Steele, ND

To assess viability,sustainability, and operating procedures  of nursing homes with 50 or less skilled beds, a survey (by the Citizens To Save Golden Manor) was sent to 29 of the 35 other facilities in North Dakota.  The other six facilities which were not surveyed included specialized facilities connected to large hospitals and Golden Manor in Steele.  The surveys were sent the administrator of the nursing facility and 15 other of the administrators returned the surveys and two when called responded by phone for a rate of 52%.

When asked if they foresaw their facility remaining viable for the next 5 to 10 years or longer, 13 of the 15 administrators responded yes and 2 said they were unsure.  Thus, 87 of the respondents fully expect their particular facility will be operating in future years.  13 of the 15 facilities reported they were non-profit organizations.  6  reported being independently operated, 3 stated they were part of a chain, 1 reported being a state run facility, and 5 did not respond to the question.

When asked if the facility was operating “in the black”, 69% indicated they were presently operating in the black while 23% indicated they were operating in the red and one of the administrators chose not to respond to the question.  4 of the administrators indicated that they also use supplemental income in the form of donations, gifts, grants, and fundraising events to update or buy additional equipment.  When asked if the facility was able to maintain an occupancy rate of 90% or better 69% indicated their facility was able to keep their census at that level while 31% of the administrators indicated that they were operating at an occupancy rate of 89% or less.  Obviously, the key to operating in the black is maintaining an occupancy rate of 90% or better since that is the occupancy rate required for full reimbursement from the state of North Dakota.  When asked if their facilities had a waiting list, only 5 indicated that they had a waiting list with 2 or 4 people on the waiting list.  Several of the administrators mentioned the stress  that comes with trying to manage a facility when the census drops below 90% level and just how unpredictably and quickly it can happen.

When asked about staffing problems, most indicated finding adequate nursing staff was a chronic problem with a shortage of CNA’s being the most critical need.  To remedy staffing shortages, the administrators mentioned the fallowing remedies:

          Paying a premium such as $3-$5 per for overtime

          Bonuses for picking up extra shifts

          Providing referral bonuses

          Higher pay on week ends

           A flex position for on-call hours who must work a minimum of 3 shifts p/month

         Paying $30 an hour for casuals

          Using contract nurses (very expensive)

          Using a higher wage rate for call in pay

          Paying a higher shift differential rate   

When asked if their facility provided benefits, 92% of the administrators indicated that their facility offered benefits with health insurance being the most common benefit listed.  Other benefits  that some of the facilities provided are:  dental insurance, life insurance, disability insurance, AFLAC, sick leave, paid time off, vacation time, retirement, day care, education/CEU training.   

Because of the wording of the question in regards to cooperatives and outsourcing, there was some confusion as to what was meant by the terms cooperative and outsourcing.  For example, 5 of the facilities are managed by Good Samaritan Society and likewise several of the facilities are a part of a medical complex.  However, 8 of the administrators said they were part of a cooperative.  The copperative efforts mentioned were sharing an administrator, purchasing supplies, and sharing of dietary and laundry staff, and specialists such as physical therapists, doctors and social workers.  In regards to outsourcing, 4 indicated that they used some outsource services such as payroll and accounting. More exploration and a rewording of the question would have to be completed before any definite answers could be accessed.

Finally in regards to whether we should expect to pay between $70,00 and $80,00 for administrator, 1 administrator thought the figure was too low, 7 thought  the figure was accurate, 4 thought it was too high and 3 chose not to respond to the question. 

The results of the survey indicate that it is possible to profitably operate a 50-bed or less nursing facility.  It is interesting to note that the majority of the facilities (13/15) in the survey are non-profit organization.  The key to operating at a profit margin is to maintain an occupancy rate of 90% or greater in order to receive full-reimbursement from the sate.  Staffing problems are another issue of concern with a shortage of CNA ’s being a universal problem.  Although there was some confusion about the terms cooperative and outsourcing, it appears as if most of the facilities have not formed cooperatives nor do they outsource many of their services or operations.  The exception being facilities not only in North Dakota, but other states as well.  Corporate offices for Good Samaritan provide the same soft ware to all their facilities and manage the financials for each facility.  Those facilities that have cooperative arrangements mentioned the sharing of being cost effective.  In regards to hiring of an administrator the range of $70,00 to $80,00 seems to be realistic.

