5/5
CMS (the Centers for Medicare & Medicaid Services) is the federal agency that rates nursing home quality. Its Overall Rating runs from 1 to 5 stars, combining health inspections, staffing, and quality measures, with inspections weighted most heavily.
5/5
CMS (the Centers for Medicare & Medicaid Services) is the federal agency that rates nursing home quality. Its Overall Rating runs from 1 to 5 stars, combining health inspections, staffing, and quality measures, with inspections weighted most heavily.
Tuff Memorial Home is a 48-bed nursing home in Hills, Minnesota, a small rural town near the South Dakota state line. The surrounding area is car-dependent, with a Walk Score of 8, which is standard for a community this rural and this size. Rehabilitation services, respite care, and 24-hour staffing are on-site. Medicare, Medicaid, and private pay are all accepted, while the minimum admission age is 50.
At 78% occupancy and an average length of stay of 285 days, the resident population here leans longer-term. The facility handles both extended care and rehabilitation admissions, though the stay-length average suggests the majority of residents are not short-term rehab cases. Total nursing hours are 4 hours and 47 minutes per resident per day; registered nurses account for 43 of those minutes.
Meals are adapted to individual needs, with regular, liberalized, and modified diet options available. Housekeeping and utilities are included, and the facility has a chapel with Sunday morning services.
Two structural details stand out: first, the facility maintains both an Active Resident Council and an Active Family Council, which means there are organized, ongoing forums for raising concerns about care, policies, and daily life. Those aren’t universal in small rural nursing homes. Second, the dietary program specifically accommodates modified diets, which matters for residents with swallowing difficulties or other clinical dietary needs.
At 48 beds in a rural Minnesota town with Medicare, Medicaid, and private pay accepted, Tuff Memorial Home is a small, community-based nursing home that covers the essentials of long-term and rehabilitative care for the region it serves.
The Overall CMS Rating combines results from health inspections, staffing levels and quality measures. Health inspections carry the most weight. Staffing and quality scores can increase or decrease the final rating based on performance compared to state and national standards.
Based on the results of the facility's three most recent standard inspections and any complaint investigations. CMS reviews the number, scope, and severity of deficiencies, with more recent findings weighted more heavily.
Measures average nursing staff hours per resident per day, including Registered Nurses (RNs) and total nursing staff. Ratings are adjusted based on the level of care residents require and are compared to state and national benchmarks.
Based on clinical and physical health indicators reported to CMS, such as hospital readmissions, falls, pressure ulcers, and improvements in mobility. These measures reflect how well residents' health needs are being managed.
Daily nursing hours per resident by staff type, reported to CMS. Higher is generally better — compare this facility to state and national averages to see where staffing stands.
This home is ranked 36th out of 84 homes in South Dakota for nurse hours. Total adjusted nursing hours per resident per day, combining RN, LPN, and aide time. CMS adjusts this for case-mix so facilities can be fairly compared.
| Staff type | Hours / Day / Resident | vs state avg |
|---|---|---|
|
Registered Nurse (RN)
RNs hold the highest nursing license and can assess residents, interpret test results, and direct care plans. More RN hours per day often signals stronger clinical oversight and faster response to health changes.
| 43m per day | ▼ 12% State avg: 49m per day · National avg: 41m per day |
|
LPN / LVN
Licensed Practical Nurses (LPNs) or Licensed Vocational Nurses (LVNs) deliver routine hands-on care — medication administration, wound dressing, and monitoring vital signs. They work under RN supervision and make up a large share of daily bedside care.
| 18m per day | ▼ 37% State avg: 29m per day · National avg: 52m per day |
|
Nurse Aide
Certified Nurse Aides (CNAs) provide the most direct day-to-day assistance: bathing, dressing, feeding, and mobility. Nurse aide hours are typically the largest staffing category and directly affect residents' quality of life.
| 2h 56m per day | ▲ 14% State avg: 2h 34m per day · National avg: 2h 20m per day |
|
Weekend Total Nursing
Combined nursing hours (RN + LPN + Nurse Aide) per resident per day on weekends. Staffing often drops on weekends — this figure reveals whether the facility maintains adequate coverage outside of weekday hours.
