North Dakota Regulations

North Dakota Long-Term Care Licensing Authority: Regulations and Oversight

The quality and safety of long-term care facilities in North Dakota are rigorously overseen by the North Dakota Department of Health and Human Services (ND DHHS), primarily through its Health Facilities Unit (HFU) [1]. This unit is the state's central licensing authority, responsible for ensuring that all healthcare providers and facilities, including those offering long-term care, meet stringent state and federal standards for patient health, safety, and quality of service.

This comprehensive guide explores the critical role of the Health Facilities Unit, the different types of long-term care facilities it licenses, the detailed regulatory framework in place, and the enforcement actions taken to protect North Dakota's vulnerable residents.

I. The Role and Mission of the Health Facilities Unit

The mission of the Health Facilities Unit is to promote the health, safety, quality of life, and independence of North Dakota residents by educating and monitoring the care and services provided by healthcare suppliers and providers [2]. This is achieved through a multi-faceted approach that includes:

• Licensure: Granting initial licenses and renewing them annually for various healthcare facilities.
• Certification: Ensuring facilities that wish to participate in the Medicare and Medicaid programs meet federal certification requirements.
• Surveys and Inspections: Conducting unannounced, periodic inspections to verify compliance with state and federal regulations.
• Complaint Investigation: Investigating complaints of abuse, neglect, or regulatory violations in licensed facilities.

The HFU's work is essential to maintaining a high standard of care and providing a safe environment for all residents receiving long-term care services in the state.

II. Types of Licensed Long-Term Care Facilities and Regulations

The HFU licenses and certifies several categories of facilities that provide long-term care services. The regulatory requirements vary significantly based on the level of care provided, as outlined in the North Dakota Administrative Code and Century Code.

A. Skilled Nursing Homes (SNF)

Skilled Nursing Homes provide the highest level of medical care outside of a hospital. They are licensed by the state and certified by the federal government to participate in Medicare and Medicaid programs.

• Regulatory Authority: Licensing is governed by Chapter 33-07-03.2 NURSING FACILITIES of the North Dakota Administrative Code [3].
• Scope of Care: Services include 24-hour skilled nursing care, rehabilitation services (physical, occupational, and speech therapy), and medical management for complex conditions.
• Staffing Requirements: Regulations mandate specific staffing levels to ensure adequate care, including registered nurses (RNs), licensed practical nurses (LPNs), and certified nurse aides (CNAs). The facility must ensure sufficient staff to meet the needs of all residents.
• Resident Rights: SNFs must adhere to extensive federal and state resident rights, including the right to be free from physical and chemical restraints, the right to privacy, and the right to participate in care planning [4].

B. Basic Care Facilities (BCF)

Basic Care Facilities are licensed to provide personal care and services to residents who require assistance with activities of daily living but do not require the level of skilled nursing care found in a nursing home. This category often includes facilities that function as assisted living.

• Regulatory Authority: Licensing is governed by Chapter 33-03-24.1 BASIC CARE FACILITIES of the North Dakota Administrative Code [5].
• Scope of Care: Services typically include assistance with bathing, dressing, medication management, meals, and housekeeping.
• Staffing Requirements: While specific staffing ratios may not be mandated, BCFs must provide 24-hour supervision and sufficient staff to meet the needs of all residents, as determined by the residents' care plans [6]. The facility must also have policies to check state registries and licensure boards prior to employment [7].
• Medicaid Status: It is important to note that BCFs are generally not certified by CMS to participate in the Medicare/Medicaid programs for the basic care services themselves [8]. However, the state's HCBS Waiver may cover the cost of "Adult Residential Care" in certain settings.

C. Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)

These facilities provide comprehensive and individualized health care and rehabilitation services to people with intellectual disabilities or related conditions. The HFU ensures these facilities comply with both state licensing standards and federal certification requirements for Medicaid participation.

III. The Licensing, Survey, and Enforcement Process

The process for a facility to obtain and maintain a license is rigorous and continuous, with the HFU employing a robust system of oversight and enforcement.

A. Initial Licensure and Ongoing Surveys

1. Initial Licensure: A prospective facility must submit a detailed application, including architectural plans and operational policies. An unannounced survey is conducted before the facility can open to ensure compliance with all regulations.
2. Periodic Surveys: Licensed facilities are subject to periodic, unannounced surveys. For federally certified facilities (like SNFs), these surveys are conducted on behalf of the Centers for Medicare and Medicaid Services (CMS) and typically occur at least once every 15 months. Surveyors review resident care, facility operations, and compliance with resident rights.
3. Complaint Investigations: The HFU also conducts unannounced investigations in response to complaints of abuse, neglect, or regulatory violations.

B. Enforcement Actions and Penalties

If a facility is found to be out of compliance with state or federal regulations, the HFU is authorized to impose a range of enforcement remedies, as detailed in Chapter 75-02-05.2 NURSING FACILITY ENFORCEMENT ACTION of the North Dakota Administrative Code [9].

Any funds received as penalties must be applied to protect residents of the nursing facility, to relocate residents, or to maintain the operation of the nursing facility pending correction of the deficiencies [10].