Many thanks to all you great people in Kidder County who took the time to fill out a survey to help us write a business plan for Golden Manor, in the event we are granted our nursing beds back.  The results of the survey are listed below. 

In early December, the Citizens to Save Golden Manor conducted a random survey to determine the preferences of Kidder County residents, in regards to nursing home care.  A total of 363 adults responded with 56% of the respondents being 64 years or younger while 37% were between the ages of 65 and 84 years of age.  The survey was conducted before or after church services and all churches in Kidder County, with the exception of the Lutheran Church in Tuttle which declined, participated along with one church in Burleigh County, the Lutheran Church in Driscoll.  The results of the survey are as fallows.

When asked if you are no longer able to care for yourself and would require 24 hour nursing care where would you want to reside, 82% of the respondents would want to reside at Golden Manor if given a choice as compared to 5% who would prefer the Bismarck/Mandan area, while another 11% would prefer moving out of the area completely to be closer to children or other family members.  2% of the respondents chose not to respond to the question.

When asked whether the respondents had long-term care insurance, 22% indicated that they had insurance as opposed to 77% who indicated they did not have long-term care insurance  .  1% did not respond to the question.  About 1/4 to 1/3 of the respondents who said they had long-term care insurance indicated they did not know if their policy included coverage for assisted-living or home-care.  In addition, of those who said they had long-term coverage, only 77% indicated that their policy included nursing home care.  Thus, one must conclude that possibly there was some confusion between long-term care and life insurance of other insurance policies since normally nursing home care is covered , but assisted-living and home care coverage may or may not be covered.  The older the policy the more likely assisted-living and home care are not covered.

When asked which factor you consider most important when choosing a nursing care-facility, 59% of the respondents indicated that being close to family was the most important factor while 37% indicated that receiving quality care was the most important factor.  only 3% of the respondents indicated that having private room was the most important factor and less than 1% indicated that a variety of activities or beautiful new surroundings were the most important factor.  It should be noted that 36 of the 363 respondents checked more than one factor and of those 36 who checked more than one factor, 5 checked all factors listed even though they were asked to check only one.  There fore their responses are not included in the above percentages.  However, if all their responses are included the data would indicate that being close to family (224 of the 363 respondents) and receiving quality care (155 of the 363) were the two most important factors.  A variety of activities and  a private room was indicated by only 19 and 22 of the respondents respectively while 9 of the 363 respondents checked beautiful new surroundings as a factor.

Based on the results of this rando survey, one must begin questioning the wisdom ofmoving nursing homes to urban areas when the survey clearly indicates that the respondents thought being close to family was the most important factor when deciding where they would want to reside if given a choice.  Also, who benefits the most from building nursing facilities that emphasize private rooms when only 22 of the 363 respondents considered having a private room as an important factor?  Finally, what actions should be taken so that the residents of Kidder County and the surrounding areas have a choice as to where they want to reside and how can their preferences be relayed to those making decisions about the future of the nursing home industry in North Dakota?

One of the loveliest places on the prairie lies just southeast of Steele on the Kidder and Stutsman County line.  In 1977  the Central Grasslands Research Extension Center (CGREC) was built 6 1/2 miles northwest of Streeter. It serves 18 counties in what is known as the Missouri Coteau region, an area bound by the Missouri River on the west and the James River on the east. This is a land of rolling hills and shallow wetlands.  Hence the name so familiar to birders “the Prairie Pothole region”.

 Although I was swamped with things to do last Thursday I decided to attended the Grasslands annual field tour and I came away with a much deeper appreciation for the land and it people.

