Attempting for three years to address labor issues associated with adult foster care through the North Dakota Department of Health and Human Services (HHS), Nelson satid it was a good feeling to see the bill she helped draft and advocate for enacted into law.

“It’s been a lot,” she said of the process, “but I’m very happy with where we are right now. I feel confident in what I can offer to my families.”

Nelson admits she didn’t fully comprehend the state’s rules for adult foster care when she opened her home three years ago. She didn’t immediately recognize the limit on an operator time off was 1½ days a week, the equivalent of 36 hours.

“For me, personally, living in the rural area, that was difficult,” Nelson said. “If I was only allowed to leave the house once a week, that one day a week would get filled with everything I have to do.”

Jessica Nelson arranges the medical equipment she keeps in her adult foster care home as she cares for residents June 19.

Specializing in dementia care, her job is 24/7. Providing personal care for one resident while trying to monitor a second resident with dementia was a strain, but she could not bring in an employee under the rules.

“It became really unsafe,” she said. In addition, the task of transporting one resident to a medical appointment required taking along other residents. Her home is licensed for four, but she currently has two residents.

Nelson said there were employees in HHS who understood her dilemma or questioned the application of the rules because she didn’t have residents on Medicaid. However, there was no relief when the final interpretation of the rules was made.

There was one message she was hearing consistently.

“They said, ‘If you’re going to get a change, you’re just going to have to go through the Legislature. That’s the only people that can change it for you,'” Nelson said.

“I was like, ‘OK. Well, what is that process?'” she said. “I was very intimidated about what I thought it was going to be.”

She started by contacting the governor’s office, which steered her toward her district legislators.

She met with District 6’s Sen. Paul Thomas of Velva and Dick Anderson of Willow City, who encouraged her to offer ideas that would promote the growth of adult foster care to meet the needs in the state.

Nelson came up with four changes. She proposed two days off a week and up to three weeks off as vacation. She proposed that time in excess of 12 hours – rather than eight hours – be considered a full day off. Another change would allow an employee to assist with the operator present.

Nelson had used baby monitors to heighten the safety of residents and improve her personal rest at night. She asked for a change to officially allow the use of electronic equipment with the permission of the family.

Nelson traveled to Bismarck to testify before both the House and Senate Human Services committees. Although the public speaking was nerve racking, the process was made easier with the encouragement of her legislators, she said.

“They just gave me the confidence. They just said that you don’t need the fancy words. You have a point here. You just go and you say it,” she said. “They definitely gave me the little push that I was looking for, and they were respectful and kind and professional.”

As a legislator, Thomas said, he can assist with getting bills written, identifying key legislators to work with and interacting with legislators to ensure they understand the bill.

“But when it comes to standing before that committee and really explaining the details of why this is really important,” Thomas said, ” nobody can do that better than the person that’s directly affected. That’s where that teamwork between the legislator and that citizen advocate is so valuable.”

He added he appreciated Nelson’s advance legwork in researching existing law and identifying what needed to be done because it created a place for action to begin.

“One of the things citizens need to realize is that it’s more than just identifying a problem, telling your legislator that and then hoping change occurs, especially if it’s significant change,” he said. “It does require advocacy, not only from the legislator but also from you as that affected constituent.”

Often problems can be addressed without legislation, but in visiting with HHS, that was not the case with the adult foster care concerns, Thomas said.

“In Jessica’s case, she was really the primary driver in this one, but it isn’t just Jessica’s issue. It’s an issue for all the adult foster care home people as well as future individuals that may want to do exactly what Jessica is doing to meet the need in their local community,” he said.

Nelson’s testimony on the need for a change in work standards resonated with legislative committee members, who called the existing time off standards “appalling” and “abusive” and raised concern about resident safety and the small number of people willing to work under those conditions. The state was reported to have 11 adult foster care homes at that time.

When HB 1460 reached the Senate after passing the House 87-0, the focus was on tweaking electronic monitoring language to meet federal law, including gaining permission from the resident if capable, and removing a Legislative Management study from the bill. The House objected to eliminating the study and restored it in conference committee. The bill then passed the House 91-1 and the Senate 46-0.

“It felt really relieving,” Nelson said. “They understood what I was trying to get at, and so, that was really nice. … They were all really just fighting to try to help me.”

Nelson now is following the legislative study discussion. Licensed as a certified nursing assistant, Nelson would like to see legislators consider independent work in an adult foster care home as CNA hours for license renewal purposes because she feels strongly about having a higher credential than Qualified Service Provider to work with her dementia clients. Current rules require a CNA to have worked under a nurse a minimum number of hours to renew a license.

Nelson previously worked seven years in different facets of elderly care with Heart of America Medical Center in Rugby and also in providing home care.

Her experience with the Legislature revealed that changing a law is more complicated than it might initially seem, Nelson said. Specific changes may require funding, face restrictions in federal law or impact more areas or agencies than anticipated.

Still, she is glad she engaged as a citizen with the Legislature.

“I had a really great experience with it. It was exciting. It was a learning curve,” she said. “But the fact of the matter is the important stuff is being changed, and there’s actually room for more things to get changed.”