IV. Resident Rights and Advocacy

A core function of the HFU's oversight is the protection of resident rights. The state provides detailed summaries of rights for residents in different settings:

• Nursing Facility Resident Rights: These rights are based on both Federal and North Dakota State Law and cover areas like freedom from abuse, the right to make independent choices, and the right to voice grievances [4].
• Basic Care Residents' Rights: These rights are summarized in a dedicated booklet and cover the right to treat one's living quarters as one's home, the right to privacy, and the right to manage one's own financial affairs [11].
• Assisted Living Resident/Tenant Rights: These rights are also summarized in a guide and ensure that tenants keep the rights they had before moving into the assisted living apartment [12].

V. Contacting the Licensing Authority

For individuals seeking information about a facility's licensing status, or to report a concern about the quality of care in a North Dakota long-term care facility, the Health Facilities Unit is the appropriate point of contact.

The HFU also provides an online portal for various services, including applications, verifications, renewals, and access to the Abuse List [13].

Conclusion

The North Dakota Health Facilities Unit serves as the essential regulatory backbone for the state's long-term care system. By diligently licensing, surveying, and enforcing regulations through a clear and comprehensive legal framework, the unit ensures that facilities like Skilled Nursing Homes and Basic Care Facilities operate at a standard that protects the health, safety, and dignity of their residents. Understanding the scope of this authority, the specific regulations for each facility type, and the enforcement actions available is crucial for residents, families, and providers alike in navigating the long-term care landscape in North Dakota.

---

References

[1] North Dakota Department of Health and Human Services. "Health Facilities Unit." hhs.nd.gov. [2] North Dakota Department of Health and Human Services. "Health Facilities Unit Mission Statement." hhs.nd.gov. [3] North Dakota Legislative Branch. "CHAPTER 33-07-03.2 NURSING FACILITIES." ndlegis.gov. [4] North Dakota Department of Health and Human Services. "A Guide to Your Rights as a Resident of a Nursing Facility." hhs.nd.gov. [5] North Dakota Legislative Branch. "chapter 33-03-24.1 basic care facilities." ndlegis.gov. [6] American Health Care Association. "2019 State AL Reg Summaries: North Dakota." ahcancal.org. [7] North Dakota Department of Health and Human Services. "Basic Care Facility Interpretive Guidelines." hhs.nd.gov. [8] North Dakota Department of Health and Human Services. "Basic Care Facilities." hhs.nd.gov. [9] North Dakota Legislative Branch. "chapter 75-02-05.2 nursing facility enforcement action." ndlegis.gov. [10] North Dakota Legislative Branch. "North Dakota Century Code t23c16." ndlegis.gov. [11] North Dakota Long Term Care Association. "A Guide to Your Rights as an Individual Living in a Basic Care Facility." ndltca.org. [12] North Dakota Department of Health and Human Services. "A Guide to Your Rights as an Assisted Living Resident/Tenant." hhs.nd.gov. [13] North Dakota Department of Health and Human Services. "ONLINE Services." hhs.nd.gov.

North Dakota Medicaid Programs: A Comprehensive Guide to Long-Term Care and Financial Assistance

The North Dakota Medicaid program, known as ND Medicaid, is a crucial state and federal partnership administered by the North Dakota Department of Health and Human Services (ND DHHS) [1]. It provides essential health care coverage and financial assistance to eligible low-income adults, children, pregnant women, and individuals who are aged, blind, or disabled. For seniors and those with chronic illnesses or disabilities, ND Medicaid is the primary source of funding for long-term care services, both in institutional settings like nursing homes and through community-based alternatives.

This comprehensive guide delves into the various components of ND Medicaid, with a specific focus on the programs designed to cover long-term care, particularly the critical Medicaid Waiver for Home and Community Based Services (HCBS Waiver), and outlines the financial and medical eligibility criteria.

I. ND Medicaid and Long-Term Care Coverage

Long-term care encompasses a wide range of medical and non-medical services that help people with chronic illnesses or disabilities perform daily activities. In North Dakota, Medicaid covers this care through two primary pathways: institutional care and Home and Community-Based Services (HCBS).

A. Institutional Long-Term Care

ND Medicaid covers the cost of care in a Skilled Nursing Facility (SNF) for individuals who meet the state's medical necessity criteria for this level of care. This is the traditional form of long-term care coverage.

• Medical Necessity: To qualify, an applicant must undergo a comprehensive assessment to determine if they require the level of care provided in a nursing home. This is known as meeting the "institutional level of care."
• Patient Liability: Even when eligible, recipients of institutional Medicaid are typically required to contribute most of their monthly income toward the cost of care, a payment known as the "patient liability" or "share of cost." Only a small personal needs allowance (PNA) is exempt from this contribution.
• Swing Bed Services: Medicaid also covers "swing bed" services, which are provided in rural hospitals that have an agreement with Medicare and Medicaid to use their beds for either acute care or skilled nursing care, depending on the patient's needs [2].

B. Home and Community-Based Services (HCBS) Waiver

The Medicaid Waiver for Home and Community Based Services (HCBS Waiver) is the cornerstone of North Dakota's effort to allow individuals to receive long-term care in their homes or other community settings, such as assisted living facilities, rather than in a nursing home. Authorized under Section 1915(c) of the Social Security Act, this waiver allows the state to offer a broader array of services to a specific population [3].

