Assisted Living FAQs: Staff Requirements

• Option one: Purchase the Alzheimer's Association Person-Centered Dementia Care Training Program, which includes the essentiALZ® exam. Dementia Care Training Program & essentiALZ® Exam | alz.org. This training was developed with evidence from the Alzheimer's Association Dementia Care Practice Recommendations listed here: Alzheimer's Association Dementia Care Practice Recommendations | The Gerontologist | Oxford Academic (oup.com)
• Option two: Purchase a training program recognized by the Alzheimer's Association and essentiALZ® Exam from the Alzheimer's Association.
  You can find Recognized Dementia Care Training Programs that have been recognized by the Alzheimer's Association as reflecting the five topic areas of the Dementia Care Practice Recommendations. Providers using these training programs are eligible to purchase essentiALZ® exams for their staff.
• Option three: Purchase a curriculum review from the Alzheimer's Association and essentiALZ® Exam from Alzheimer's Association. Providers and training companies using proprietary training materials may submit their training programs for review. See the Dementia Care Training Curriculum Review page of the Alzheimer's Association website (alz.org) for a link to the Curriculum Review Guidelines.
• Option four: For subscribers of EduCare, EduCare's 5-part Dementia Series and test may be used to meet the statutory requirement. For more information, see the EduCare website.

• Option five: Purchase one of the HealthCare Interactive CARES Dementia Care Training options that meets the statutory requirements:

  • CARES Basics (4 hours) CARES Advanced (6 hours)
  • CARES Activities of Daily Living (ADL) (4 hours or 10 hours)
  • CARES Dementia Related Behavior (4 hours)

  For more information, see the HealthCare Interactive Online website.

• Option six: Purchase the Clinical LMS courses from Residex, which includes 8-hour and 4-hour bundles to meet the statutory requirements, as well as a 2-hour bundle to meet the annual training requirements. See the Residex Clinical LMS website for more information.

Per 144G.83 Subd. 3 anyone providing or overseeing staff training pertaining to dementia care must pass a skills competency or knowledge test required by the commissioner. MDH recommends the essentiALZ® Exam from Alzheimer's Association.

Yes, each Minnesota licensed assisted living facility must employ an assisted living director licensed by the Minnesota Board of Executives for Long Term Services and Supports (BELTSS) under Minnesota Statutes 144G.08 Subd. 6. Under Minnesota Statutes 144G.10 Subd. 1a, each assisted living facility must employ an assisted living director licensed or permitted by the BELTSS.

All health care professional licenses indicate that a credential holder has met the minimum knowledge, skills, and abilities of an entry level practitioner. The legislature establishes those minimums in statute and rules are created by the assigned agency to provide greater detail to the law's framework. A Registered Nurse, Medical Doctor, Social Worker, Alcohol Drug Counselor, plus 13 other professions in Minnesota, have met the minimum education and prior experience requirements to obtain a professional individual license. The ongoing practice standards are established by the Professional Practice Analysis of the National Association of Long Term Care Administrator Boards (NAB) every five years to assure a contemporary community standard developed from a practitioner perspective.

Licensees who serve as directors for two or more facilities must obtain approval for a secondary license(s) from the board. You can find the Shared Director form required to apply for a secondary license on the Forms and Tutorials page of the BELTSS website.

Leadership of organizations and management of daily operations continues to evolve. BELTSS intentionally does not identify a minimum number of hours for the Licensed Assisted Living Director but expects that the LALD has assessed how to communicate, interact, monitor for quality control, delegate, investigate, monitor safety and environment controls while being the Director of Record.

You are required to notify BELTSS within five (5) days of a change of LALD in the facility per 6400.7050C. You can find information about how to update your Director of Record on the Forms & Tutorials page of the BELTSS website.

Yes. The individual would be required to possess both licenses.

Under the statute it does NOT give staff ratios that the facility must follow. They must be able to satisfy the requirement to meet the scheduled and reasonably foreseeable needs of each resident.

