Dec. 2—FREEMAN, S.D. — Amid a trend of small-town assisted living care facilities closing around South Dakota, two medical entities in Freeman are taking a step to help ensure area residents continue to receive quality care in their twilight years.
The Salem Mennonite Home, an assisted living facility in Freeman, plans to merge with Freeman Regional Health Services, a full-range healthcare facility, to consolidate resources and strengthen the level of care provided at both, according to officials. The exact date of the merger has not been established, but administrators with both facilities expect completion by the end of 2022.
"Plans are well underway to make the merger finalized by the end of the year," said Courtney Unruh, CEO of Freeman Regional. "By combining (Salem Mennonite Home) and (Freeman Regional) we have the opportunity to provide excellent and compassionate care for our communities through streamlining our senior living services."
Freeman Regional and the Salem Mennonite Home have been in discussions about partnering for years. Plans began moving forward quickly in 2020, when both entities entered into a management agreement with Avera Health. At the beginning of 2021, Freeman Regional and the Salem Home entered into a unified health care campus collaborative agreement, and by the end of the year had signed a letter of intent to work together through shared resources, Unruh said.
"In March of 2022, the leadership and boards decided it was in the best interest of our communities to move forward with a merger," Unruh said.
The Salem Mennonite Home serves about 35 residents with assisted care services. It is a longtime establishment in the community, having been founded in 1949 and is currently the oldest assisted living facility in South Dakota that is still in operation, according to Shirley Knodel, administrator for the center.
Freeman Regional Health Services began life as the Freeman Community Hospital, opening in 1952 as a 16-bed hospital. It has since expanded to include clinics, congregate living independent apartments and Oakview Terrace, a 56-bed Medicare skilled nursing home.
Both have served the community since, and a working relationship between the two has long been natural.
"We've been working together for quite some time. It's not unusual for us to partner on things," Knodel said. "This will get us to where we want to be, which is to be one entity."
Knodel and Unruh have worked together even more closely in recent years to combine the resources of the two facilities to help reduce costs and labor crunches. That has set the table for the full merger.
"We have a contract that allows us to share staff, and it's been wonderful. When you're a bigger facility like (Freeman Regional), the benefit offerings can be better. It's good for staff all the way around, and it gives them the opportunity to have experience in an area that they haven't necessarily worked in before," Knodel said.
Unruh said the connection between the facilities has grown stronger in the last several years.
"(With Knodel and I) working closely these past seven years, we've built a trusting and lasting relationship. We've been collaborating at the department leader level for the last couple of years," Unruh said. "Just recently we entered into a personal contract in order to save costs and ensure assisted living residents are cared for by invested employees."
Unruh said the care teams from the independent apartments, assisted living and the nursing home will work in tandem to serve their senior residents.
The merger comes when many small communities in South Dakota are seeing their assisted care facilities close, either from funding issues, staffing problems or,
in the case of Avantara Salem, in Salem, storm damage.
A derecho that swept through the area earlier this summer damaged the building so severely it was elected to close the center, displacing many residents.
Denise Kurth, a former assisted living center CNA who worked at Avantara Salem in Salem for 28 years before retiring in 2020, said it was hard to see the facility close its doors. As the daughter to an aging father, she worries about people like her who have limited options for care in rural South Dakota and can't just pick up and move to be with their loved ones when it's time to change their living arrangement.
"It's unfortunate because we were kind of a hub for Sioux Falls," Kurth said. "My dad is 91, and I don't know what to expect. If I need (a nursing home) I don't want to have to travel to Nebraska or Wyoming or Montana. My livelihood is raising cattle."
Even finding alternatives with openings within the state can be a stretch for people who want to be near their loved ones in their later years, she said.
"To have to go to Arlington or Milbank or Watertown? Watertown is a two-hour drive," Kurth said.
Other communities that have seen their care centers close recently include Lennox, Clear Lake, Ipswich, Custer, Hudson, Sioux Falls, Huron, Madison, Mobridge, Tripp, Bryant, and Rosholt.
Kurth said she understands the financial aspects of the closures, but laments the often low pay received by professionals staffing such centers, a general shortage of employees, especially employees that are highly-invested in their work and residents, and the lack of Medicaid funding that is crucial to making ends meet for those rural centers.
"I'm not blaming anybody, it's just the way society is," Kurth said.
Those are all pitfalls the merger in Freeman is hoping to continue to avoid with their new arrangement. There will be some new faces in administrative positions when the move is complete, and a there is hopefully some new construction on the way, as well.
Knodel is expected to retire from her role at the Salem Mennonite Home in December. Amanda Mettler, who had served as director of social services at Freeman Regional, will step into the role of senior living assistant administrator in her stead.
Knodel said she and Mettler had been working together on the transition.
"Amanda brings a wealth of knowledge in senior care and she is highly dedicated to residents, families, employees and our communities. Amanda will be directly supervising the department directors and their teams at assisted living," Unruh said.
Nikki Mehlhaf, director of nursing at Freeman Regional, will take on the role of director of nursing at the assisted living, supporting Mettler with staffing and nursing care.
While there has been talk about a merger dating back to at least the 1990s, with both facility boards expected to sign off on the endeavor, all that remains now is paperwork. After that, the new entity will set its sights on another big step — a new combined facility expected to be built on the south side of Freeman, one that will combine the services of both on one campus.
"Our vision is to have all the Freeman Regional Health Services services on one campus. We want to build a healthcare campus that will serve the whole continuum of care and support again in place," Unruh said. "We have a dynamic and enthusiastic team that focuses on high-quality care. With a new and combined facility comes efficiency. We can combine costs and provide the best continuity of care by having services, employees, equipment and supplies all on the same campus."
Unruh said she does expect some challenges along the way, including cost, although robust local community support and a possible boost from an Avera Health capital campaign should help alleviate that.
"Currently, Freeman Regional is one of four communities invited by Avera to help create criteria to prioritize Avera's rural healthcare capital expenditures. Avera is looking at the overall probability of success and value of potential rural projects and how each project would benefit the Avera system," Unruh said. "Overall, I believe (we) are positioned well and, as with any large project, significant financial support is needed to make it a reality."
Unruh said Freeman Regional officials were expected to meet with Avera Health soon to evaluate how they are positioned compared to other communities interested in building projects. But she knows the support within the Freeman community at large is strong.
"(The response from the community has been) very positive. Our community has been anticipating this collaboration for a while. Working together is God's plan and it feels very natural moving into the future," Unruh said.
Knodel praised the community, the cooperation between her and Unruh, the quality of staff that will take the helm in the partnership and the respective boards of directors for coming together to make the move a reality. It will help ensure quality care remains a staple of the community, and that's the goal of everyone involved, she said.
"We have very visionary board members, that's what made this possible when it couldn't happen years ago. I just am so blessed to have Amanda (Mettler) in that role, and that our boards have been so willing to work together, and the positive community people that this is happening," Knodel said. "It's been a dream to come together. This is just awesome."
