If a project advances, Garrison will be following in the footsteps of other North Dakota communities that recently built new hospitals, including Rugby, Cando and Cooperstown. Northwood also broke ground on a major renovation and expansion in 2024.

Adam Maus, administrator at CHI St. Alexius-Garrison Memorial Hospital, said the aging building needs a lot of improvements.

“It’s starting to cost a lot of money to maintain,” Maus said. “We just had a generator replaced and a transfer switch because our electrical system wasn’t meeting code.” An electrical system upgrade cost about $500,000.

“We’ve had some plumbing issues. The plumbing is original to the building,” he added. He cited a cost of about $40,000 when a pipe broke under the boiler room.

“Costs are going to get higher and higher as we go along. And it’s just inefficiently designed. We get reimbursed through the state on the cost support, based on square footage that we designate to different services, and our building really wasn’t set up to maximize that cost support. So, we lose out on some revenue on that side as well,” Maus said. “If we can raise the money for the new hospital, even with the mortgage payments to pay for the hospital, we’d still come out ahead financially because of the reduction in maintenance costs for the facility and also being able to maximize our revenues.”

Discussions regarding a new hospital are in an early stage.

“We’ve just been communicating with the community members and just getting their feelings, their thoughts, whether or not this is something we want to move forward with, because without community support, it’s just not possible,” Maus said. “I have talked to some other facilities that have done this, so we have a pretty good roadmap, and I’ve talked to the USDA (U.S. Department of Agriculture) and the North Dakota Hospital Association, just to get their input and any assistance they can provide. But as far as investment and taking the first concrete steps, we’re still not quite there yet.”

The proposal is to build a new community-owned hospital to be leased to CommonSpirit Health, whose Midwest division includes CHI St. Alexius in Bismarck. The Garrison hospital currently partners with CommonSpirit and CHI St. Alexius.

A location for a potential new hospital hasn’t been determined.

The existing 22-bed critical access hospital includes 28 beds in a skilled nursing facility, an attached health clinic, an emergency department and outpatient services such as physical therapy, radiology and laboratory services and cardiac rehabilitation, according to CHI information.

“We’re not looking to build on a whole lot of new services. Just maximize the fundamental things that we do well,” Maus said.

Maus said if the community wants to move forward, the next step is to hire a firm to evaluate the services needed now and into the future. Once that information is obtained, an architect would be hired to begin design and determine a cost estimate.

“We’re probably a year away from even raising money for it,” Maus said. “Even if everything goes to plan, I think we’re at least four years from actually opening a new hospital, and probably at least two from actually breaking ground.”

The intent is to apply for loan assistance through the USDA Rural Development program. Maus said the community’s 10% share upfront could be as much as $3 million just for a fundamental hospital, with no extra services.

“We’ll be taking advantage of any grants that we can,” Maus said. “There’s grants available through the state to help pay for this, but the majority of what we get will be raised locally through donations.”