| 3h 17m per day | ▼ 3% State avg: 3h 23m per day · National avg: 3h 27m per day |
|
Physical Therapist
Hours per resident per day provided by licensed Physical Therapists (PTs) or PT Assistants. PT services help residents recover mobility after injury or illness and are especially important for post-acute (short-stay) rehabilitation.
| 0m per day | ▼ 100% State avg: 3m per day · National avg: 4m per day |
|
Weekend RN
Registered nurse hours specifically on weekends. Facilities sometimes reduce RN presence on Saturdays and Sundays — a low weekend RN figure compared to weekday hours can indicate reduced clinical oversight when most administrative staff are absent.
| 22m per day | ▼ 28% State avg: 31m per day · National avg: 29m per day |
Average number of days residents stay at this facility, based on CMS cost report data. Shorter stays often reflect post-acute or rehab care; longer stays reflect long-term care.
Reporting period: October 1 – December 31, 2025 (Q4 2025). Source: CMS Payroll-Based Journal report.
16% fewer staff per resident than South Dakota average
6% better than South Dakota average
This data comes from the CMS Payroll-Based Journal report covering October 1 – December 31, 2025.
Manages medical care and health needs.
7 total: 5 full-time employees and 2 contractors.
7
Average shift length. Calculated as total hours divided by days worked and average staff per day.
10.9 hoursAssists with medical care and medications.
All 3 LPN Staff are full-time employees. No contractors work on this role.
3
Average shift length. Calculated as total hours divided by days worked and average staff per day.
9.1 hoursHelps with daily care and mobility.
39 total: 38 full-time employees and 1 contractor.
39
Average shift length. Calculated as total hours divided by days worked and average staff per day.
7.6 hours
This data comes from the CMS Payroll-Based Journal report covering October 1 – December 31, 2025.
Total hours from contractors
609 contractor hours this quarter
This data comes from the CMS Payroll-Based Journal report covering October 1 – December 31, 2025.
| Certified Nursing Assistant | 38 | 1 | 39 | 8,367 | 92 | 100% | 7.6 |
| Registered Nurse | 5 | 2 | 7 | 1,447 | 87 | 95% | 10.9 |
| Other Dietary Services Staff | 3 | 0 | 3 | 1,089 | 88 | 96% | 6.8 |
| Licensed Practical Nurse | 3 | 0 | 3 | 1,058 | 81 | 88% | 9.1 |
| Nurse Aide in Training | 2 | 0 | 2 | 1,000 | 79 | 86% | 8.1 |
| Medication Aide/Technician | 3 | 0 | 3 | 980 | 78 | 85% | 12.2 |
| Nurse Practitioner | 1 | 0 | 1 | 684 | 71 | 77% | 9.6 |
| Administrator | 1 | 0 | 1 | 622 | 71 | 77% | 8.8 |
| Dental Services Staff | 1 | 0 | 1 | 431 | 57 | 62% | 7.6 |
| Clinical Nurse Specialist | 1 | 0 | 1 | 423 | 49 | 53% | 8.6 |
| Dietitian | 1 | 0 | 1 | 404 | 57 | 62% | 7.1 |
| Occupational Therapy Assistant | 0 | 1 | 1 | 33 | 8 | 9% | 4.1 |
| Occupational Therapy Aide | 0 | 1 | 1 | 9 | 3 | 3% | 2.8 |
| Medical Director | 0 | 1 | 1 | 6 | 18 | 20% | 0.4 |
Includes penalties issued in 2023
Federal penalties imposed by CMS for regulatory violations, including civil money penalties (fines) and denials of payment for new Medicare/Medicaid admissions.
Source: CMS Penalties Database (Data as of Jan 2026)
In line with South Dakota averageSouth Dakota average: $44K
498% more fines than South Dakota averageSouth Dakota average: 2.0
Serious action where Medicare and/or Medicaid temporarily stops payments for new residents until issues are fixed.
1
130% more payment denials than South Dakota averageSouth Dakota average: 0.4
Penalties are imposed by CMS for violations of federal nursing home regulations.
13 penalties in the past 3 years
Multiple penalties were reported in the last 3 years.
Fines imposed for noncompliance, which can be assessed per day or per instance of violation.
Nov 13, 2023
Fines imposed for noncompliance, which can be assessed per day or per instance of violation.
