WHITE CLAY— As impressive as the Oglala Lakota Nursing Home south of White Clay already is, construction got underway this October on a 12-bed “memory unit” wing expansion, to provide Alzheimer’s and dementia patients with specialized service.
The Nursing Home Board met in mid-September to set the first wave of construction in motion. Richard Rangel handled the construction of the present facility, and his Rapid City based firm which also built the Rapid City Hospital, will handle the construction of the memory wing.
“The game plan is to get a floor slab completed by the first part of December,” Rangel said, “at worst by Christmas, and that way framing, which is a little less weather dependent, can begin in December. Generally, the rest of the design will be done for bidding by the first part of December that would be all the interior finishes, floors, windows, hardware, those sorts of things.”
The nature of the soil on the tribal land in Nebraska creates a special problem for Rangel: “One of the things that takes place before any of the concrete work, is something we call an ‘engineered fill.’ In this instance, the site had a very fine powdery type soil, and what we’re required to do by the testing company, the geo-tech company, we’re required to dig three feet deeper than where the footings are going to be. And then with controlled moisture, water, we have to back fill back up to where the bottom of the footings are going to be. This will stabilize your building walls so that you don’t have movement over the years. Same thing under the floor slab, we have to dig down three feet deeper and pack all that back in with water.”
The original design of the nursing home allowed for expansion, and the memory wing expansion will soon get the facility near its capacity. Ron Ross, who heads up a Native American Health Care Management consulting firm out of Lincoln, Nebraska, has been the indispensable cog that has driven the efforts to realize the nursing home. His company now manages the nursing home, is in charge of staffing, but also understands the relationship with the federal government necessary to fund the home. Board Director, Kathy Janis, has been working to realize the home for even longer. Fourteen years ago, she first approached the state of South Dakota with a nursing home proposal. She ran into a brick wall.
“The third time we went there,” Janis said, “the secretaries were the only ones came to meet with us. They said no there’s a moratorium on it, we walked out of there, got home, and they said, ‘We got land in Nebraska.’”
That is where Ross entered the picture. He understood how the system worked, and he knew exactly what was needed to make the nursing home a reality.
Mario Gonzalez is the tribal attorney that handled the legal aspect of the financing when the home was being built, with $13.5 million of funds from a Shakopee loan, and $2.5 million from the tribe, and he now advises the nursing home board: “There’s a lot of teamwork that went into this, it isn’t just recent, it goes clear back. Kathy’s been involved for 14 years. Gary Russ played a very instrumental role, he doesn’t get enough credit, really a mover to keep things going.”
Russ was the tribal financial advisor, but his Nebraska state connections were vital in getting the political and logistical support to fund the nursing home. But Gonzalez gives high praise to Ross: “We couldn’t do this without him, because he’s got the understanding, expertise, to put all of this together.”
That understanding is based upon enhanced Medicaid payments, without which, the tribe could not afford the nursing home. “Financially the facility is fortunate that we have entered into a relationship with Indian Health Service,” Ross said, “which then has a relationship with the center for Medicare and Medicaid services. Tribal facilities that have a relationship with IHS enable them to access enhanced Medicaid rates, which, then in turn, pays for the operating costs of the building, nursing, housekeeping, administration, maintenance, all the operating costs, as well as the interest and the depreciation which makes the mortgage payment.”
Ross is involved helping tribes all across the nation, start their own health care operations, funded by enhanced Medicaid payments: “Tribal facilities are starting to explore that and there are about 18 nursing homes across the United States that are tribally owned and operated. There’s a few tribes exploring putting in their own nursing home and so there’s a national organization called UNITE and we have gotten involved with those folks in helping other tribes understand how to access enhanced Medicaid rate, because you can’t operate a facility on the normal Medicaid rate on facilities, there’s just not enough money there, and especially if you consider that probably a hundred percent of your residents are gonna be on Medicaid. A normal nursing home might have fifty percent of their residents on Medicaid, and you can charge private pay enough to make up for what Medicaid doesn’t pay.”
“Ron has been traveling to all the tribes,” Kathy Janis said, “assisting them, but this was the first tribe.”
The memory wing, will allow the Tribe to keep even more tribal members near home and relatives because it will give the facility the wing necessary to accept people with memory issues.
“It’s really an important thing because we have a lot of people that need that care,” Gonzalez said. “A lot of thought went into this. For example, we looked at would we like to have a lot of color in there, and I think one of the architects said you put color in it, it confuses people, because they come to the edge, and they think they’re walking a foot off the edge, so you have to really understand all of this, it’s really specialized care. You have to really accommodate the kind of care they need, and all of that goes into the architectural structure so that can be accomplished.”
Ross described the new memory wing in greater detail: “Every resident has their own room and their own bathroom which we feel is necessary. You notice that the hallway between the rooms is large compared to normal nursing homes, and the reason for that is people with dementia, they need to wander, and there will be some stations along the way that gives them an opportunity to stop and rest. This wing is designed for folks that have a dementia, Alzheimer’s, or other types of dementia. It was important for each resident to have their own bathroom, their own room, sometimes in their confusion they might not like somebody in the bathroom. When you first come in from the other part of the building, there’s an activities area for them, there’s a dining room right there, and that will be easy for family members, if they want to join a meal with a family member, and it’s all next to the windows, so this will give the dining area a huge amount of light. Folks with dementia, they need a way to walk off their energy, and so in the summer and fall and spring they can go outside and just take in the outdoors, and we’ll have things for them to look at and do. That’s a nice design, and you can see there’s some outside tables for them to sit at if they want to do that, too, and we’ll probably have some flower beds for them.”
The Nursing Home Board started with three members, Kathy Janis, Leonard Little Finger and Duane Brewer. Little Finger and Brewer have both passed on, and have been replaced by Valerie Janis and Seymour Young Dog. The tribal nursing home will always be the first facility to be totally funded by Medicaid, to not only save the Tribe money, but the state as well, and still provide the Tribe with something it did not have and sorely needed, a nursing home for the elderly, instead of shipping them off, sometimes thousands of miles from home, away from their family and their culture.
(James Giago Davies is an enrolled member of the Oglala Lakota tribe. He can be reached at skindiesel@ msn.com)