I love the prairie with its changing seasons.  Spring always brings the birding migration of literally hundreds of birds.  When I tell you I need a check list to just to keep track of how many different species I see while birding I am not kidding.  Summer brings the smell of clover and alfalfa being made into hay under the blazing prairie sun and clear blue sky.  Sometimes the heat is so intense that just for a split second it takes your breath away. Then fall comes and trees shimmer with gold, red, and green leaves as the migrating birds say good by and make the long trek to warmer lands in the south.  And who can not love winter? The howling winds, the dark nights snuggled under a quilt drinking hot chocolate and watching all the movies you didn’t have time to catch in the summer. 

Perhaps living here I may miss out on some “cultural” opportunities that large cities offer but my life is rich and full. 

Bill Well from Medina summed up my feelings with this quote, “I came to Medina to teach Vocational Agriculture in 1956 and I’m still here.  The Coteau is where my wife Janet and I built our homestead and raised our family.  The Coteau offers such a variety of opportunities to raise crops and livestock that is almost unequaled.  The wildlife and migratory bird populations on the Coteau has been a definite influence on our family as they grew and started careers in agriculture and education here in North Dakota on the Coteau.  I wouldn’t have traded my life and my experiences on the Coteau for anything.”

Isn’t hard to believe that summer is flying by?  Next week will be the 4th of July already and then it will be time for busy Moms to think about school shopping.

Butthis week something special just for kids is happening at the Four Seasons Park next to the football field.  Child Evangelism Fellowship (CEF) will be holding a free day camp for kids in the park on Monday and Tuesday from 10:30 am to 2:00 pm.  The outdoor camp is geared for elementary kids.  Pre-schoolers are welcome too but they must be accompanied by an adult.  The only thing you will need to bring is a sack lunch.

During a recent visit to the Kidder County Community Health Clinic in Steele, I asked a waiting patient what it meant to her to have the clinic.  “I love it and I’m glad we have the clinic.  It is very much needed and it saves in time and travel,” said Dora.  Since I had heard the great story of how the community came together to open the clinic I wanted to see the clinic first-hand.  Both patients and clinic staff talk about the benefits of having the clinic.  According to Anna, the clinic receptionist, “The clinic offers a service that really benefits the community.  From our elderly population to our young families, the clinic provides access to basic health care.  It’s also about being convenient, keeping jobs in the community, and saving long distance travel expenses for our patients.”  The Clinic opened in December of 2006 and the people of Kidder County will tell you it was a true Christmas present.         

If you are looking for a fun family sport try disc golf.  I found a new twelve-hole disc golf course nestled in Steele’s Four Seasons Community Park.  The twelve hole disc golf course is designed for a novice beginner like me and the most avid Frisbee golfers.  Named after the heritage of many local area residents and funded in part by the Horizon Program, the ‘Norse Course Disc Golf Santuary’ is also becoming a popular spot for birding information.  I found information on 48 different birds that can be found and heard around the Steele area.  At first, the word ’sanctuary’ seemed a odd word for a place to throw a flying disc into a basket.  However, the more I tried to get the fewest number of disc throws into the baskets throughout the course, the more I was also learning about birds.  The combined challenges of improving my Frisbee skills and expanding my knowledge of birds brought about a new appreciation for the the word ’sanctuary.’   I could have spent the entire day in Steele at the Norse Course Disc Golf Sanctuary.  It’s free to the public.  Bring your own discs, family and friends and enjoy a great day of golfing and birding in Steele. 

Congratulations to the community of Steele on your recent selection as one of the top three finalist for the Federal Home Loan Bank of Des Moines’ Capital Community Award.  This award recongizes Steele’s strong commitment to economic development and their efforts to creating innovative solutions to small community challenges and building a lasting future for their residents.  It is exciting to hear that Steele was selected from a five state nomination list that included the states of Iowa, Minnesota, Missouri, North Dakota and South Dakota.  More details on the award are available at www.fhlbdm.com

I have enjoyed the whole experience of the Horizons project.  It has not only challenged me to totally re-evaluate my thinking about the definition of poverty but it has challenged me to grow as a person.  So I must admit that at times I feel a bit dazed.

