PIERRE - South Dakota's elderly population will double in the next two decades, but the state lacks nursing home beds and other services in areas where the need will be greatest, according to a study done for the Department of Social Services.

The areas around Sioux Falls, Rapid City and the Black Hills will have the largest growth in people older than 65, according to the study done by Abt Associates of Cambridge, Mass.

Many aging nursing homes need to be replaced, additional nursing home beds must be provided in the Sioux Falls and Rapid City regions, and more assisted living facilities are needed in many areas, the study recommends. South Dakota also should expand home health care, meals and other services that allow older people to remain in their own homes, the researchers said.

"This is really scary. There are a lot of challenges facing us in this arena," state Social Services Secretary Deb Bowman told a legislative committee this week.

The study on long-term care was required by a law passed by the 2006 Legislature. Bowman said state officials will likely make proposals to the South Dakota Legislature sometime next year.

The U.S. Census Bureau has reported that South Dakota ranked eighth nationally in 2000 in the percentage of population 65 and older. That's expected to hold steady at about 14 percent of the population until 2010. But by 2030, an estimated 23 percent of the state's residents will be 65 or older, according to the Census projections.

The Abt study reached essentially the same conclusion, estimating that about 24 percent of South Dakota's population will be older than 65 by 2025.

Bowman said she supports the nearly 20-year-old state moratorium that prevents an increase in nursing home beds. But she said nursing homes in some areas have beds that are never used, so authorization for those beds could be shifted to areas where they are needed.

"We've got a real rebalancing issue facing us in order to meet the needs of our elderly," she said.

The 1988 moratorium was aimed partly at reducing the number of people who enter nursing homes. The idea was to provide more services that enable older people to remain independent and live in their own homes.

South Dakota has joined with some other states in a long-term care partnership program, which urges people to start thinking about how to pay for nursing home care, assisted living and other services. Many people in nursing homes run out of money, which means their bills are paid by Medicaid, the state-federal program that covers the medical expenses of low-income people.

Bowman said many people do not buy long-term care insurance or make other plans to pay for those services.

Many South Dakotans want to stay out of nursing homes, which means there is a need for additional services provided to those who remain in their own homes, the social services secretary said. Services provided in the home or at senior centers include home health care, meals and housekeeping.

The study reported that South Dakota now has about 6 licensed nursing home beds for every 100 people older than 65, while the national average is 4.8 beds per 100 elderly.

If the state percentage of elderly in nursing homes can be reduced to match the national average, the number of beds allowed in the moratorium cap could be about sufficient to meet future needs, the report said.

But many rural communities now have an excess capacity in their nursing homes, while the Sioux Falls area will need 400 more nursing home beds and the Rapid City region will need another 250 beds in the next two decades, according to the study.

In addition, 45 percent of the state's nursing homes were built at least 40 years ago, and many do not meet modern safety and quality standards.

"Rather than renovating existing facilities, the state has the opportunity to consolidate and to replace aged structures with newer facilities that can offer more efficient and effective care," the consultant's report said.

To serve people who want to stay out of nursing homes, South Dakota needs more assisted-living facilities and an expansion of services that provide health care, meals and other programs in homes and communities, the report said.

Work must also be done to make sure enough qualified workers are available to provide the services needed by the elderly, according to the study.

Bowman said the state must address many issues in deciding how to meet the needs of a growing population of elderly people.

"We have a lot of work ahead of us," she told the legislative panel.

On the net: http://dss.sd.gov/news/2007/LTCStudy.asp