The HCBS Waiver is particularly significant because it covers Adult Residential Care Services, which is the service that makes assisted living a financially viable option for many Medicaid recipients in North Dakota.

II. Financial and Medical Eligibility Criteria

To qualify for ND Medicaid long-term care programs, applicants must meet stringent financial and medical criteria. These rules are complex and often require careful planning.

A. Financial Eligibility: Income and Asset Limits

North Dakota applies specific financial limits for long-term care Medicaid, which are generally more restrictive than for other Medicaid programs.

Countable Assets typically include cash, bank accounts, stocks, and bonds. Exempt Assets generally include the primary residence (up to a certain equity limit), one vehicle, household goods, and personal effects.

B. Spousal Impoverishment Protections

For married couples where only one spouse is applying for long-term care Medicaid (the "institutionalized spouse"), federal and state rules protect the non-applicant spouse (the "community spouse") from financial ruin. These protections are known as the Spousal Impoverishment Prevention Coverage [4].

• Community Spouse Resource Allowance (CSRA): The community spouse is allowed to keep a portion of the couple's combined countable assets, up to a federally set maximum, which is adjusted annually. This allowance is intended to ensure the community spouse has sufficient resources to live on.
• Minimum Monthly Maintenance Needs Allowance (MMMNA): The community spouse is also allowed to keep a portion of the institutionalized spouse's income, if needed, to meet a federally determined minimum monthly income level. This prevents the community spouse from becoming impoverished while their partner receives care.

C. Medical Eligibility: Level of Care

All applicants for long-term care Medicaid, whether for institutional care or the HCBS Waiver, must meet the state's Level of Care (LOC) requirement. This means a medical assessment must confirm that the individual requires the level of care provided in a nursing home. The HCBS Waiver is specifically designed to provide services that meet this need in a community setting, thus preventing unnecessary institutionalization.

III. Comprehensive Services Under the HCBS Waiver

The North Dakota HCBS Waiver offers a broad and individualized array of services and supports. An individual's specific care plan, developed through a comprehensive assessment, determines which of these benefits they will receive [5].

IV. The Application and Enrollment Process

Applying for ND Medicaid long-term care is a multi-step process that begins with a formal application to the ND DHHS.

1. Application Submission: Applications can be submitted online, in person at a local human service zone office, by phone, or by mail. Applicants must provide extensive documentation, including proof of income, assets (for ABD applicants), and identity [4].
2. Level of Care Determination: A medical team conducts a thorough assessment to determine if the applicant meets the nursing home Level of Care requirement.
3. Financial Determination: A financial eligibility worker reviews the applicant's income and assets against the state's limits.
4. Care Plan Development: Once approved, a case manager works with the individual and their family to develop an individualized care plan that outlines the specific HCBS Waiver services they will receive.

V. Medicaid Estate Recovery Program (MERP)

Applicants for long-term care Medicaid who are 55 years of age or older should be aware of the Medicaid Estate Recovery Program (MERP). This program allows the state of North Dakota to recover the costs of certain Medicaid benefits, primarily long-term care services, from the estate of a deceased recipient [6].

• Targeted Services: Recovery is sought for payments made for nursing facility services, Home and Community-Based Services (HCBS), and related hospital and prescription drug services.
• Estate Definition: For MERP purposes, the estate includes all real and personal property and other assets passing from the deceased by will or intestacy. In some cases, it may also include assets that passed outside of probate, such as property held in joint tenancy.
• Exemptions and Waivers: North Dakota limits recovery in certain situations, such as when the deceased has a surviving spouse or a child who is under 21, blind, or permanently disabled. The state may also waive recovery if it would cause an undue hardship to the heirs.

Conclusion

ND Medicaid is a complex but essential program that provides a financial safety net for long-term care in North Dakota. The HCBS Waiver, with its comprehensive list of services including Adult Residential Care, offers a vital alternative to institutionalization, allowing many seniors and disabled individuals to receive necessary support in their own communities. Understanding the strict financial eligibility rules, the protections for community spouses, and the implications of the Medicaid Estate Recovery Program is paramount for anyone planning for long-term care in the state. The North Dakota Department of Health and Human Services remains the authoritative source for all program details and application assistance.

---

References

[1] North Dakota Department of Health and Human Services. "North Dakota Medicaid." hhs.nd.gov. [2] North Dakota Department of Health and Human Services. "Medicaid Long Term Care Services." hhs.nd.gov. [3] North Dakota Department of Health and Human Services. "Medicaid Waivers." hhs.nd.gov. [4] North Dakota Department of Health and Human Services. "Medicaid Eligibility." hhs.nd.gov. [5] Medicaid Planning Assistance. "North Dakota’s Medicaid Waiver for Home and Community Based Services." medicaidplanningassistance.org. [6] North Dakota Department of Health and Human Services. "Medicaid Estate Recovery." hhs.nd.gov. [7] North Dakota Department of Health and Human Services. "ND HCBS Waiver Comprehensive Service Array." hhs.nd.gov.

