On Saturday, May 19, the Minnesota House and Senate passed legislation strengthening protections for older and vulnerable adults in long-term care residential facilities. Currently the only state to not license assisted living facilities, Minnesota's Department of Health receives approximately 400 cases of abuse and neglect every week. The bill passed earlier this week (HF90/SF8) seeks to address this critical problem.
The bill establishes licensure of assisted living facilities and strengthens the rights of older and vulnerable adults. The licensing requirements are strong, and establish high standards to ensure that residents, including those with dementia, receive the care they need and deserve. In addition, the bill provides the necessary tools to ensure public enforcement of the licensing rules and standards.
Below is the list of the new requirements in the bill:
Protections Against Arbitrary Termination, Appeals, and Ensuring Safer Transfers
Licensure will not go into effect until 2021. In the interim, the Minnesota Department of Health (MDH) must prioritize and help prevent harmful discharges from assisted living facilities for two years prior to licensure. MCH will develop guidance for providers on what constitutes a coordinated transfer and how to prevent unsafe and inappropriate discharges, avoiding discharges to homeless shelters and hospital dumping.
In addition, more robust termination and appeals rights kick in when licensing goes into effect in 2021. The bill establishes strong protections against arbitrary discharges and due process appeal rights for residents. The bill requires that every effort is made to prevent the discharge in the first place and, if a move is necessary, puts requirements in place to make sure the process of relocation is as seamless and the least disruptive to the care and well-being of the resident.
The bill establishes an immediate prohibition of retaliation against residents in nursing homes and assisted living facilities. Those same protections continue to apply when the facilities become licensed in 2021. Under this bill, residents will be protected from retaliation if they speak up about poor quality of care, file a maltreatment report, participate in an investigation, or take other actions to advocate on their own behalf. The law calls out specific retaliatory acts including discharge, discrimination of any kind, restricting family or visitors, punishment, or restriction of rights.
Maltreatment Restitution Fund
From now until licensing is implemented in two years, the bill creates a new fund to provide compensation for victims of maltreatment. The fund is made up of the fines from substantiated maltreatment violations in nursing homes and assisted living facilities. It allows the victim of maltreatment to choose to either receive restitution of $1,000 (for a Level 3 violation) or $5, 000 (for a Level 4 violation) or to exercise their right to seek compensation in a court of law.
Right to Electronic Monitoring
The bill provides the right for residents to place a camera in both nursing homes and assisted living facilities. Residents will be allowed to place a camera for fourteen days without notice to facility if one fears retaliation.
Protections for Residents on the Elderly Waiver Program
AARP fought to ensure that elderly Minnesotans who spend down their life savings and became eligible for Medicaid (known as the Elderly Waiver Program) could continue to live in a facility. While not in the bill this year, it does include an incentive for facilities who do care for Medicaid-eligible Minnesotans by providing a discount on their licensure fees if 50% of their residents are on the Medicaid program.
“I’m OK” Checks
Another key issue for AARP is to ensure that non-regulated Senior Independent Living offering daily safety checks (commonly called “I’m OK” checks) clearly defines and spells out in the contract whether they provide the service and what it entails. The bill will allow residents to sue for breach of contract if the facility fails to provide the service.
Assisted Living Licensure
The bill establishes two levels of licensure: Assisted Living Facilities and Assisted Living Facilities with Dementia Care. Each licensure level sets minimum standards around safety, staffing, and training requirements, including protections for people with dementia. Facilities must conduct a needs assessment prior to move-in and clearly disclose the services provided under their license. In addition, Assisted Living Administrators must be trained and certified and inspections of assisted living facilities will be conducted every other year rather than the current three year schedule.
Funding for the Office of Long-Term Care Ombudsman Office
Finally, the bill funds seventeen new staff positions at the Office of Long-Term Care Ombudsman. The Ombudsman’s office provides advocacy services to older Minnesotans in nursing homes, assisted living facilities, and those receiving home care services. Minnesota ranked very low compared to other states in the number of ombudsmen per the number of vulnerable adults served.
While AARP did not win everything we fought for, this bill sets in motion the process to bring Minnesota in line with every other state in licensing assisted living facilities.