Yes, North Dakota Has Fallen Behind On In-Home Care For Elderly And People With Disabilities

Yes, North Dakota has fallen behind in funding home and community based services to keep people with disabilities and the elderly in their own homes. The imbalance of state funding going toward nursing homes and other institutions instead of less expensive in-home services was a cause of concern for many over the years. Unfortunately, the state drug it’s feet and was slow to act. Now, with a federal investigation underway about spending practices the state has started to correct course. Elected officials were warned year ago this could happen if they didn’t act. I know, because I was one of the people raising those warnings.

My first legislative session in the North Dakota Senate was 2013. One of the first bills I introduced was SB 2375 to have the state seek a federal waiver in an attempt to shift and balance Medicaid dollars to keep people in their own homes longer. Many people with disabilities and those aging find themselves in need of some assistance, but don’t meet the level of care necessary for a nursing home. Not only is it better for those in need of care, but it is also cheaper for the state. Unfortunately, many have few options other than entering a nursing home.

That bill, supported by AARP and organizations that focus on helping people with disabilities achieve independence like Freedom Resource Center was met with resistance from long-term lobbyists and legislators. Some claimed it was an attack on nursing homes. Nothing was further from the truth. The reality is, there are populations whose level of care require nursing home services.

That bill was ultimately turned into a study. An interim committee adopted the study and looked into the situation. Unfortunately, not enough was done following that study to expand home and community based services across North Dakota.

Beyond providing services in-home and community based settings at a lesser rate, there was a 1999 court decision that could come into play we warned. In 1999, “The United States Supreme Court held in Olmstead v. L.C. that unjustified segregation of persons with disabilities constitutes discrimination in violation of title II of the Americans with Disabilities Act. The Court held that public entities must provide community-based services to persons with disabilities when (1) such services are appropriate; (2) the affected persons do not oppose community-based treatment; and (3) community-based services can be reasonably accommodated, taking into account the resources available to the public entity and the needs of others who are receiving disability services from the entity.” North Dakota wasn’t providing adequate resources to meet these requirements by law.

Fast forward to 2015 when the interim study was finished and it was time for the state to act. That year, The Department of Justice notified North Dakota “it was launching an investigation in response to multiple complaints it received that allege the state “fails to serve people in nursing facilities in the most integrated setting” and puts people at “serious risk of nursing facility placement,” according to a letter sent to then-Gov. Jack Dalrymple’s office.” The state didn’t disclose that investigation to the public until the Bismarck Tribune was notified of the investigation in 2019. Current Governor Doug Burgum has finally acknowledged, “there has been limited investment in home- and community-based services for individuals with disabilities in North Dakota.”

Finally, North Dakota is acting to balance funding for those in need of assistance. It is long past time considering the Supreme Court decision requiring such a balance was made in 1999. Twenty years ago. The thing is, this shouldn’t have taken so damn long nor should it have taken the fear of what a federal investigation would uncover about state practices to get something done. People with disabilities and those representing aging populations have pushed this for years. Until recently, the state chose not to listen.

Full disclosure: I was employed by Freedom Resource Center for approximately five years. Our staff was intimately involved in trying to keep people with disabilities as independent as possible. That included keeping people out of nursing homes as long as their health and independence allowed. Though I’ve moved on to another career in media, Freedom Resource Center continues that work and recently celebrated 30 years of work in Southeast North Dakota and West Central Minnesota.