North Dakota Long-Term Care Ombudsman Program: Resident Advocacy and Rights

The North Dakota Long-Term Care Ombudsman Program is a crucial resource dedicated to protecting the rights, health, safety, and welfare of residents in long-term care facilities across the state [1]. Housed within the North Dakota Department of Health and Human Services (ND DHHS), Adult and Aging Services, the program serves as an independent advocate, investigating and resolving complaints made by or on behalf of residents [2].

The term "Ombudsman" is a Swedish word meaning "someone who speaks on behalf of another" [1]. In North Dakota, this role is essential for ensuring that the voices of long-term care residents are heard and that their rights are respected in a variety of care settings.

I. The Mission and Scope of the Ombudsman Program

The primary mission of the Long-Term Care Ombudsman Program is to improve the quality of life and care for all residents in North Dakota's long-term care facilities. The program achieves this by:

• Investigating Complaints: Ombudsmen investigate complaints related to the quality of care, resident rights violations, and facility practices.
• Advocating for Residents: They advocate for changes that will benefit residents individually and collectively, ensuring that residents' wishes are central to the care planning process.
• Educating on Rights: They inform residents, families, and the public about the rights of long-term care residents and the means for asserting those rights.
• Promoting Self-Advocacy: They encourage and assist residents and their families to resolve concerns on their own when appropriate.

A. Facilities and Individuals Served

The Ombudsman Program provides services to residents in a wide range of long-term care settings, including:

• Nursing Homes (Skilled Nursing Facilities)
• Basic Care Homes
• Assisted Living Homes
• Hospital Swing Beds
• Transitional Care Units

The program's services are not limited to the residents themselves. They also serve as a resource for:

• Families and friends of residents.
• Community members concerned about the welfare of residents.
• Employees and administrators of long-term care facilities seeking guidance on resident rights and best practices.
• Various regulatory and certification agencies [1].

II. The Complaint Resolution Process and Key Statistics

The Ombudsman program is designed to be a confidential and accessible avenue for resolving concerns. A cornerstone of the program is confidentiality: the Ombudsman will not disclose the identity of the complainant or the resident without their express permission, except when required by court order or when disclosure is necessary to prevent imminent risk of serious harm [3].

A. Complaint Data and Resolution Success

The program's annual reports provide a clear picture of the volume and nature of the issues addressed. In Federal Fiscal Year (FFY) 2022, the program demonstrated significant activity and success in resolving resident concerns [4]:

• Total Cases Investigated: 276 total cases were investigated and closed.
• Total Complaints: These cases involved 371 separate complaints.
• Complainant Source: Residents themselves were the source of 49% of the complaints, with resident representatives, friends, or family accounting for another 25%. This high percentage of resident-initiated complaints underscores the trust residents place in the program.
• Verification Rate: 68% of the 371 complaints were verified, meaning the Ombudsman confirmed that most or all facts alleged by the complainant were likely to be true.
• Resolution Rate: 61% of the complaints were partially or fully resolved to the satisfaction of the resident, resident representative, or complainant.

B. Top Complaint Categories

The complaints investigated by the Ombudsman Program fall into categories established by the Administration for Community Living. The top three major complaint categories in FFY 2022 highlight the most pressing issues facing North Dakota's long-term care residents [4]:

The high number of complaints regarding Care and Autonomy, Choice, Rights indicates a persistent need for advocacy in ensuring person-centered care and respect for resident self-determination.

III. Systems Advocacy and Program Challenges

Beyond resolving individual complaints, the Ombudsman Program engages in Systems Advocacy, working to address systemic issues that affect large groups of residents.

A. Accountability in Basic Care Facilities

A major focus of the Ombudsman's systems advocacy is the need for greater accountability and oversight in Basic Care Facilities (BCFs). Prior to the COVID-19 pandemic, BCFs were surveyed for compliance with licensing standards once every three years. Due to resource constraints, the current reality is that only complaint surveys are conducted, and only for egregious complaints [4].

Quote from the State Long-Term Care Ombudsman:

"The current reality of only complaint surveys being conducted and only for egregious complaints is even less ideal. Resources need to be allocated for staff in Health Facilities, so there can be regular and timely survey responses for the basic care facilities. Oversight and accountability are needed to track trends in basic care and to identify where changes need to be made to ensure that residents receive services to provide quality of care and quality of life." [4]

The Ombudsman advocates for increased funding and staffing for the Health Facilities Unit to allow for regular, timely compliance surveys, which are essential for proactive quality assurance.

B. Staffing and Access Challenges

The Ombudsman Program itself faces challenges in ensuring all residents have regular and timely access to its services. The federal rule mandates that residents have regular and timely access to the program. However, with only a small team of full-time and part-time local ombudsmen traveling to visit 252 facilities across the state, frequent, in-depth visits are difficult to maintain [4].

The State Ombudsman notes that more frequent visits are critical to establishing the trust necessary for residents to share their concerns, as many fear retaliation if they speak up. Increasing the number of ombudsman staff is a key goal to ensure that every resident has a trusted, visible advocate.

IV. Key Advocacy Areas and Resident Rights

The Ombudsman Program is actively involved in advocating for specific resident rights and policy changes, often providing education on complex legal and regulatory issues.

