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:
- Staff retention.
- License portability.
- Food code requirements.
- Reimbursements.
- Licensed staff requirements.