Nov 6, 2023
Fines imposed for noncompliance, which can be assessed per day or per instance of violation.
Oct 30, 2023
Fines imposed for noncompliance, which can be assessed per day or per instance of violation.
Oct 23, 2023Last updated: Jan 2026
These measures show how residents usually do over time at this home, based on health outcomes and preventive care.
A composite score based on pressure ulcers, falls with injury, weight loss, walking ability decline, and activities of daily living decline.
9.6
14% better than South Dakota averageSouth Dakota average: 11.1
A composite score based on activities of daily living decline, walking ability decline, and incontinence.
20.6
9% better than South Dakota averageSouth Dakota average: 22.6
Percent of long-stay residents whose need for help with daily activities has increased
17.0%
11% better than South Dakota averageSouth Dakota average: 18.9%
Percent of long-stay residents whose ability to move independently worsened
12.0%
50% better than South Dakota averageSouth Dakota average: 23.8%
Percent of low risk long-stay residents who lose control of their bowels or bladder
32.9%
31% worse than South Dakota averageSouth Dakota average: 25.0%
Percent of long-stay residents experiencing one or more falls with major injury
10.5%
182% worse than South Dakota averageSouth Dakota average: 3.7%
Percent of long-stay high risk residents with pressure ulcers
2.5%
54% better than South Dakota averageSouth Dakota average: 5.4%
Percent of long-stay residents with a urinary tract infection
1.5%
45% better than South Dakota averageSouth Dakota average: 2.7%
Percent of long-stay residents who lose too much weight
5.8%
41% worse than South Dakota averageSouth Dakota average: 4.1%
Percent of long-stay residents who have depressive symptoms
0.0%
100% better than South Dakota averageSouth Dakota average: 4.4%
Percent of long-stay residents who received an antipsychotic medication
15.5%
10% better than South Dakota averageSouth Dakota average: 17.2%
Percent of long-stay residents assessed and appropriately given the pneumococcal vaccine
100.0%
In line with South Dakota averageSouth Dakota average: 97.3%
Percent of long-stay residents assessed and appropriately given the seasonal influenza vaccine
100.0%
In line with South Dakota averageSouth Dakota average: 96.0%
Percent of short-stay residents assessed and appropriately given the pneumococcal vaccine
87.1%
In line with South Dakota averageSouth Dakota average: 88.9%
Quality measures are calculated from Minimum Data Set (MDS) assessments. For most measures, lower percentages indicate better care quality.
31% of new residents, usually for short-term rehab.
36% of new residents, often for short stays.
33% of new residents, often for long-term daily care.
Source: CMS Long-Term Care Facility Characteristics (Data as of Jan 2026)
Total residents
40Residents meet regularly to discuss policies, care quality, and activities
Family members meet regularly to discuss policies, care quality, and activities
Organized group of family members that meets regularly to discuss facility policies, resident care, and activities.
Organized group of residents that meets regularly to discuss facility policies, quality of life, and activities.
Data sourced from CMS Long-Term Care Facility Characteristics quarterly report. Payer mix reflects the current resident census by primary payment source.
Historical financial and operational data for Tuff Memorial Home from 2012–2023, based on CMS SNF Cost Reports.
Key figures below are for fiscal year ending in 09/2023.
Based on CMS SNF Cost Report for fiscal year ending in 09/2023.
Net patient revenue — what the home actually collects for resident care, after contractual allowances, bad debt and discounts are subtracted from its gross charges (CMS cost report, Worksheet G-3). It covers resident care only; money the home earns from other sources is shown separately as "Other income."
Net patient income: net patient revenue minus the home's total operating expenses. A positive figure means it earns more from resident care than it spends to deliver it; a negative figure means the opposite. It excludes non-operating "other income."
Net patient revenue — what the home actually collects for resident care, after contractual allowances, bad debt and discounts are subtracted from its gross charges (CMS cost report, Worksheet G-3). It covers resident care only; money the home earns from other sources is shown separately as "Other income."
Net patient income: net patient revenue minus the home's total operating expenses. A positive figure means it earns more from resident care than it spends to deliver it; a negative figure means the opposite. It excludes non-operating "other income."
