Over the past twenty-three years Hill Top’s Board of Directors and Staff members and the Foundation Board of Directors have worked very hard to meet the needs of the communities we serve. It all started back in 1985 when a group of community leaders decided that Killdeer needed a facility to meet the needs of area residents requiring long term care services. The initial plan was to develop an Intermediate Care facility, but state officials insisted that Basic Care was what was really needed. Ultimately a combination of the two care levels was approved and in November 1988 Hill Top opened with forty Intermediate Care beds and twenty-four Basic Care bed.

By 1991 the state’s long term care road map had changed, Intermediate Care was being phased out and the funding for Basic Care services had disappeared. Hill Top was fortunate to be able to make the conversion to Skilled Care and in doing so increased its capacity to eighty beds. For the next seven years Hill Top maintained occupancy levels over ninety-five percent with significant overflow coming from the Dickinson area as facilities there struggled to meet the community’s needs.

Due to care delivery changes in Dickinson and staffing shortages, Hill Top was forced to decrease its bed capacity in 1998 and again in 2000 decertifying a total of thirty beds to become a fifty bed skilled nursing facility. During this time we explored other options to meet the needs of our communities. In 1999 we started our home health program which has served five hundred eighty-three clients over the past twelve years. We also developed a skilled therapy department that provided Physical and Occupational Therapies to our residents, the residents of St. Luke’s Home in Dickinson and Inpatient/Outpatient clients of Sakakawea Medical Center in Hazen. It also gave us the opportunity to provide outpatient therapy services here in Killdeer. Unfortunately, we were unable to retain sufficient professional staff to maintain the operation and in 2008 we closed down our in house program. However, we have contracted with Applied Medical to ensure that our residents get the services they need and also to continue the outpatient therapy program in the community.

 Today, Hill Top still maintains a ninety-four percent occupancy level, but we are losing people from our communities to facilities in other cities. They are leaving the communities that they grew up in and helped to build because they are not able to live on their own anymore, but they do not qualify for skilled nursing care at Hill Top. Over the past eighteen months the Boards and staff have been exploring the possibilities of adding Basic Care and Assisted Living facilities to our campus. This would allow us to provide services on every level of the long term care spectrum and offer members of our communities an alternative to moving to a facility in another city.

"Assisted living facility" means a building or structure containing a series of at least five living units operated as one entity to provide services for five or more individuals who are not related by blood, marriage, or guardianship to the owner or manager of the entity and which is kept, used, maintained, advertised, or held out to the public as a place that provides or coordinates individualized support services to accommodate the individual’s needs and abilities to maintain as much independence as possible. An assisted living facility does not include a facility that is a congregate housing facility or licensed as a basic care facility. The living units are one, two, or three bedrooms; single room occupancy or efficiency apartments.  Each generally has a full kitchen and must have a private bathroom with a toilet, bath tub or shower, and a sink. Individuals in assisted living facilities pay with personal funds because funding is not available for rental assistance (except through the U.S. Department of Housing and Urban Development in limited situations); however, they may be eligible for services funded by state resources, Medicaid, or Medicaid waiver services. Generally, low-income individuals have limited access to assisted living. There are two components to the rate structure for assisted living, rent and services. Residents in assisted living choose and pay for only those services needed or desired with rates in North Dakota ranging from $505 to $3152 for rent and $200 to $2000 plus for services.

 "Basic care facility" means a residence, that provides room and board to five or more individuals who are not related by blood or marriage to the owner or manager of the residence and who, because of impaired capacity for independent living, require health, social, or personal care services, but do not require regular twenty-four-hour medical or nursing services and either makes response staff available at all times to meet the twenty-four-hour per day scheduled and unscheduled needs of the individual or  is kept, used, maintained, advertised, or held out to the public as an Alzheimer's, dementia, or special memory care facility. Accommodations are generally semi-private room with shared bath.  Private resident units must be a minimum of 100 square feet; semi-private resident units must provide a minimum of 80 square feet per resident.  There must be at least one toilet for every four residents and a bathtub or shower for every 15 residents. Payment can be through private funds or the Medicaid system. The individual must be Medicaid eligible to qualify for the personal care option to pay for services in a basic care facility. State general funds are available for room and board for low income individuals. Each facility has an all inclusive rate established by the Department of Human Services for all residents regardless of services used.

 A market study that was recently completed by HP&MR Inc. of Edina, MN indicates that there is an unmet need for both Basic Care and Assisted Living facilities in our area. This is further substantiated by the waiting lists prevalent at facilities located within a fifty mile radius of Killdeer. The market study shows that while the general population of the local communities is expected to maintain at the current level, the age of that population is projected to continue to grow. That means that the population in the age groups above sixty-five, which are the most likely to need long term care services, will grow and so will the need for services. This market study did not take into account the influx of people related to the current oil boom we are experiencing in the population projections.

As we continue to explore these options we would welcome any thoughts or input you may have.

Note: Did you know that the average age of residents in Assisted Living facilities is higher than the average age of residents in skilled nursing facilities?