Think what this program has done for our community. 

Over 40 people, young and old, took part in a six week study circles.  27 people took the LeadershipPlenty Training.  Over 200 people took part in the community survey.  Our library is stocked with some of the best self help books in the country. These are marvelous resources. We have an extremely efficient, user friendly, digital camera to take pictures for the blog, which I plan on mastering in my life time.

The Kidder County Food Pantry stepped out from under the umbrella of the Ministerial Association to create their own board to better serve those in need.

Last fall we reached beyond our own comfort levels  nearly a hundred people listed to Carrie Gross describe her role in keeping homeless kids in school in Bismarck.

We have a gorgeous new disc golf course and the school will be helping us sell the Frisbees here in Steele.  This course is at one of our most beautiful parks.  What a great way to utilize the park!  What a great way to spend family time! 

The Ministerial Association is planning to start a SADD chapter to give kids the tools to make better life choices.

And the movie theatre project is slowly moving along in spite of various challenges.  We will be holding a town hall meeting in the near future to get volunteer input.  So watch for ads in the Ozone on times and dates.

Many thanks to all of you who have made Horizons happen.  July 9th will be the wrap up meeting in Bismarck at the Ramkota so please let me know if you would like to attend.  We can all be proud of the hard work that has taken place!

During a recent community rural forum, representatives from Steele discussed what it took to keep medical services available in the community.  The partnerships formed and the combined efforts of individuals and businesses to open a medical clinic to ensure access to basic medical care deserve applause.  Their story is an inspiration for those who want to learn what it takes to retain basic services in a rural community.

Hi Kathy,

Thanks for the post. 

We are very proud of our community clinic and we were one of the first cities in ND to earmark 1% of our city sales tax for health care.  I’m not sure if you are of aware of this but the repayment of medicare and medicaid do not keep up with today’s cost of medical care.  Health care facilities are only reimbursed a percentage of the actual billing.  So having this little cushion of tax money every quarter is most helpful.  Plus being able to use our sales tax money like this lets everyone in the community support the clinic.  Each time we fill gas, buy groceries or eat at the cafe we can say we have “donated” to the clinic.

Alva

I have long been a great fan of rural communities.  I was born in one.  Raised in one. And when our children were old enough to start school my wife, Alva, and I made a decision that we wanted our children to receive their education in one.

At first the transition to rural living from city life was a little difficult.   But I became ingrained in the slower pace of rural living. Over the years my joy in living here has continued to grow until, now, I find it hard to picture myself living anywhere else. 

On Friday June 13th Alva and I attended a rural community forum in Bismarck sponsored by the ND Community Foundation and facilitated by Cher Hursrud.  The purpose was, not only to give rural communities a chance to share their success stories, but to encourage us to network and problem solve. The room at the Heritage Center was infused with the kind of positive energy that successful adventure always brings. 

We heard how Reeder, population 150, has renovated their old school into a multi purpose building that houses rental rooms for hunters, a first class work out room, commercial kitchen, and a gym.  It is the gathering place for the community.  We were cheered by the success of New England in starting a community owned store.   We marveled at the creativity of North Dakota folks as Annette Schilling from ND Tourism, shared information on learning based vacations now offered in the state.  We were challenged by Cheryl Planert of Beach and her quest to  organize organic farmers and spread the word about the benefits of knowing where our food is grown.  (Consider this fact: most of the potatoes we buy are sprayed 10 times before they find their way to our local grocery stores.)  Patti Pettri inspired us with her report the Bowdon Development Group who are working on keeping their meat locker plant and grocery store open since the owner suddenly died this spring. And, lastly, we were given pertinent information about starting a community Foundation by Patricia Bowen of Ellendale.

Yes, Friday was a refreshing day.  A day that was spent with great people who have great vision.  I am more certain than ever that the future is bright for rural communities who will accept the challenge of finding new ways to grow.