Minnesota senior living operators, elder care activists and state regulators announced a new framework last week intended to protect seniors from abuse and mistreatment in assisted living communities.
The proposed legislation was passed by the Minnesota Legislature and is heading to the desk of Gov. Tim Walz, who is expected to sign the bill into law and move it toward implementation in August 2021. Under the law, which has been under discussion for more than two years, the state would establish minimum standards of care for assisted living facilities, increase the frequency of surveys, and add dementia care standards and licensure for assisted living facility directors.
It also provides for the consumer’s right to electronic monitoring, as well as establish new provisions around when services are terminated and appeal rights for consumers.
But the road to completing the framework has not always been easy for assisted living industry participants, and there are major implications for operators in the state, LeadingAge Minnesota President Gayle Kvenvold tells Senior Housing News.
A new licensing framework
Most importantly, the bill would mandate for the first time that Minnesota assisted living communities be licensed. Currently, Minnesota is the only state in the U.S. that does not mandate licensure of assisted living facilities, even as the care type has expanded and provided care to customers with more complex health care needs Kvenvold said.
LeadingAge Minnesota, based in St. Paul, was a participant in the framework negotiations, which were at times challenging based on two years of discussions—some of which did not include industry representation.
“This represents months of dialogue and hard negotiations,” Kvenvold said. “Overall, it reflects the spirit of coming together to design a framework for the next generation of assisted living in Minnesota.”
Minnesota has two types of assisted living licenses — one for housing and another for home care services. Those will be folded into one overlapping license. The framework also calls for baseline standards for admission, staffing, training and discharge criteria, as well as definitions of and certification for dementia care.
The initiative began in response to a November 2017 report in the Star Tribune revealing that the Minnesota Department of Public Health received more than 25,000 allegations of theft, physical abuse, neglect and other maltreatment within state-licensed assisted living facilities in 2016 — 97% of which were never investigated.
The report identified roughly 60,000 seniors who lived in assisted living communities across Minnesota, 39% of whom have dementia and 58% of whom are older than 85.
In response to the Star Tribune investigation, former Minnesota Gov. Mark Dayton tasked AARP Minnesota with convening a consumer workgroup to develop new senior care guidelines for the state. But providers were not invited to participate, Kvenvold said.
“We didn’t have a table to sit, share and educate ourselves as consumers and providers and reach common ground,” she said.
In response, Minnesota Health Commissioner Jan Malcolmb took a more active role. She restarted negotiations to include providers and industry groups, to discuss overarching goals and find common ground. This set the stage for intense negotiations and, eventually, the foundation for the framework.
“In the end, we created a set of guidelines, based on trust that had been built and communication that had been established over the several months,” Kvenvold said.
Tweaking the framework
With the big picture aspects of the legislation in place, attention now turns to tweaking the framework before it becomes law. Stakeholders will reconvene this July to find common ground on outstanding issues to the bill. This process is expected to last roughly a year, Kvenvold told SHN. She expects less contention this time, now that the foundation has been laid.
“We wrote a pretty amazing amount of detail into the statute,” she said.
One point of contention remains the cost of enforcing the new regulations, a concern expressed by Republican state senators. The Minnesota Senate approved the legislation May 19.
The new legislation will result in higher licensing fees, and stakeholders tried to be mindful of the impact this would have on smaller providers, Kvenvold told SHN. Another topic of discussion during reconciliation will be determining guidelines for staffing requirements.
Kvenvold believes this framework can be adapted by other states seeking to institute tighter regulations on assisted living communities, which is an ongoing concern in senior living. The Long Term Care Community Coalition (LTCCC) released a report identifying key best practices and policies for assisted living facilities to regulate their own operations, and ensure the safety and dignity of residents.
The report lays out guidelines and requirements for staff training including cross training across multiple subject areas, establishing licensing and certification requirements where appropriate, allowing for alternative training methods, and required training assessments.