Money the home earns outside of resident care — such as investments, grants, rentals and other non-operating sources (CMS cost report, Worksheet G-3). It is tracked separately from net patient revenue: it is not part of that figure, and it is not included in net patient income.
Staff salaries plus wage-related costs — benefits such as payroll taxes, health insurance and retirement — from the home's own accounting records (CMS cost report, Worksheet A). Contract or agency labor is counted separately, under other operating costs.
Rank #76 / 84Payroll — State benchmarkedThis home is ranked 76th out of 84 homes in Minnesota for Payroll. Shows total annual staff payroll benchmarked to the Minnesota average. Higher payroll investment relative to peers often signals better staffing and less reliance on cheaper contract labor.Facilities with the same value for a metric share the same rank. Rankings are based only on facilities in Minnesota that report data for that category. Facilities without available data are excluded from the ranking.Click the rank badge to see the full State ranking.Click here to see the full State ranking.
Payroll as a share of revenue: staff salaries and wage-related benefits divided by net patient revenue. A higher figure means more of each revenue dollar goes to staff pay.
Rank #12 / 84Payroll % — State benchmarkedThis home is ranked 12th out of 84 homes in Minnesota for Payroll %. Shows payroll as a percentage of revenue versus the Minnesota average. Well-run Minnesota facilities typically land around 62–67% — the top third Statewide. Below 25% may signal understaffing or heavy agency use — read with Staffing ratings.Facilities with the same value for a metric share the same rank. Rankings are based only on facilities in Minnesota that report data for that category. Facilities without available data are excluded from the ranking.Click the rank badge to see the full State ranking.Click here to see the full State ranking.
Everything it costs to run the home apart from payroll — food, utilities, supplies, maintenance, contract labor and administration. Calculated as total operating expense minus payroll (staff salaries and wage-related benefits).
The home's total operating expense for the year — all the costs of running it, salaries included (CMS cost report, Worksheet G-3).
This home supports both short-term rehab and long-term care, with residents staying for a wide range of durations.
New residents most often arrive under private pay (36% of admissions), and a typical private pay stay runs around 7 - 8 months.
Coverage residents most often arrive under.
Coverage residents most often leave under.
The information below is reported by the South Dakota Department of Health, Office of Health Care Facilities Licensure.
| Bethany Home Sioux Falls/Bethany Home-Brandon | NH AL IL MC SNF | Sioux Falls | 112
Facility
112
SD AVG
69
Rank
#11 / 117 | - | - | 5.47
Facility
5.47
SD AVG
4.34
Rank
#5 / 65 | -15% | +26% | $0
Facility
$0
SD AVG
$38.5k
Rank
#1 / 67 | 13
Facility
13
SD AVG
14.8
Rank
#27 / 65 | 3.3
Facility
3.3
SD AVG
3.3
Rank
#35 / 65 | 1 | 43 | - |
65
Facility
65
SD AVG
39
Rank
#24 / 158 | Augustana Lutheran Church | $5.9MFiscal year ending 06/2024
Facility
$5.9MFiscal year ending 06/2024
SD AVG
$6.7M
Rank
#41 / 63 | $4.1MFiscal year ending 06/2024
Facility
$4.1MFiscal year ending 06/2024
SD AVG
$2.6M
Rank
