A long-awaited Nebraska nursing home on the border with South Dakota's Pine Ridge Indian Reservation will begin accepting Native residents early next year to ease a severe care shortage in one of the nation's poorest regions, a project official said Wednesday.
The facility is under construction on a 600-acre patch of tribal land in Whiteclay, a tiny Nebraska village on the South Dakota border that is known for selling millions of cans of beer each year to residents of the neighboring dry reservation.
The nursing home will open for any member of a federally-recognized Indian tribe, but most will likely come from the Oglala Sioux Tribe, said Ron Ross, the president of the Lincoln-based Native American Health Management LLC, which will manage the facility.
"The need is severe," said Ross, a former Nebraska state treasurer. "I think it will give people a reason to think differently about Whiteclay. It's going to take care of elders and provide good jobs for people."
Whiteclay has fewer than a dozen residents, but its four alcohol stores sold the equivalent of 3.9 million cans of beer and malt liquor last year, according to the Nebraska Liquor Control Commission.
Critics say the town fuels the alcoholism on a reservation with widespread poverty, unemployment and one of the nation's highest alcohol-related mortality rates. Tribe members voted in 2013 to legalize alcohol and use the profits for education and treatment programs, but the Oglala Sioux tribal council hasn't taken the formal steps required to allow sales and possession. The main Pine Ridge village sits in Oglala Lakota County, formerly Shannon County, which had the nation's third-highest poverty rate in 2010, according U.S. census data.
The 51,000-square-foot facility will have 60 beds once complete, with room to expand to 80. Ross said he expects the first residents at the home in February or March.
The home will create between 80 and 100 jobs. Project officials have already received employment applications from residents in Gordon and Rushville, Nebraska, Ross said, and they hope to make use of the nursing program at Oglala Lakota College on the reservation.
The Oglala Sioux Tribe is paying the construction costs with a $13.5 million loan from the Shakopee Mdewakanton Sioux Community of Minnesota, which owns and operates that state's largest casino, and $3 million of its own money. The federal government will repay the loan and reimburse the home's operating expenses through Medicaid and private payers.
Even though most nursing homes are funded with a combination of state and federal Medicaid dollars, Ross said Nebraska will not shoulder any of the cost. The Whiteclay facility will rely partially on federal Medicaid dollars, and the federal Indian Health Service will cover the state's usual share.
The project is in Nebraska because of a moratorium on new South Dakota nursing home beds imposed in 1988. The reservation is subject to the moratorium despite the tribe's status as a sovereign nation, according to the South Dakota Department of Health.
South Dakota has 110 nursing homes and 175 assisted living facilities throughout the state, but many are concentrated around Sioux Falls and Rapid City, the state's two largest cities.
"There's an ample number of beds overall in the state, but there are some areas that don't have enough," said Tom Martinec, deputy secretary of the South Dakota Department of Health. "It's one of the drawbacks of the moratorium. In some cases, they're not located in the right places."
Martinec said the moratorium was imposed to promote the development of other long-term care options that are less expensive, but can still serve patients who don't need around-the-clock nursing care.
South Dakota passed a law in 2010 that granted Pine Ridge an exemption to the moratorium, but the exemption was set to end in June 2012 and tribal officials didn't act on it right away. A 2012 law later removed the time limit for South Dakota Indian reservations, but project planners had already broken ground for the Nebraska facility in 2011.
The lack of nursing homes forces some elderly tribe members to move to facilities that are far from their families, culture and native Lakota language, said Leonard Little Finger, 76, who serves on the nursing home's board. Little Finger said an estimated 400 elderly residents who once lived on the reservation have left for nursing home care elsewhere.
"They're beyond the reach of their families, who can go up for maybe an occasional visit," said Little Finger, who lives in the reservation village of Oglala, South Dakota. "Families can't go 200 to 300 miles every weekend just to visit grandma. The nursing home at Whiteclay is a dream that came true."
Little Finger said the closest nursing home is in Martin, South Dakota, about 45 miles east of the main Pine Ridge village. Another is located in Kadoka, more than 100 miles from the main village. The reservation is about as large as Delaware and Rhode Island combined.
The parcel of Nebraska land owned by the tribe was part of a 10-mile-wide, 5-mile deep buffer zone that was created in 1889 to protect the reservation from whiskey peddlers. President Theodore Roosevelt returned all but one square mile of that land to the public domain in 1904, and white settlers flocked to the area.