SIOUX FALLS, S.D. — The number of rural communities with few options for elder care continues to grow across South Dakota. The Hudson Care and Rehab Center in the southeastern corner of the state was the most recent closure, and marked the sixth nursing home center closure in the past year-and-a-half.

Mark Deak, executive director with the South Dakota Health Care Association, called the closures a "crisis" and said it's all the result of inadequate funding.

"You hear the word 'crisis' a lot, and sometimes I think that word is overused. But it's certainly not in this case,” Deak said. “And the primary factor is under-funding. South Dakota has one of the largest Medicaid gaps in the country."

More than half of the total resident population in nursing centers relies on Medicaid to pay for their care. South Dakota lawmakers authorized a 10% increase in Medicaid reimbursement for the state's nursing facilities earlier this year, but Deak said nursing centers still lose an average of $42 per day for each resident paying through Medicaid.

According to Deak, the statewide costs of unreimbursed nursing-center care total more than $48 million annually. He noted South Dakota is not alone in its struggle to maintain housing options for the elderly and disabled.

"It's a widespread challenge for many, many states,” he said. “I just think, given the nature of South Dakota and its rather small population and yet very large geographic land mass, that problem is exacerbated."

In Nebraska, 16 nursing facilities closed between 2015 and 2018, and 22 have been placed under state receivership - the majority of them located in rural areas. Deak said he believes the crisis calls for a statewide and national discussion.

"None of us are getting any younger, and I believe that obligation to care for our loved ones - our parents, our grandparents cared for us, we need to be able to do the same for them - and we just need to make it a priority,” he said.

In addition to Hudson, recent long-term care center closures in South Dakota have occurred in Sioux Falls, Huron, Madison, Mobridge, Tripp, Bryant and Rosholt.


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Indiana's busy holiday roads can put older drivers to the test.

With 2.8 million Hoosiers traveling this season, the AAA Hoosier Motor Club encouraged families to help senior drivers stay safe.

Christina Griffiths, manager of public affairs and communications for the club, highlighted the importance of preparation for older drivers.

"It really isn't about age necessarily," Griffiths explained. "It truly is a case-by-case basis of what am I dealing with physically, mentally, emotionally, and what can I do better to be as safe as possible?"

Griffiths recommended older drivers take simple steps to prepare for challenging conditions. She suggested checking car tires, brakes and visibility aids like wiper blades. For all drivers, she also stressed the value of adjusting travel times to avoid peak traffic and bad weather.

Winter weather raises the stakes for older drivers. Snow and ice create extra challenges, increasing stress and risk on the road. Griffiths pointed out AAA offers free online assessments and refresher courses to help seniors adjust to physical or emotional changes affecting driving.

"It asks a bunch of questions that you can evaluate: Am I checking behind me when I change lanes? Do I have difficulty with merging, or do I just feel that anxiety, I think is a big one too!" Griffiths outlined. "Maybe you have specific things you need to brush up with on your own skills."

Griffiths urged families to talk openly about driving habits. Small adjustments, like shorter trips or avoiding peak travel times, help seniors stay safe without giving up their independence. She added preparation and support help protect everyone on the road.


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Dementia, a disease with profound effects on families, loved ones and caregivers, affects more than 55 million people globally, including 6 million in the U.S.

New research shows people can reduce their risks by making even small changes in their daily routines, for example, through exercise and eating more vegetables.

Sarah Lock, senior vice president for policy at AARP, said there are also important steps policymakers can take to make it easier for people to maintain healthy behaviors.

"When we do that, we can disrupt dementia," Lock asserted. "That's a really exciting possibility, given that so many of us -- as our nation is aging -- are facing that risk."

Dementia is the third-largest cause of death in the nation for people age 70 and older, and two-thirds of Americans have at least one major potential risk factor. People who smoke five cigarettes per day have a 16% higher dementia risk than nonsmokers. People with prediabetes face a 25% increased risk, which rises to 50% with full-blown diabetes. Prolonged exposure to air pollution is also a major dementia risk factor.

Other risk factors include alcohol use, depression, high body mass index, hearing loss, hypertension, low education, physical inactivity, social isolation and traumatic brain injury. Lock pointed out policies to reduce these risks can vary by state. For example, in Colorado, physical inactivity may not be as big of a
problem as in other states, but hearing loss is relatively high.

"We can suggest to policymakers that they focus on ways to help people screen and correct for hearing loss," Lock noted. "In Colorado, that might be a wiser use of public dollars, to go after the problem that seems to be biggest in your state."

Lock added the goal of the research is to offer people pathways to better brain health and to give older Americans more quality time with their loved ones. The findings were released by the new Dementia Risk Reduction Project, a collaboration between AARP, the Alzheimer's Disease Data Initiative and the University of Washington.

Changes coming to Medicare in 2025 could be beneficial for Oregon residents who are eligible for the program.

Oregonians who qualify for Medicare are now in the open enrollment period through Dec. 7, which allows them to search for health coverage plans to best suit their needs.

Ryan Kibby, Oregon Senior Health Insurance Benefits Assistance project director for the Oregon Department of Human Services, said there will be expanded care options for dementia patients with the Guiding and Improved Dementia Experience or GUIDE program.

"Some of the resources available through GUIDE would include a 24-hour support line, caregiver training and up to $2,500 a year for respite services," Kibby outlined. "That's really just going to help benefit the people who are providing these family caregiver services."

There will also be expanded mental health benefits for people with Medicare in 2025. In 2023, nearly 920,000 Oregonians were enrolled in Medicare. People can get free help to find coverage through Oregon's SHIBA program, either on its website or at 800-722-4134.

Kibby pointed out another major improvement in 2025 is prescription drug costs will be capped.

"There will be a lower maximum to pay for covered drugs, under both Medicare Part D policies and Medicare Advantage drug coverage," Kibby explained. "The maximum amount that people will pay in 2025 is $2,000, and they won't have to pay anything for covered drugs once they reach that amount."

Prescription payment plans will be an option for people who cannot pay in full up-front. The out-of-pocket cost cap also eliminates a gap in coverage, known as the "donut hole," which some have experienced in the past. While Medicare cannot cover prescriptions specifically for weight loss, people can access these drugs for treatment of conditions like Type 2 diabetes.


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