#23 / 63 | 68.6%Fiscal year ending 06/2024
Facility
68.6%Fiscal year ending 06/2024
SD AVG
40.8%
Rank
#12 / 63 | 435096 | ||||
| Tuff Memorial Home | NH SNF | Sioux Falls | 48
Facility
48
SD AVG
69
Rank
#76 / 117 |
79.8%
Facility
79.8%
SD AVG
82.2
Rank
#24 / 34 | +9% | 4.78 | -24% | 0% | $44.4k | 13 | 3.3 | - | 38 | - |
8
Facility
8
SD AVG
39
Rank
#138 / 158 | Alex Dysthe | $4.0MFiscal year ending 09/2023 | $2.7MFiscal year ending 09/2023 | 67.9%Fiscal year ending 09/2023 | 245548 | ||||
| Good Samaritan Society Sioux Falls Center | NH SNF | Sioux Falls | 98
Facility
98
SD AVG
69
Rank
#23 / 117 |
81.6%
Facility
81.6%
SD AVG
82.2
Rank
#23 / 34 | -1% | 3.93
Facility
3.93
SD AVG
4.34
Rank
#28 / 65 | +21% | -9% | $11.3k
Facility
$11.3k
SD AVG
$38.5k
Rank
#26 / 67 | 14
Facility
14
SD AVG
14.8
Rank
#29 / 65 | 4.7
Facility
4.7
SD AVG
3.3
Rank
#52 / 65 | 1 | 80 | - |
19
Facility
19
SD AVG
39
Rank
#113 / 158 | Luke Wanous | $8.1MFiscal year ending 09/2023
Facility
$8.1MFiscal year ending 09/2023
SD AVG
$6.7M
Rank
#16 / 63 | $4.5MFiscal year ending 09/2023
Facility
$4.5MFiscal year ending 09/2023
SD AVG
$2.6M
Rank
#11 / 63 | 56%Fiscal year ending 09/2023
Facility
56%Fiscal year ending 09/2023
SD AVG
40.8%
Rank
#18 / 63 | 435046 | ||||
| Avantara Norton | NH HOS SNF | Sioux Falls | 110
Facility
110
SD AVG
69
Rank
#12 / 117 |
90.0%
Facility
90.0%
SD AVG
82.2
Rank
#12 / 34 | +9% | 3.53
Facility
3.53
SD AVG
4.34
Rank
#41 / 65 | +53% | -19% | $153.6k
Facility
$153.6k
SD AVG
$38.5k
Rank
#63 / 67 | 75
Facility
75
SD AVG
14.8
Rank
#64 / 65 | 4.2
Facility
4.2
SD AVG
3.3
Rank
#47 / 65 | 18 | 99 | - |
61
Facility
61
SD AVG
39
Rank
#36 / 158 | Jeremy Klinkhammer | $10.3MFiscal year ending 12/2023
Facility
$10.3MFiscal year ending 12/2023
SD AVG
$6.7M
Rank
#9 / 63 | $4.4MFiscal year ending 12/2023
Facility
$4.4MFiscal year ending 12/2023
SD AVG
$2.6M
Rank
#9 / 63 | 42.4%Fiscal year ending 12/2023
Facility
42.4%Fiscal year ending 12/2023
SD AVG
40.8%
Rank
#37 / 63 | 435039 | ||||
| Good Samaritan Society Sioux Falls Village | NH AL IL MC | Sioux Falls | 177
Facility
177
SD AVG
69
Rank
#3 / 117 |
90.7%
Facility
90.7%
SD AVG
82.2
Rank
#10 / 34 | +10% | 4.02
Facility
4.02
SD AVG
4.34
Rank
#23 / 65 | +5% | -7% | $72.8k
Facility
$72.8k
SD AVG
$38.5k
Rank
#56 / 67 | 43
Facility
43
SD AVG
14.8
Rank
#63 / 65 | 6.1
Facility
6.1
SD AVG
3.3
Rank
#62 / 65 | 5 | 161 | - |
2
Facility
2
SD AVG
39
Rank
#147 / 158 | Dana Bachmeier | $19.5MFiscal year ending 09/2023
Facility
$19.5MFiscal year ending 09/2023
SD AVG
$6.7M
Rank
#1 / 63 | $10.5MFiscal year ending 09/2023
Facility
$10.5MFiscal year ending 09/2023
SD AVG
$2.6M
Rank
#4 / 63 | 54.1%Fiscal year ending 09/2023
Facility
54.1%Fiscal year ending 09/2023
SD AVG
40.8%
Rank
#29 / 63 | 435045 |
Tuff Memorial Home is located in Sioux Falls, South Dakota.
Here are the financial assistance programs available to residents in South Dakota.
Tuff Memorial Home has a walk score of 8. Car-dependent. Most errands require a car, with limited nearby walkable options.
Tuff Memorial Home's occupancy is 78.0%.
Tuff Memorial Home is registered as a non-profit.
Yes — there are 23 photos of Tuff Memorial Home in the photo gallery on this page.
(701) 780-6000 will put you in contact with the team at Tuff Memorial Home.
Yes — Tuff Memorial Home is a CMS-certified provider of Medicare and Medicaid.
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