A. Right to Freedom from Restraints

A significant area of advocacy is the resident's right to be free from unnecessary physical or chemical restraints. The Ombudsman works to ensure that facilities use restraints only as a last resort, with proper documentation, and as part of a comprehensive care plan designed to reduce their use.

B. Authorized Electronic Monitoring (AEM)

The Ombudsman provides guidance on North Dakota's regulations regarding Authorized Electronic Monitoring in long-term care facilities. State law permits electronic monitoring (e.g., video cameras) in a resident's room under specific conditions, such as obtaining the resident's and, if applicable, the roommate's consent [5]. The Ombudsman helps residents and families understand the rules and necessary documentation for implementing this right, which is a key tool for ensuring safety and accountability.

C. Essential Caregiver Access

The program ensures compliance with the Essential Caregiver protocols, which guarantee that a resident can designate an essential caregiver who is allowed in-person access to the resident, even during a public health emergency or facility lockdown, to provide necessary support [6]. This advocacy is vital for maintaining the emotional and physical well-being of residents during times of crisis.

V. Becoming a Volunteer Ombudsman

The North Dakota Long-Term Care Ombudsman Program relies on dedicated volunteers to extend its reach and impact. Volunteer Ombudsmen are assigned to serve at local long-term care facilities, where they:

• Visit residents regularly to listen to their concerns.
• Educate residents about their rights.
• Advocate for the resolution of individual and systemic issues.

A. Volunteer Certification and Training

To become a certified volunteer ombudsman, individuals must meet specific qualifications and complete a rigorous training program, as outlined in the North Dakota Administrative Code [7]:

1. Initial Training: Volunteers must complete an initial certification training program, which covers resident rights, the long-term care system, complaint investigation techniques, and confidentiality requirements.
2. Continuing Education: Ongoing training and continuing education are required to maintain certification, ensuring that volunteers stay current on changes in law, regulation, and best practices.
3. Qualifications: A volunteer ombudsman must be free from conflicts of interest that would compromise their ability to advocate impartially for residents.

This is a rewarding opportunity for community members to directly improve the quality of life for seniors and vulnerable adults in their area. Individuals interested in becoming a volunteer can contact the program directly to learn more about the training and responsibilities involved.

VI. Contacting the Ombudsman Program

The Ombudsman Program is a free and confidential service. Residents, family members, and concerned citizens are encouraged to use the following contact information to report a concern or seek information:

Conclusion

The North Dakota Long-Term Care Ombudsman Program is an indispensable advocate for the state's long-term care residents. By providing a confidential and effective mechanism for complaint resolution, backed by a strong commitment to systems advocacy and the promotion of resident rights, the program plays a vital role in ensuring accountability and compassion within the long-term care system. The program's success, as evidenced by its high complaint resolution rate, is a testament to the dedication of its staff and volunteers. Residents and their families are strongly encouraged to utilize this free and independent service whenever they have questions or concerns about the care being provided.

---

References

[1] North Dakota Department of Health and Human Services. "Long-Term Care Ombudsman Program." hhs.nd.gov. [2] North Dakota Department of Health and Human Services. "Adult and Aging Services." hhs.nd.gov. [3] North Dakota Department of Health and Human Services. "Long-Term Care Ombudsman Program Complaint Form (SFN 1829)." nd.gov. [4] North Dakota Long-Term Care Ombudsman Program. "2023 Annual Report." ltcombudsman.org. [5] North Dakota Department of Health and Human Services. "Administrative Rule - Chapter 75-03-42 Authorized Electronic Monitoring." hhs.nd.gov. [6] North Dakota Legislative Branch. "North Dakota Century Code (NDCC) 50-10.3." ndlegis.gov. [7] North Dakota Legislative Branch. "chapter 75-03-25 ombudsman program." ndlegis.gov.

North Dakota Long-Term Care Complaint Process: Reporting Concerns and Ensuring Quality Care

Ensuring the safety and quality of care for residents in North Dakota's long-term care facilities is a shared responsibility involving state agencies, residents, families, and the public. North Dakota has established clear and accessible channels for reporting concerns, abuse, or neglect in facilities such as nursing homes, basic care facilities, and assisted living homes.

This comprehensive guide outlines the primary avenues for filing a complaint in North Dakota, detailing the roles of the key state agencies involved in the investigation and resolution process, and providing detailed steps for reporting.

I. Primary Complaint Authorities in North Dakota

In North Dakota, complaints against long-term care facilities are primarily handled by three distinct, yet complementary, state entities, all working under the umbrella of the state government: the Health Facilities Unit (HFU), the Long-Term Care Ombudsman Program, and Adult Protective Services (APS).

A. Health Facilities Unit (HFU)

The HFU is the state's regulatory authority responsible for licensing and certifying health care facilities. The HFU investigates complaints related to violations of state licensing regulations and federal certification requirements (for Medicare/Medicaid facilities) [1].

What to Report to the HFU:

The HFU is the appropriate contact for complaints concerning:

• Abuse, Neglect, or Exploitation: Any instance of physical, sexual, verbal, or mental abuse, or financial exploitation of a resident.
• Quality of Care: Concerns about inadequate medical care, medication errors, poor wound care, or insufficient staffing levels.
• Environmental Safety: Issues related to the physical environment, such as fire safety, sanitation, or structural hazards.
• Regulatory Violations: Any suspected violation of state licensing laws or federal Medicare/Medicaid conditions of participation.

