Assisted Living Licensure

A Collaboration Between Minnesota Department of Health, Office of Ombudsman for Long-Term Care, Long Term Care Imperative, And Office of the Secretary of State. American citizens who live in long-term care facilities in the United States have the right to vote. However, getting to the polls may be hard for some residents. Some assistance or support may be needed for residents to get access to and/or cast a ballot. This document explains ways facilities can reduce the spread of illness while ensuring that residents have the opportunity to exercise their right to vote. Facilities should establish systems to promote and protect resident voting access, though it is important to emphasize that these efforts must be consistent with each facility’s obligation to implement infection control practices that mitigate and reduce the spread of illnesses. This guidance is designed to further these goals, address the existing procedures for resident voting, highlight resident rights on this topic and outline ways to support residents to vote. Read the full Election and Voting Guidance for Long-Term Care Facilities.

Date: Monday, Aug. 19
Time: 1 – 2:15 p.m.

The Minnesota Department of Health is hosting a quarterly assisted living update webinar for providers to learn about the most recent assisted living licensing and regulation trends. This webinar will be recorded and posted at a later date for those unable to join the live presentation.

Topics:

• Hot topics in Assisted Living regulation
• Most cited Assisted Living survey correction orders
• Complaint investigation trends
• Licensing update

Information about how to join the call is available on the Assisted Living Teleconference Calls page.

DHS will add new quality ratings based on MDH surveys to its Minnesota Assisted Living Report Card in early 2025. The Resident Health, Safety, and Staffing ratings will be updated quarterly based on MDH completes on or after July 1, 2024. Information about how surveys are conducted can be found on the Be Prepared for Your Survey section of the Forms and Self-Audit Tools.

For more information, including DHS’ schedule for posting new ratings on the AL Report Card and how MDH surveys will be used to calculate report card ratings, see the Assisted Living Report Card information page on the DHS website.

In 2023, the Minnesota legislature directed the department of health (MDH) and department of human services (DHS) to “consult with assisted living facility license holders who provide customized living and whose facilities are smaller than 11 beds to compile a list of regulatory requirements, compliance with which is particularly difficult for small providers.” The mandate requires the departments to present the list to the chairs and ranking minority members, along with recommendations for easing regulatory burdens.

Burdens identified

MDH and DHS worked with small providers, provider organizations, consumer advocates, and related state offices and boards, from March 2023 until October 2023, and compiled a list of burdens for small providers:

• Reimbursements — payments do not cover the costs of providing care in small facilities.
• License portability — license is attached to the address of the facilities, which is especially burdensome for small providers in rental properties.
• 55-plus age limit for new customized living settings – this is difficult for both new providers and providers who need to move facilities.
• Staff retention - hiring and keeping employees in the facility.
• Training portability - the burden of having to retrain someone who is coming from a different building, especially when they are employed by the same provider and up to date with their training.
• Physical environment - providers need additional education and guidance on the unique requirements for residential-style facilities as well as financial and technical help in meeting those requirements. The cost and effort to comply with the future requirement of installing sprinklers in facilities with dementia care by Aug. 1, 2029, concerns small providers, especially those in rental properties.
• Food code - the ability to hire and maintain a certified food protection manager in every facility, the unique challenges of maintaining a commercial-code kitchen in a residential-style facility, especially when the facility is rented, and the cost of providing food to residents without reimbursement.
• Termination requirements - procedures to end a resident contract can be difficult.

Workgroup suggestions

The workgroup offered several suggestions to alleviate some of these burdens, which included three potential legislative fixes:

• License portability - a fix to allow small providers to move without having to obtain a new license.
• Food code exemptions - several exemptions to relax standards in residential-style kitchens that still protected resident and staff safety.
• Training portability - allowing for an employee who is moving to a new facility and already current with their training to be able to start work without repeating unnecessary training. This bill allows for resident protections by requiring that the employee must still complete building-specific training, such as emergency procedures.

In addition, the workgroup identified many areas where MDH and DHS could optimize processes to increase communication, training, and streamline licensing and payments. Those recommendations are being reviewed and implemented.

Small provider survey

Additionally, MDH and DHS sent out a survey to every licensee who was licensed for 10 or fewer beds in November 2023. The survey, which asked about the burdens that were identified by the workgroup, as well as giving open-ended questions to identify additional burdens, had 28% completion rate by providers. You can find the full results at Assisted Living Small Provider Survey Results Report.

The top burdens identified in the survey were:

1. Staff retention.
2. License portability.
3. Food code requirements.
4. Reimbursements.
5. Licensed staff requirements.