The administration of Gov. Tim Walz is proposing a dramatic expansion of the state’s powers to fight abuse and neglect of elderly and frail Minnesotans who live in care facilities across the state.
The multipronged proposal, outlined Tuesday in Walz’s two-year budget plan, would subject care facilities to more frequent inspections and immediate fines in cases of health and safety violations. The state would also create a licensing system for assisted-living homes, which now serve more than 60,000 Minnesotans but operate under less supervision than nursing homes.
If approved, the package would cost $62.5 million over four years and would represent the broadest expansion of consumer protections for vulnerable adults in Minnesota in generations. It would also bring Minnesota’s enforcement powers more in line with the rest of the country, at a time when reports of maltreatment are on the rise statewide. Records show Minnesota had fallen behind other states in its regulation of programs and facilities for vulnerable adults.
“This is transformational change in how we ensure the safety and security of vulnerable adults across the state,” Human Services Commissioner Tony Lourey said. “It’s really about engaging the voices of consumers … and listening to family members of vulnerable adults, who have watched and seen that our … efforts have not been enough.”
The proposal also culminates years of work by seniors’ organizations and families of elder abuse victims, who have raised alarm at the State Capitol over the state’s slow response to serious incidents of maltreatment and what they see as an imbalance of power between the residential care industry and vulnerable adults.
The case for reform gained momentum early last year following a Star Tribune investigation detailing how senior care facilities had failed to protect their residents from hundreds of incidents of criminal abuse, including beatings, sexual assaults and thefts. The report also found that residents of assisted-living facilities had few protections against unsafe or unfair business practices. Those who spoke openly about being mistreated sometimes faced retaliation by facility staff, and even threats of eviction, the Star Tribune found.
A coalition of senior care organizations called attention to the fact that Minnesota regulators were hamstrung in their ability to hold assisted-living facilities accountable, even in cases of serious abuse, because the state had failed to keep pace with rapid changes in the residential care industry. Minnesota is the only state that does not license assisted-living facilities, which makes it difficult for the state to enforce minimum standards of care for a complex population.
Assisted-living facilities, which often resemble apartment buildings with services, were intended originally for older people who needed some assistance to live independently but wanted greater freedom and social interaction than they would find in a conventional nursing home. Over time, however, the distinctions have blurred and assisted-living facilities have begun serving residents who are frail or have serious medical conditions.
“We didn’t have our eyes fully focused on the fact that the needs of the population … have grown,” said Health Commissioner Jan Malcolm. “They are living longer, and their care needs are more complex, and a larger and larger percentage of folks are diagnosed with dementia.”
Under Walz’s proposal, assisted-living facilities would be formally licensed by the state Department of Health for the first time. The proposal calls for the creation of a three-tiered licensing system based on the services offered and the needs of the residents being served. Assisted-living facilities that provide complex medical care, such as taking care of residents with dementia, would operate under greater scrutiny than communities that offer little more than housing.
The new licensing system would take effect over four years and would represent a major expansion of the Health Department’s authority. The agency estimates it would hire approximately 90 more staff over the next several years just to create and enforce the new standards.
Minnesota families would also have more specific information on the health and safety records of these facilities, long a source of frustration. Walz’s budget would fund the creation of an assisted-living “report card” that would allow people to compare facilities based on quality of care. It would be modeled after a report card developed more than a decade ago for nursing homes.
Beyond increased oversight of assisted-living, the proposal also empowers the Health Commissioner to impose immediate fines when a violation is identified during an on-site survey of a health facility. Under current law, facilities are given time to correct health and safety violations before fines are imposed.
On-site surveys would also become more frequent. The proposal, for instance, would enable the Minnesota Department of Human Services (DHS) to conduct on-site reviews of group homes and other state-licensed facilities for adults with disabilities every three years. It would also allow DHS licensing staff to conduct on-site reviews of adult day centers at least once every two years, amid compliance concerns. Last year, federal health regulators released a scathing audit report highlighting widespread health and safety problems at adult day centers in Minnesota, which primarily serve seniors and adults with disabilities.
Walz’s budget also calls for expanding the staff of the Ombudsman for Long-Term Care, a state office that advocates for seniors and raises awareness about consumer rights. Complaints to the ombudsman’s office have more than doubled since 2015, to 4,188 last year. Yet the office’s staffing has remained almost unchanged and now ranks the lowest of any long-term care ombudsman’s office in the nation. Walz’s budget funds 10 new, full-time positions for the office.
“This is long overdue,” Rep. Diane Loeffler, D-Minneapolis, a member of the Health and Human Services Policy Committee, said of the package. “It will make a significant difference in bolstering the public’s confidence that their loved ones are safe.”