to find Oglala Lakota elderly and bring them home. “Over the years, we’ve lost several of them,” Pourier said, “but we’re fighting to get as many of them as we can.” The administrator said nursing home regulations that prohibit recruiting hamstrings their efforts.
“Nursing homes are among the most heavily regulated industries in the country,” Janis said, “and our people have no experience in this area.” To make up for that shortfall in knowledge and experience, the tribe hired Ron Ross. Ross is president of both Native American Health Management, LLC (NAHM), and Rural Health Development, Inc. (RHD), a health care consulting and management firm that currently operates 26 nursing homes in Nebraska.
The tribe’s contract with NAHM stipulates training and oversight for tribal employees for the nursing home with an eye toward eventual self-management. The first contract with RHD is for three years, and will follow a staged plan to achieve self-proficiency and adequacy in all phases of nursing home operations, Pourier said.
NAHM was formed specifically for the Oglala Lakota Nursing Home to deal with its operations and handle issues unique to its development. But, according to Ross, also to preserve the lessons learned, problems solved and networks developed that would be invaluable for any new tribal nursing homes made possible by Oglala Lakota Nursing Home.
The nursing home was made possible through a loan from the Mdewakanton Shakopee tribe. Before the Oglala Lakota Nation could receive the loan, the tribe had to agree to an independent advisory board and an experienced outside management firm, both non-negotiable items. The three-members on the advisory board are Leonard Little Finger, Duane Brewer, and board chairwoman Janis, all tribal members.
A few tribal council members expressed concern over “lack of control” on how board members are seated. “My concern with the nursing home is the way the charter for board members was drawn up. At the end of the day, our tribe is responsible for these loans. If they fail it falls on us. I’m not saying they’re going to fail, but that’s the deal,” said Robin Tapio, Councilwoman from Pine Ridge, South Dakota. Robin Tapio did underline she was “very happy the home was finished and ready to assist the tribe’s elderly.”
An agreement with the federal government concerning Medicaid reimbursement holds great promise for the future of such facilities, believes Gary Ruess, financial advisor to the tribe. “The agreement is a result of a little known provision in Obamacare,” said Ruess, “that allows for direct negotiations for Medicaid reimbursement with tribes. The tribe’s agreement with the Center for Medicaid Services provides 100 percent reimbursement for resident expenses. The first of its kind in the nation.