PIERRE, S.D. - State lawmakers are revisiting the issue of how tribal governments can build nursing homes for tribal residents, many of whom are far from their lifelong homes on the reservation.
While tribal leaders have asked the state's legislators to lift a moratorium on nursing homes that would allow such construction, federal legislation may allow the tribes to side step the state's regulations.
Aubrey James, a representative from Democrat Sen. Tim Johnson's office, said Senate Bill 212, part of the Indian Health Care Reorganization Act, will circumvent the moratorium, allowing the tribes to bypass it and access the third-party reimbursement for Medicare and Medicaid.
"The moratorium in South Dakota blocks building of nursing homes and law blocks transfer of funds," State Rep. Thomas Van Norman, D-Eagle Butte, said.
Van Norman said tribal elders continue to be forced into long-term care environments where staff is less sensitive to their needs. Lonely American Indian people sit in rooms at nursing homes far removed from their relatives.
"Indian people are not very well understood by the staff in those institutions and are far from home."
James said Senate Bill 212, if passed, will allow the tribes to tap into Medicare and Medicaid for tribal members.
"I know over the years you have worked at the state level. I'm glad to hear about the bill 212," said Sen. Richard Hagen, a Democrat from Pine Ridge.
There is only one tribally operated nursing home in South Dakota and it is owned by the Rosebud Sioux Tribe. Other tribes in the region are willing to build, but are waiting for the ability to pick up the third-party billing which will provide additional operating funds beyond what the tribes may be able to fund.
State Sen. Paul Valandra, D-Mission, said it takes nearly $200,000 to operate the White River nursing home facility owned by the tribe. Valandra indicated it is no longer an investment for financial gain, but a remedy for needs of a growing number of reservation seniors and their families. More families are facing having to enter a loved one into long-term care in addition to those elders who move back to the reservation to live out their golden years.
Bryce In The Woods, a Cheyenne River councilman, shared comments of people from five reservation districts who want to see a nursing home there.
"Being sent away is more like a death sentence," In The Woods told lawmakers at a State Tribal Relations Committee meeting July 9.
"Sensitivity isn't there," he said of nursing homes in some areas of the state.
"Praise be if Senate Bill 212 gets passed. They need to do it. It is long overdue. Alta and myself serve on the elderly protection team. We desperately, desperately need a home on our reservations. I'm so happy," he said.
"We're absolutely ready. We have 45 people in nursing care centers in South Dakota. We probably have that many who are ready to go in. We have plans of that facility," Alta LeClaire said.
She said there are eight manors where elders are living, including some off the reservation. I'm sure people would come here, plus I think people from Standing Rock would come there. There are elderly people in at least 15 homes in Eagle Butte where elderly people are ready to move to long-term care.
"At some point these people want to come home to be with other Indian people," she said.
Mobridge has a waiting list and even efforts to place people in beds under emergency placement are difficult, she said.
"We are not very successful. Some of these elderly people placed in Mobridge could hardly speak English. We try to find people who can speak their language. If you go visit these elderly people, they are going to ask you to take them home."
And, nursing home facilities on the reservation could provide employment for a large number of people, LeClaire said.
Valandra said his mother had her pick of area nursing homes, but chose the White River facility because she wanted to be close to American Indian people.
A newer nursing home in Winner, which has struggled financially, was one she considered, but when it came down to making the choice she was willing to settle for an older facility so she could be in the company of people she knew, he said.
Valandra, a member of the Rosebud Sioux Tribe, cautioned tribal leaders, reminding those considering building nursing homes that it is an expensive venture to operate.
"We lose a couple hundred thousand dollars a year there. It takes a lot of money to fly one of these things."
Van Norman said his uncle, in an off-reservation nursing home wanted to go home. When he attempted to leave, he was placed in an Alzheimer's ward. He also spoke on behalf of Cheyenne River residents who want to see their elders closer to home.
"We have to think creatively," he urged.
The committee will hold a series of meetings on and near reservations to discuss other issues including redistricting, racial profiling and child placement during the next few weeks.
Pine Ridge tribal leaders have proposed building a nursing home on tribal land across the border in Nebraska to skirt the moratorium issue.
Standing Rock tribal leaders face a similar moratorium in North Dakota that has limited their opportunities for building long-term care facilities.