STEELE - Alice Dewitz is fretting over her future.

"She wants to get a truck to move her things and get an apartment," daughter-in-law Nancy Dewitz said. "She is really upset."

Alice Dewitz is a resident of Golden Manor, a nursing home in Steele. By the middle of next year, Golden Manor will be a basic care and assisted living facility.

Medcenter One leases Golden Manor, a 50-bed nursing home in Kidder County. About six months ago, Medcenter officials started talking to the Golden Manor Inc. board about changing the use of the facility because of a workforce shortage and need for nursing home beds in the Bismarck-Mandan area.

"Change is hard for people," said Medcenter One CEO Jim Cooper. "This is the only way to keep it viable."

Medcenter notified families about the pending change and held a standing-room-only meeting for family and residents earlier this month.

"Anger" was Dorlyn Hoffman's response to how he first felt when he read the letter from Medcenter One.

"Disbelief," said Nadine Hoffman, his wife.

Dorlyn Hoffman's father, Peter Hoffman, will need to move to another nursing home. Again. As his Alzheimer's progressed, he's gone from living at home to an apartment to an assisted living facility to a basic care facility to a skilled nursing facility in Napoleon and finally Golden Manor in Steele.

"When we moved him to Golden Manor, we thought it would be for the rest of his life," Dorlyn Hoffman said. "Each move is difficult."

Now Peter Hoffman will move a sixth time. The Hoffmans have applied at another facility and are waiting to hear if there is an opening. If there isn't one by the end of October he'll go to Medcenter's facility in Mandan.

"If it (Steele) was dilapidated, that's one thing, but it's not," Nadine Hoffman said.

Golden Manor is home to 42 residents, as of the third week of July. The grounds of Golden Manor are landscaped and have walking paths because of the auxiliary and a family member from Minnesota who owned a greenhouse.

Golden Manor families can choose to find another nursing home facility, or have their family member go to one of the Medcenter One nursing homes in Mandan. In November, it will open a new nursing home in Mandan and plans are to shift staff and patients from the existing Mandan facility to the new facility, Cooper said.

The new option comes at a price. The Haugens were told at their family meeting that the room rate at the existing Mandan facility would be the same as Golden Manor, while the new facility would be an increased price, Dennis Haugen said.

His father-in-law, Dan Albright, is in Golden Manor. He and his wife, Jody Albright Haugen, who live in Wichita, Kan., found out about the plans from her brother in Bismarck. Her brother received the letter from Medcenter.

Room rates are set by law, Medcenter officials said. The newer facility will cost more, while the existing facility in Mandan would be at a lower rate than Golden Manor, Medcenter officials said.

The Haugens already have met with Golden Manor administrators, while other families will meet with them in the coming weeks.

"Dan's name was never mentioned," Jody Albright Haugen said.

The conversation was about the facility in Mandan and why the changes in Steele needed to occur because of what's happened in Bismarck and Mandan, Dennis Haugen said. He would have liked more attention focused on his father-in-law. A social worker they also talked to spoke more about Dan Albright.

Golden Manor is the largest employer in Kidder County, Dorlyn Hoffman said. Staff will be reduced at Golden Manor, and the other staff will move to other jobs within Medcenter One. Golden Manor employs 93 people, but as a basic care and assisted living facility it would need 12 to 15 employees. The remaining employees likely will be moved to the existing Mandan nursing home because the staff at that facility will be moved to the new Mandan nursing home.

"What we're trying to do in planning the Steele facility is to not become obsolete," Cooper said.

There are three types of aging care facilities in North Dakota: nursing homes, which offer skilled nursing care 24 hours a day and are federally regulated; basic care, which is a state-regulated facility that offers some services similar to nursing homes, but are not eligible for Medicare or Medicaid; and assisted living facilities for aging adults who can live more independently and contract for services.

There are 83 nursing facilities, 55 basic care and 60 assisted living care facilities in the state, said Shelly Peterson, president of the North Dakota Long Term Care Association. Her husband is Wade Peterson, administrator of Golden Manor and the Mandan nursing home.

In the next two years, rural areas will lose 240 beds to the four urban areas, Peterson said. Those areas are Bismarck, Fargo, Grand Forks and Minot. The bulk will go to Bismarck and Fargo. Fargo has three nursing home projects, she said.

The existing nursing home in Mandan has 120 beds. It will be reduced to 50, Cooper said. The new facility is four times larger than the existing facility, Cooper said. Each room is a private room.

This movement of nursing home beds is meant to balance the availability of beds in the state. Rural areas have a surplus of beds, while urban areas sometimes have no availability. When an organization like Medcenter opens a new facility it must buy a previously licensed bed or transfer it from another one of its facilities because a state moratorium will not allow new beds to be licensed.

Now, there will be more job opportunities in the Bismarck-Mandan area with three nursing home projects. Medcenter's nursing home in Mandan will be the first to come on line in November. The others are in the planning phases. Good Samaritan and Benedictine Health Systems are each planning nursing homes in Bismarck.

With this growth in the area, Cooper does not see how Medcenter's physicians can continue referring patients to Steele, he said. Instead, it will transfer Golden Manor's nursing home beds in Steele to Mandan.

Some families, like Dewitzes and the Hoffmans, plan to keep their family members in Golden Manor as long as they can.

"I have to move her somewhere," Nancy Dewitz said. "I won't do it until the last minute. I want her to be comfortable."

Rural nursing homes in North Dakota have been losing beds and closing in the last 15 years.

Some communities have remained stable, while others have decreased since 1994, when the association started keeping track. The facility in Crosby has decreased from 81 beds to 42 beds during that time, while the Marion Manor Healthcare Center in Glen Ullin has stayed at 86 beds.

"(The) Census will fall dramatically when Bismarck adds beds, this will take years to recover from, assuming we will recover," wrote Rod Auer, administrator of Marion Manor Healthcare Center, in a July 17 e-mail survey with the NDLTCA. "Staffing will probably drive down bed capacity."

Auer gave Peterson permission to share his responses to her e-mail. Her e-mail was sent out to NDLTCA members to gauge bed reduction in rural areas.

Other facilities closed, like Carrington, Noonan and Bottineau. The special care unit of the Baptist Home of Kenmare will be closed Aug. 8. Its three patients were given 30-day notice, which is standard, and the facility operators helped locate new accommodations for the patients.

"This was a very hard decision to make," said Karen Schwartz, administrator of the Baptist Home of Kenmare in an e-mail last week. "Critical shortage of staff was the major factor along with our low census. Our staffing shortage had escalated to the point we are no longer able to deliver the high level of care and service that we have prided ourselves in and that our residents and families deserve and expect."

(Reach reporter Sara Kincaid at 250-8251 or sara.kincaid@bismarcktribune.com.)