1. Changes to Minnesota’s Long Term Care Settings – What Every Minnesotan Should Know
MEJC Webinar
October 17, 2019

2. Welcome – Webinar Basics
Webinar Basics: 15 Minutes for Questions at the End
CLE applied for and CEU available at out website:
Slides and archived webinar also available at our website

3. Today’s Agenda Introduction and History (10 Minutes)
2019 Eldercare and Vulnerable Adult Act Overview (25 Minutes)
Assisted Living Licensure
New Protections for Residents
Other Changes from the Law
Next Steps – What to Expect Next? (10 Minutes)
Questions (15 Minutes)

4. National Context Nursing Homes are federally regulated
Assisted Living settings are regulated differently in each state
National Trends show a decreasing amount of the NH population and increasing amount of AL population – including a population with higher needs (cognitive, physical, etc.)
Trends show AL regulations are changing

5. Why 2019 in Minnesota?
Pre-2017: Some work to address Health Department investigations of abuse and neglect
Winter 2017: MN Star Tribune series, Health Commissioner resigns and Governor creates a Consumer Taskforce
2018 Legislative Session: Various bills but session ends with veto of an Omnibus Bill
Fall/Winter 2018: New Health Commissioner convenes assisted living work groups
2019 Legislative Session: Stakeholders work to pass legislation with compromises from all sides
: Transition period from current regulatory scheme to Assisted Living Licensure
2021 and beyond

6. Key Parts of the New Law Consumer Protections
Other: Ombudsman Funding, AL Director, Rulemaking Authority
Assisted Living Licensing

7. A Snapshot of Minnesota’s New Assisted Living Licensing System
Old system
New system
Housing with Services registration and licensed home care
No clear licensing standards for dementia care
Regulatory confusion about what entity is responsible
Regulatory gaps in physical plant and other areas
Consumer protection lacking in discharge, retaliation, and other areas
Assisted Living license with one licensee
Two levels of assisted living – AL and AL with Dementia Care
Regulatory clarity and new powers for MDH to hold providers accountable in AL settings
More consumer protections in AL (and other long term care) settings

8. AL Licensure – Basic Structure
Leadership, Staffing, and Ownership Requirements
Services and Programing Requirements
Physical Plant and Safety Requirements

9. AL Licensure – Further Changes
Quicker MDH survey process (2 years instead of 3)
Requirements regarding staffing levels plan, staff training, infection control policies, staff supervision policies
New assessment requirements upon admission
Requires use person-centered planning and delivery
Incorporates HCBS requirements (these apply to all facilities, not only HCBS)
Minimum service offerings such as: nutritious meals, laundry and housekeeping, transportation assistance, culturally appropriate programming, assistance with accessing community resources, and daily recreational programing
Assisted Living Director position is regulated by a State Board

10. AL with Dementia Care
Heightened physical plant standards and optional locked unit
Enhanced programing with emphasis on dementia care best practices
Enhanced training for staff about dementia specific care

11. Electronic Monitoring (Effective January 1, 2020)
Can a resident or a resident’s representative place a camera, including a hidden camera, in a resident’s room in a Nursing Home and/or Assisted Living?
2016
Committee to create report on issues
2018
Several proposals vetoed as part of omnibus bill
2019
Resident or Resident Representative can place a monitoring device in NH/AL
Must complete a consent form and provide notice to facility with some exceptions
Facility must allow the device and cannot retaliate for its placement

12. Protections Against Retaliation
Step 1
The law identifies the types of advocacy actions that are protected from retaliation. The list includes many common examples residents attempt to assert their rights in long term care settings like threatening to file a complaint or actually making a complaint to the health department or the facility itself. Includes protections for others advocating on the resident’s behalf.
Step 2
The law identifies the types of actions taken by a facility that may be considered retaliatory. These actions include, but are not limited to, common ways facilities have retaliated in the past such as restricting access of a resident’s visitors, reducing the resident’s access to care or services, or terminating an agreement between the resident and the facility.
Step 3
It creates a review process by which the health department may determine whether retaliation did or did not occur. If step 2 happens within 30 days of step 1, MDH must

13. Discharge/Termination Protections
A pre-termination meeting is required
A permissible reason for termination required
Pre-Termination
If challenging the reason for termination, resident can appeal to Office of Administrative hearings
Appeal Rights
Facility required to help with discharge process
Cannot be discharged to unsafe location
Coordinated Transfers

14. What Comes Next? Assisted Living Licensure Rulemaking
Topics Must Include:
Staffing
Assessments
Discharge Appeals (timelines and process)
Fees
Fines for planned closures
Training issues
Definition of serious injury
Topics May Include:
Contents of a Service Plan
Physical Plant definitions
Other definitions of key terms (cultural competency, temporary service plan, resident’s change in condition)
Development of a Grievance Form
Possibly any other area of the law

15. Assisted Living Licensure – Rulemaking – Basic Timeline
OAH Review - hearing
Notice of Intent to Adopt Rules
Gov. Office for Final Review
Request for Comments
Publish Notice of Adoption
Publish Proposed Rules
OAH Review – No Hearing ?
8/12/19
By 12/31/20
By 12/31/19

16. Resident Protections Before 2021
Some protections are established “now”
Anti-retaliation protections (August 2019)
Electronic Monitoring (January 1, 2020)
Prioritization of Enforcement of Arbitrary Discharges
MDH Issues Guidance on “Lock-outs”
Maltreatment Fund

17. Resources
MDH Vulnerable Adult Dashboard:
Minnesota Adult Abuse Reporting Center:
MDH Rulemaking Process: Forthcoming
MN Ombudsman for Long Term Care:
Our Office Information:

18. Sean Burke, Policy Director