New North Dakota Law Allows Licensure of Residential Hospices

North Dakota Gov. Doug Burgum (R) has signed legislation that will permit the establishment of residential end-of-life care facilities in the state. The new law gives the state Department of Health authority to license these operations. 

Such laws are common in the United States. North Dakota may be the last state in the nation to approve residential hospice. Previously, residents of the state could only receive care in their home, nursing homes or in a hospital. 

“We are now serving more individuals residing in nursing homes and assisted living facilities – in addition to our traditional home-based populations,” said Stephen Astrup, regulatory and project counsel for Hospice of the Red River Valley in testimony before the sate’s legislature. “We serve patients and families across North Dakota’s comprehensive continuum of care and support patients and families’ right of choice – including where a patient wishes to call home.” 


The state defines residential hospice as a freestanding facility that provides 24-hour residential and support services in a home-like setting for hospice patients receiving hospice services from a third-party hospice program.

Patients come to these facilities when their symptoms are too severe to be managed in the home, when the home is found to be unsuitable for safety or other reasons, or when the patient believes ending their days at home would be too difficult for the family.

Following approval of the law, an estimated $35 million dollar development campaign is set to begin to fund the Gaia Home, which would be the first residential hospice in the state. The facility is expected to open in 2025. The project is spearheaded by the philanthropic organization the Rockstad Foundation.


The facility is expected to have 12 private twin homes for hospice patients and family members. Residents may receive care from the hospice of their choice while staying in at Gaia Home, which will be located in the state’s capital of Bismark.

“There have been many conversations throughout the years about offering this type of home for the community,” said Chad Wachter, Gaia Home board chairman, in a statement. “We’re excited that law is now passed, recognizing this concept so we can confidently continue to develop more relationships with people and organizations who support this option.”

Hospice utilization is low in North Dakota. About 31% of Medicare decedents in the state elected hospice in 2018, compared to a national average of slightly more than 50%, according to the National Hospice & Palliative Care Organization.

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