The article “Weak home care rules victimize the frail, sick” (June 22), detailing the bankruptcy and closure of Crystal Care Home Care, effectively put a face to the issues surrounding home care in Minnesota.

Our state’s aging population and Minnesotans’ desire to live in their own homes is driving demand for these services. The number of Minnesota home care providers has now swelled to about 1,650, up from about 1,100 in 2010. The article showed the importance of this care and the suffering that can follow when it is disrupted.

As regulators of home care, the Minnesota Department of Health recognized this growth and the need for reform and worked with lawmakers, home care providers, consumers, advocates and others to put forward a series of legislative recommendations. With the support of Gov. Mark Dayton, the Minnesota Legislature passed this reform package in 2013. The Health Department is now implementing these reforms.

These changes did not come in time to prevent the problems Crystal Care clients experienced, but today we are in a far better position to help prevent inadequate care and to respond more quickly to concerns and complaints.

A key component of this package was a significant new investment in overseeing Minnesota’s rapidly growing home care industry. The 2013 reform package allowed us to increase nurse surveyors and boost other staff levels to better reflect the greater number of care providers. With this new help, we are committed to inspecting each new home care provider during its first year of operation. We will revisit all home care providers at least once every three years, and more frequently if there are reasons for concern.

This increased oversight will allow us to more quickly identify problems in staffing, client services, funding challenges and other areas that may pose a risk to patients. We are also able to more quickly respond to and investigate complaints so emerging problems can be found and fixed.

Other positive reforms in the bill included:

• Strengthening license requirements to ensure that applicants can provide appropriate and safe home care;

• Strengthening licensing requirements regarding medication management and staff competency;

• Toughening the licensing review process by establishing a one-year temporary license for new providers that includes an on-site inspection;

• Simplifying and streamlining the licensing process, and

• Creating an Advisory Council that includes clients and providers to advise the Health Department about provider practice issues.

We are confident these changes will result in better care for Minnesotans. But there is still work to be done outside of the scope of the changes.

For example, the Crystal Care case showed we need better coordination among agencies to recognize problems early and to seek to avoid the disruptions in care highlighted in the article. During the past year, the Minnesota Department of Human Services, the Office of Ombudsman for Long-Term Care, the Office of Ombudsman for Mental Health and Developmental Disabilities and the Health Department came together to develop a more comprehensive and coordinated system of oversight to protect vulnerable adults.

To mitigate the risks of an increasing number of older adults and people with disabilities living in community settings rather than institutions, the Department of Human Services is building a stronger adult protection system, which will include a single, toll-free number people can call when they or loved ones are being neglected by a caregiver; are being abused physically, emotionally or sexually, or are being financially exploited.

In the end, with proper oversight, a growing home care industry is a positive trend for Minnesota. The Health Department, lawmakers and Minnesota’s providers recognized this trend and have responded. We are optimistic that these reforms will further our goal of ensuring that individuals get the quality care they need, when they need it and in a setting of their choice.


Ed Ehlinger is commissioner of the Minnesota Department of Health.