How to File a Complaint with the HFU:

1. Online Complaint Form: The most direct method is to use the Health Facility Program Complaint Intake Form available on the ND DHHS website [2].
2. Phone: Concerns can be reported directly to the Health Facilities Unit by phone at (701) 328-2352 [3].
3. Mail: Written complaints can be sent to the Health Facilities Unit's mailing address.

Confidentiality: Complainants can choose to remain anonymous. The HFU is required to keep the identity of the complainant confidential unless the complainant gives permission to release their name or a court order requires disclosure.

The HFU Investigation Process:

Upon receiving a complaint, the HFU will:

1. Triage and Prioritize: Complaints alleging immediate jeopardy to a resident's health or safety are investigated within two working days.
2. Unannounced Investigation: An unannounced on-site investigation is conducted by state surveyors. This involves interviewing residents, staff, and family members, observing care, and reviewing medical records and facility policies.
3. Enforcement: If the investigation substantiates the complaint, the facility is cited for deficiencies, and enforcement actions, such as civil monetary penalties or license revocation, may be imposed.

B. Long-Term Care Ombudsman Program

The Long-Term Care Ombudsman Program is an independent advocate that works to resolve complaints on behalf of residents. The Ombudsman acts as a mediator and advocate, focusing on the resident's satisfaction [4].

What to Report to the Ombudsman:

The Ombudsman is the ideal resource for complaints concerning:

• Resident Rights: Violations of a resident's rights, such as the right to privacy, the right to manage one's own finances, or the right to refuse treatment.
• Quality of Life: Issues related to food quality, social activities, or a facility's failure to accommodate a resident's personal preferences.
• Communication Issues: Problems with communication between the resident, family, and facility staff.

How to File a Complaint with the Ombudsman:

1. Online Complaint Form: The Long-Term Care Ombudsman Program Complaint Form (SFN 1829) is available for online submission [5].
2. Phone: Call the toll-free number (855) 462-5465, select option 3, or the direct line (701) 328-4617 [4].

Confidentiality: The Ombudsman maintains strict confidentiality and will not proceed with an investigation or disclose the resident's or complainant's identity without their explicit consent.

II. Reporting Abuse, Neglect, and Exploitation

For the most serious concerns involving the mistreatment of a vulnerable adult, two specialized agencies must be contacted: Adult Protective Services and the Medicaid Fraud Control Unit.

A. Adult Protective Services (APS)

Adult Protective Services (APS) is the state program responsible for receiving and investigating reports of abuse, neglect, or exploitation of vulnerable adults who are unable to protect themselves [6].

Definition of a Vulnerable Adult:

In North Dakota, a vulnerable adult is defined as an individual eighteen years of age or older who is unable to protect themselves from abuse, neglect, or exploitation due to a physical or mental impairment or a dependency on others [7].

Types of Maltreatment Investigated by APS:

• Abuse: The willful infliction of physical pain, injury, or mental anguish, or the deprivation of necessary services by a caretaker.
• Neglect: The failure of a caretaker to provide necessary services, or the failure of a vulnerable adult to provide for their own needs (self-neglect).
• Exploitation: The illegal or improper use of a vulnerable adult or their resources for another's profit or advantage.

How to Report to APS:

North Dakota has mandatory reporting requirements, meaning certain professionals (e.g., medical, mental health, law enforcement) are required by law to report suspected maltreatment. However, any person can and should report suspected abuse.

1. Contact Local Human Service Zone Office: The most direct way to report is to contact the local Human Service Zone office in the county where the vulnerable adult resides.
2. State Reporting Form: A dedicated form for reporting abuse and neglect of a vulnerable adult is available on the ND DHHS website [8].
3. Emergency: For immediate danger, always call 911.

B. Medicaid Fraud Control Unit (MFCU)

The North Dakota Medicaid Fraud Control Unit (MFCU), part of the North Dakota Attorney General's Office, has a dual mission [9]:

1. Medicaid Provider Fraud: Investigating and prosecuting health care providers who defraud the ND Medicaid Program through false claims, billing for services not rendered, or other fraudulent activities.
2. Abuse or Neglect: Investigating and prosecuting abuse or neglect of residents in health care facilities that receive Medicaid funding.

What to Report to the MFCU:

• Fraud: Suspected fraudulent billing or financial schemes by a facility or provider.
• Criminal Abuse/Neglect: Cases of abuse or neglect that rise to the level of a criminal offense.

The MFCU works closely with the HFU and local law enforcement to address these serious matters.

III. Summary of Complaint Contacts

The following table summarizes the key authorities for reporting concerns in North Dakota's long-term care system:

IV. Resident Rights and the Complaint Process

North Dakota law mandates that all long-term care facilities must have a process for handling complaints made by residents or on behalf of residents [10]. This internal process is the first step in resolving many issues.

