Wahpeton, ND — With nursing home beds in short supply and staff vacancies still stubborn, more families in the Red River Valley are turning to home health care to keep loved ones safe and close to home.
Local providers say referrals for in-home services have jumped in the past two years as facilities manage waitlists and workforce gaps. CHI St. Francis Home Health in nearby Breckenridge, Minn., reports a 25% increase in referrals since 2023, driven by capacity constraints and a growing preference to age in place.
Home care fills the gaps
At the Wahpeton Good Samaritan Center, occupancy hovers around 85%, according to industry data. But staffing remains a limiting factor: certified nursing assistant vacancies near 15%, leaving administrators to delay admissions or direct families elsewhere.
That’s where home health has stepped in. CHI St. Francis serves more than 300 clients a year across the ND–MN border, coordinating skilled nursing, therapy and hospice services in people’s homes. Nurses typically visit two to five times a week and work closely with primary care clinics like Essentia Health-Wahpeton to manage medications, wound care and rehab.
“Home health isn’t just a bridge — for many families it’s the only way care gets delivered when beds aren’t available,” said Nicole Peyerl, director of CHI St. Francis Home Health. “We’ve seen a notable uptick in referrals this year, but sustained funding will determine how many we can accept.”
Costs and access drive the shift
Money matters, too. In the region, home health typically runs $3,500 a month, compared with $5,000 to $7,000 for a nursing home stay, according to national cost surveys. Medicare often covers the bulk of eligible home-based services, though families may still face out-of-pocket costs for personal care or equipment.
For residents like 78-year-old Evelyn Thompson of Wahpeton, home care offered a faster option after a hip fracture put her on a nursing home waitlist. “I didn’t want to leave my home after 50 years,” Thompson said. “Home health gave me that choice, even if coordinating everything is a lot.”
The trend aligns with broader preferences. Roughly three-quarters of adults over 50 say they want to age at home, recent surveys show. In rural communities where household incomes lag statewide averages, families say the math and the desire to stay near relatives often point to home-based options.
Workforce and distance remain hurdles
Delivering care across long distances is not easy. Home health aides and nurses can drive 50 miles or more for a single visit in the valley, stretching schedules and budgets. Turnover among aides remains high — more than one in five nationally — and providers say recruitment is a constant scramble.
Despite those challenges, local experiments are encouraging. A Richland County telehealth pilot launched in 2024 integrated remote monitoring with home visits for 150 seniors and was associated with a 15% drop in emergency department visits, according to county officials.
Policy clouds on the horizon
Providers warn that looming federal payment changes could undermine progress. Pending Medicare reimbursement reductions for home health, slated to take effect in 2026, have small agencies worried about margins and caseloads. State leaders acknowledge the risk.
“We’re committed to expanding home-based options, but federal cuts could slow that momentum — especially in rural areas,” said Tim Blaesing, an official with the North Dakota Department of Health and Human Services. The agency is currently reviewing applications for targeted grants aimed at bolstering the workforce and stabilizing access, according to state updates.
Local health systems are watching closely. Clinicians say home-based care can reduce hospital readmissions when paired with strong care coordination, but needs reliable reimbursement to scale. “In rural areas like ours, home care supports personalized recovery and dignity,” said Essentia Health-Wahpeton physician Maria Gonzalez. “Patients often heal faster in their own beds.”
What comes next
Demographics suggest the need will grow. North Dakota’s 65-plus population is projected to climb by roughly 30% by 2030, and industry sources say nursing home admissions could fall as more care shifts to the community. Whether home health can absorb that demand will depend on a mix of staffing, funding and flexible rules tailored to rural realities.
For now, families in and around Wahpeton are piecing together solutions — a few weekly nursing visits, therapy at home, tech tools to monitor vitals — to avoid long waits for facility placement. It’s a pragmatic pivot shaped by workforce math and patient preference, and one that could redefine elder care across the Red River Valley if policymakers keep pace.
