Life Skills & Transition Center reports declining census, more short-term admissions and statewide outreach

Heather Jenkins, superintendent of the Life Skills and Transition Center (LSTC) in Grafton, told the Appropriations committee the center had a point-in-time census of 46 people as of Dec. 2024, comprised of 32 adults and 14 youth, and that the center has focused on shorter-term crisis admissions and transitions to community providers.

Nut graf: Jenkins and HHS staff described LSTC's shift from long-term institutional care toward a stabilization-and-transition role, provided data showing more admissions but shorter stays and explained budget pressures driven by overtime, contract staffing and increased clinical supports.

Jenkins said LSTC serves as a specialized crisis and stabilization resource for people with intellectual and developmental disabilities and offers residential crisis, short-term stabilization, transition supports, vocational services, applied behavior analysis, a statewide crisis stabilization team and adaptive-equipment services. "We support families and private residential facilities," Jenkins said. "We are not a permanent home, but rather the right service at the right time, helping individuals stabilize to build skills and prepare for future independence."

Census and transitions

- Jenkins reported a December 2024 census of 46 (32 adults; 14 youth). Between July 2023 and Dec. 2024 LSTC admitted 22 people, diverted 21 (referrals that did not result in admissions), completed 31 transitions out of the center and had 11 people "on deck" for transition. She said admissions increased while the overall point-in-time census fell, reflecting more short-term stays and successful moves to community settings.

- Jenkins noted long-term residence cases have declined; she said fewer than six residents now remain in long-term specialized care and gave a near-term example of a resident who had lived at LSTC for 71 years and was scheduled to transition to a community provider in mid-February.

Services, outreach and equipment

Jenkins described LSTC's nonresidential services: applied behavior analyst (ABA) teams that provide functional assessments and training; a statewide crisis-stabilization team that responds to community crises to prevent admission or to support transitions; specialized outpatient therapy (physical, occupational, speech and aquatic); and a robust adaptive-equipment program that fabricates and modifies mobility and assistive devices and offers short-term loans of gently used equipment.

She said the adaptive-equipment team completed 1,500 projects for about 346 people and provides mobile services across the state; the department contracts with an intermediary called Viridian for some waiver modifications (mentioned during the DD presentation).

Admissions, outcomes and readmissions

Jenkins said short-term crisis admissions (nine since July 2023; eight discharged, one current) resulted in shorter average lengths of stay and a low readmission rate of 5.5% during the period she reported. She said 66% of admissions that triggered a 30-day notice did not result in admission because the team helped identify alternatives or supports.

Budget drivers and staffing

Jenkins said staffing and personnel costs are the primary budget drivers (about 79% of LSTC operating costs). As of Dec. 1 the facility reported 276.44 position slots, 225.48 filled positions, 50.86 vacancies and 71 temporary staff. Average employee age was 49.3 and average years of service 12.2. Jenkins reported a turnover rate of 16.6% (as of Feb. 2024) and a retirement risk of 12.5%.

She told the committee the department uses contracted staff to fill shifts when needed and that overtime and contracted staffing have increased costs; the presentation requested additional general and federal funds to cover overtime and contracted-service needs and some capital repairs including Cedar Grove's roof replacement.

Policy and legislative items

- Jenkins described work to secure alternate billing mechanisms for crisis-stabilization and transition services now largely paid with state general funds.

- HHS staff and Jenkins discussed Senate Bill 2,112, legislation the department proposed to allow LSTC to serve a very small number of youth who are not DD-eligible in narrowly defined, short-term circumstances if no other safe, short-term placement exists. Jessica Thomason (HHS) said the bill is meant to provide a last-resort, time-limited option, not a permanent placement path; the fiscal note estimated a small biennial impact on the order of one youth per biennium in the modeling used for committee materials.

Committee questions and next steps

Committee members asked about regional access to adaptive-equipment services, LSTC's staffing vacancies and vacancy durations, use of contracted staff and the facility's psychiatrist coverage. Jenkins said the center is expanding outreach into western North Dakota and is collaborating with regional partners on psychiatric coverage and recruitment. She offered to provide additional vacancy-duration and contract-staffing detail to the committee.

Ending

Jenkins said the center will continue expanding mobile adaptive-equipment services, pursue billing options to reduce reliance on general funds for stabilization services, pursue dual accreditation and explore options to consolidate underused campus buildings. She provided contact information and asked the committee to follow up on staffing and facility capital needs.