1. Internal Grievance: Residents are encouraged to first discuss their concerns with the facility's staff, the Director of Nursing, or the Administrator.
2. External Reporting: If the internal process fails, or if the concern is serious (e.g., abuse, neglect), the resident or family should immediately contact one of the external authorities listed above.
3. Protection Against Retaliation: North Dakota law strictly prohibits retaliation against a resident who files a complaint or participates in an investigation. The Ombudsman and HFU are committed to protecting residents from any adverse action taken by a facility in response to a complaint.

Conclusion

The North Dakota long-term care complaint process is structured to provide multiple layers of protection for residents. Whether the concern is a regulatory violation requiring an official investigation by the HFU, a quality-of-life issue best resolved through advocacy by the Ombudsman, or a serious case of abuse or fraud requiring the intervention of APS or the MFCU, residents and their families have clear, confidential, and free resources available. By understanding and utilizing these official channels, the public helps ensure that North Dakota's long-term care facilities are held to the highest standards of safety, quality, and compassion.

---

References

[1] North Dakota Department of Health and Human Services. "Health Facility Concerns." hhs.nd.gov. [2] North Dakota Department of Health and Human Services. "Health Facility Program Complaint Intake Form." hhs.nd.gov. [3] North Dakota Department of Health and Human Services. "Health Facilities Unit." hhs.nd.gov. [4] North Dakota Department of Health and Human Services. "Long-Term Care Ombudsman Program." hhs.nd.gov. [5] North Dakota Department of Health and Human Services. "Long-Term Care Ombudsman Program Complaint Form (SFN 1829)." nd.gov. [6] North Dakota Department of Health and Human Services. "Reporting Abuse and Neglect of a Vulnerable Adult." hhs.nd.gov. [7] North Dakota Legislative Branch. "vulnerable adult protection services." ndlegis.gov. [8] North Dakota Department of Health and Human Services. "Vulnerable Adult Abuse Reporting Form." hhs.nd.gov. [9] North Dakota Attorney General. "Medicaid Fraud." attorneygeneral.nd.gov. [10] North Dakota Legislative Branch. "chapter 33-03-24.1 basic care facilities." ndlegis.gov. [11] North Dakota Department of Health and Human Services. "North Dakota Medicaid Fraud Control Unit Information." hhs.nd.gov.

North Dakota Veterans Benefits: Long-Term Care and Financial Assistance

North Dakota is committed to honoring its veterans, service members, and their families by providing a comprehensive suite of benefits, with a particular focus on long-term care and financial assistance. The North Dakota Department of Veterans Affairs (NDDVA) serves as the central coordinating agency, working in partnership with the U.S. Department of Veterans Affairs (VA) and the state's Veterans Service Officers (VSOs) to ensure veterans receive the support they have earned [1].

This guide details the key long-term care and financial benefits available to North Dakota veterans, including the state's Veterans Home, federal programs like Aid and Attendance, and state-specific financial grants.

I. The North Dakota Veterans Home (NDVH)

The most significant state-level long-term care benefit is the North Dakota Veterans Home (NDVH), located in Lisbon. Established in 1893, the NDVH is a living tribute to North Dakota veterans and their spouses, providing a range of care services in a dedicated, compassionate environment [2].

A. Levels of Care Provided

The NDVH offers two primary levels of care to meet the diverse needs of its residents:

1. Skilled Care (Skilled Nursing Facility - SNF): This unit provides 24-hour skilled nursing supervision and assistance for residents with significant medical needs and those requiring assistance with all Activities of Daily Living (ADLs). The NDVH has a capacity of 52 skilled nursing beds.
2. Basic Care: This unit is designed for residents who are largely independent but require personal care and services. Residents in basic care must have total independence with personal care needs such as bathing, dressing, and ambulating. The Basic Care Unit has a capacity of 98 beds [2].

B. Eligibility for Admission

Admission to the North Dakota Veterans Home is governed by state law and is open to veterans, their spouses, and surviving spouses who meet specific criteria [3]:

• Veteran Status: A veteran is defined as an individual who has served on continuous federalized active military duty for 180 days or the full period for which they were called to duty (other than training), and who was discharged or released under other than dishonorable conditions.
• Spouses/Surviving Spouses: The spouse or surviving spouse of an eligible veteran or service member may also be admitted.
• Residency: Applicants must be bona fide residents of North Dakota preceding the application for admission.
• Disqualifications: No veteran whose last period of service was terminated under dishonorable conditions is eligible. Additionally, no veteran convicted of a felony or a crime involving moral turpitude may be admitted without sufficient evidence of subsequent good conduct and reformation of character.

C. Cost of Care and Financial Calculation

The cost of care at the NDVH is determined on a sliding scale, ensuring that the home remains accessible to veterans regardless of their financial situation. The calculation is based on the resident's ability to pay, with a clear formula established for basic care.

• Basic Care Cost: Room and board charges for basic care are calculated at 55% of the resident's monthly net income [4]. The net income is determined by subtracting allowable medical expenses from the gross income. This structure ensures that residents retain a significant portion of their income for personal needs.
• Skilled Care Cost: The cost for skilled nursing care is often covered by a combination of Medicare, Medicaid, VA benefits, and private insurance. The NDVH works with residents to maximize their benefits to cover the cost of care.
• Financial Planning: Veterans are strongly encouraged to work with a Veterans Service Officer (VSO) to ensure all potential benefits, such as the VA Aid and Attendance benefit, are applied for to help offset the cost of care.