Statute does not address whether a nurse can have more than one place of employment. Statute does address a nurse and the services provided must comply with the Nurse Practice Act in 148.71 to 148.285. Statute also defines a clinical nurse supervisor as a Registered Nurse (RN) licensed in Minnesota. The statute dictates certain duties that must be completed by the RN:

• Resident assessments
• Delegation of nursing tasks
• Training and competency testing of unlicensed personnel
• Be available for consultation to staff performing delegated nursing tasks (either in person, by telephone, or by other means)
• Supervision of staff based on statute requirements in 144G.62 Subd. 4
• Certain policy development

Statute does not address whether unlicensed personnel can have more than one place of employment. If the "organization" is the "W-2 holder" and is responsible for the provision of such staff across several locations, the "organization's" requirement is to ensure adequate staffing at all its facilities.

For assisted living licensure, under 144G.41, subdivision 1 (12): ensure that one or more persons are available 24 hours per day, seven days per week, who are responsible for responding to the requests of residents for assistance with health or safety needs. Such persons must be:

• awake;
• located in the same building, in an attached building, or on a contiguous campus with the facility in order to respond within a reasonable amount of time;
• capable of communicating with residents;
• capable of providing or summoning the appropriate assistance; and
• capable of following directions.

So at an assisted living licensed entity, the staff must be awake, however one staff member could be responsible for covering more than one unit.

For an assisted living with dementia care license, under 144G.81 Subd. 4. Awake staff requirement: An assisted living facility with dementia care providing services in a secured dementia care unit must have an awake person who is physically present in the secured dementia care unit 24 hours per day, seven days per week, who is responsible for responding to the requests of residents for assistance with health and safety needs, and who meets the requirements of section 144G.41 Subd. 1, clause (12).

None. See 144G.41 Subd. 1 (12): "ensure that one or more persons are available 24 hours per day, seven days per week, who are responsible for responding to the requests of residents for assistance with health or safety needs. Such persons must be:

1. awake;
2. located in the same building, in an attached building, or on a contiguous campus with the facility in order to respond within a reasonable amount of time…"

A nurse who is not on site but is available for consultation to staff performing delegated nursing tasks (either in person, by telephone, or by other means), may be asleep (at home) if the nurse is able to respond accordingly when summoned.

Each provider licensed by MDH is required to complete a TB risk assessment annually. Completion of this assessment will assist providers in the development of an infection control committee and in determining the frequency of screening.

Resource: Facility Tuberculosis (TB) Risk Assessment Instructions and Worksheet for Health Care Settings Licensed by MDH (DOCX)

All Minnesota health care personnel should receive TB education annually, regardless of facility risk level classification. TB education should include information on TB exposure risk factors (both occupational and nonoccupational), the signs and symptoms of TB disease, and TB infection control policies and procedures.

Baseline TB screening is required at the time of hire for all health care personnel in Minnesota.

Baseline TB screening includes:

• assessing for current symptoms of active TB disease
• assessing TB history
• testing for the presence of Mycobacterium tuberculosis by administering either a two-step tuberculin skin test (TST) or single TB blood test

Resources:

• Tuberculin Skin Test (TST) - Minnesota Dept. of Health
• Baseline TB Screening Tool for Health Care Personnel (DOCX)
• Tuberculin Skin Testing (TST) Protocol for Screening Health Care Workers (DOCX)

A test should be dated with 90 days of hiring is acceptable.

All settings that require TB screening for employees, employers must cover the costs of those tests. Refer to Occupational Safety and Health Standards 182.655 Subd. 10a regarding protective equipment, monitoring exposure levels, and medical exams.

A CXR alone is not acceptable documentation. You either need

• documentation of a positive two-step Tuberculin Skin Test (TST) or Interferon-Gamma Release Assay (IGRA) test, and
• a CXR with provider evaluation after that date

or

• documentation of refusal of both the two-step TST and IGRA
• followed by a new CXR and provider evaluation.

If the health care worker had a prior positive TB test result, and they only have the CXR but no other test documentation, then they need to take a new TB test. If the result is positive, a new CXR needs to be completed. The CXR needs to be done within 90 days of the positive test date or dated any time after the positive test date.

Resources:

• Regulations for TB Control in Minnesota Health Care Settings
• Tuberculosis Screening, Testing, and Treatment of U.S. Health Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019 | MMWR
• Subscribe to Tuberculosis (TB) Updates from Minnesota Department of Health