Thursday, April 29, 2021 - 11:09 am

People prefer to remain living at home and in their communities as they age and their abilities change, however finding caregivers and support can be a challenge – especially in rural areas.

The Nelson County Health System in McVille, N.D., started re-envisioning services just as the pandemic hit after applying for and receiving a small grant from the North Dakota Department of Human Services to pilot an expanded business model. The grant supported a key department priority: serving people closer to home. Funding provided resources to increase access to in-home personal care, housekeeping and other related long-term support services for individuals who qualify for federal and state funded programs, by assisting providers with start-up costs.

The Nelson County Health System, which includes a 39-bed nursing home, a 12-unit assisted living facility, a hospital, and clinics in McVille and Michigan, N.D., was an ideal grant applicant because it was already serving rural residents and its board and leadership team were acutely aware of gaps in services.

“People want to remain living independently. In Nelson County, we lacked many of the services that could make that possible,” said the health systems’ Chief Financial Officer Steve Forde. “So, we thought – why not us? The grant helped us get started and expand access to in-home and community-based care and support services in our rural communities.”

While the pandemic delayed the start of the program, Forde said the rural health system is now serving several clients with a team of two, which includes program manager and licensed practical nurse Lynette Smaage and certified nursing assistant Dee Lillehaugen who are well known and trusted by county residents. 

Services are available to individuals who participate in government-funded programs such as Medicaid, as well as private pay individuals.

Smaage said she meets with individuals to discuss the types and amount of care and support they need. She also explains the services the health system now provides, which include housekeeping, personal care help with bathing, dressing and other related needs, and non-medical transportation. 

“We want to help keep people safe and healthy in their homes, and we try to be flexible with clients’ schedules,” she said. “Our services bring peace of mind to family members.”

She said that if an individual needs additional services or other resources, they coordinate with public health, home health agencies and other community partners, such as the senior meal provider. 

Nelson County residents and individuals residing in neighboring areas who could benefit from the new in-home care, housekeeping and related support services that Nelson County Health System provides can learn more by calling 701-322-4328, extension 214.

The North Dakota Department of Human Services awarded five $10,000 grants in 2020 to increase the number of qualified service providers – especially in rural areas – so that older adults and other adults with physical disabilities at risk of Medicaid-funded nursing facility care have access to services so they can choose to live at home and enjoy community living.

The department’s Aging Services Division Director Nancy Nikolas Maier said, “To serve more people at home, we need additional service providers statewide. In-home care is a growing trend and is generally less expensive. Our goal is to give people more options and to make sure they know they have choices beyond nursing facility care, so they can choose what is right for them. North Dakotans who qualify for skilled nursing facility care can and do live at home with the help of qualified service providers and other in-home care and support service partners.”

During the 2020 state fiscal year, the average cost of care per North Dakota Medicaid client residing in a nursing home was $95,000. In contrast, the average cost to the department per client for in-home and community-based long-term care services ranged from $5,000 to $27,000.

To learn more about care choices, adults with physical disabilities and their family members can contact North Dakota’s Aging and Disability Resource Link toll-free at 855-462-5465 (toll-free), 711 (TTY), by email at or can explore services online at