II. State-Specific Financial Assistance Programs

The NDDVA administers several state-funded programs designed to provide direct financial relief to veterans and their families, which can be crucial for those facing long-term care expenses.

A. Hardship Assistance Grant

The Hardship Assistance Grant program provides direct financial support to eligible North Dakota veterans, their spouses, and un-remarried surviving spouses who are experiencing a financial hardship [5].

• Purpose: The grant is intended to assist with essential needs, which can include medical expenses, housing costs, utilities, and other critical financial burdens that may arise during a long-term care crisis.
• Eligibility: Applicants must be North Dakota residents and meet the definition of a veteran or eligible dependent as defined in the North Dakota Century Code. The hardship must be verifiable and not caused by the applicant's own negligence.
• Application: Applications are processed through the local County or Tribal Veterans Service Officer (VSO), who assists the veteran in compiling the necessary documentation and submitting the request to the NDDVA.

B. Other State Benefits

The NDDVA also oversees other benefits that can indirectly support long-term care:

• Property Tax Exemptions: Disabled veterans may be eligible for property tax exemptions, which can reduce the financial burden of maintaining a home while receiving long-term care services.
• State Employment Preference: While not a direct care benefit, this helps ensure veterans and their spouses have employment opportunities, contributing to overall financial stability.

III. Federal Financial Benefits for Long-Term Care

North Dakota veterans are also eligible for federal benefits administered by the U.S. Department of Veterans Affairs (VA), which can significantly offset the cost of long-term care, whether in a facility or at home.

A. VA Aid and Attendance (A&A) Benefit

The Aid and Attendance (A&A) benefit is a special monthly payment added to the amount of a VA pension for qualified veterans and survivors. This benefit is specifically designed to help cover the costs of a caregiver or long-term care [6].

Eligibility for A&A:

To qualify for the A&A benefit, a veteran must be eligible for the basic VA pension and meet one of the following medical criteria:

• Require the aid of another person to perform Activities of Daily Living (ADLs), such as bathing, feeding, dressing, or using the restroom.
• Be confined to bed due to a disability.
• Be a patient in a nursing home due to mental or physical incapacity.
• Have severely limited eyesight (5/200 visual acuity or less).

The A&A benefit is a non-service-connected pension, meaning the disability does not have to be related to military service. However, it is an income-adjusted benefit, and applicants must meet certain financial thresholds.

B. VA Health Care and Long-Term Services

The VA provides a range of long-term services and supports (LTSS) through its health care system, including:

• Home-Based Primary Care: Health care services provided to veterans in their homes.
• Skilled Home Health Care: Short-term services for veterans who are homebound.
• Medical Foster Home Program: A program that offers an alternative to nursing home care in a private home setting, where a trained caregiver provides 24-hour supervision and care [7].

IV. The Critical Role of Veterans Service Officers (VSOs)

The most valuable resource for any North Dakota veteran seeking benefits is the network of VA Accredited Veterans Service Officers (VSOs). These officers are experts in VA benefits and provide free, professional assistance at the county and tribal level.

A. VSO Services

VSOs provide comprehensive assistance, including:

• Claims Assistance: Filing claims for disability compensation, pension, and A&A, ensuring all necessary documentation is included.
• Appeals: Assisting veterans with the complex process of appealing denied claims.
• Benefit Counseling: Advising veterans and their dependents of their rights and entitlements under various federal and state laws [8].
• Long-Term Care Planning: Guiding veterans through the process of applying for the North Dakota Veterans Home and federal long-term care benefits.

B. Finding a VSO

The NDDVA strongly encourages all veterans to work with a VSO. The NDDVA website provides a locator tool to find the nearest County or Tribal VSO, ensuring personalized, local support [9].

V. Summary of Key Long-Term Care Resources

Conclusion

North Dakota provides a strong support system for its veterans, with the North Dakota Veterans Home offering a dedicated facility for long-term care and the NDDVA actively connecting veterans to crucial federal and state financial benefits, including the Hardship Assistance Grant. By utilizing the expertise of a Veterans Service Officer, North Dakota veterans can successfully navigate the complex landscape of benefits to secure the long-term care and financial stability they deserve. The state's commitment to its veterans is evident in the comprehensive nature of these programs.

---

References

[1] North Dakota Department of Veterans Affairs. "Home." veterans.nd.gov. [2] North Dakota Veterans Home. "Levels of Care." ndvh.nd.gov. [3] North Dakota Veterans Home. "Eligibility." ndvh.nd.gov. [4] North Dakota Veterans Home. "NDVH Costs 2025." ndvh.nd.gov. [5] North Dakota Department of Veterans Affairs. "Hardship Assistance Grant." veterans.nd.gov. [6] U.S. Department of Veterans Affairs. "VA Aid And Attendance Benefits And Housebound Allowance." va.gov. [7] VA Fargo Health Care. "Medical Foster Home Program." va.gov. [8] North Dakota Association of Counties. "Veterans Service Officer." ndaco.org. [9] North Dakota Department of Veterans Affairs. "Veteran Service Officers (VSO)." veterans.nd.gov.