Deal reached for new protections against Minnesota elder abuse, neglect

A landmark agreement has been struck to overhaul Minnesota's porous system for protecting seniors from abuse and neglect.

Senior advocacy groups, state regulators and the elder care industry finalized the deal Tuesday after two years of contentious deliberations, hearings and protests.

It would license assisted-living facilities for the first time and require them to maintain minimum standards of care, much the way the state already regulates nursing homes.

It would also establish new safeguards for the more than 80,000 Minnesotans who live in senior care facilities. Residents would be able to use surveillance cameras to monitor care, report abuse or poor quality care without fear of retaliation and be protected against arbitrary discharges.

The far-reaching deal, widely expected to become law in this session of the Legislature, would represent the broadest expansion of protections for vulnerable seniors in Minnesota in generations.

"It's critically important that the Legislature take advantage of this momentum and get this done now," state Health Commissioner Jan Malcolm said Wednesday.

It would also bring the state's regulatory oversight of the long-term care industry more in line with the rest of the country, at a time when reports of maltreatment are on the rise statewide. Minnesota is the only state in the nation that does not license assisted-living facilities, even as the industry has mushroomed in size and accepted residents with more complex medical needs.

A bill containing many of these protections passed the Minnesota House by a clear majority last Friday, though it's unclear if the measures will ever come to a vote on the Senate floor. Senate Republicans, in particular, have raised concerns about the cost of enforcing the new regulations, which will reach $50 million over the next four years. Lawmakers said the new protections likely will be wrapped into a larger omnibus budget bill if the Senate does not act.

Still, in a strongly worded letter Tuesday to legislative leaders, a broad coalition of consumer advocacy and industry groups — including AARP Minnesota, Care Providers of Minnesota and LeadingAge Minnesota — warned that failure to pass elder-care legislation "would be catastrophic for thousands of vulnerable adults" in Minnesota.

"The case for doing this is urgent in public health terms," said Malcolm.

A year ago, a broad-based effort to reform Minnesota's system for protecting seniors collapsed amid partisan divisions and stiff opposition from the senior care industry. Yet this failure only energized a loose-knit coalition of senior advocacy groups. Volunteers with Elder Voice Family Advocates, a grass-roots group representing victims of elder abuse and their family members, returned to the State Capitol this spring armed with reams of data, showing that unsafe conditions at senior homes had contributed to numerous preventable deaths and hospitalizations.

They were met with less resistance this time around from the state's two large industry groups, which expressed support early in the legislative session for a licensing framework for Minnesota's assisted-living industry. The state Health Department also took a more active role, convening advocates and industry groups as early as last fall, and presenting its own package of proposed consumer protections.

"It had become evident that Minnesota had fallen behind other states, in a number of areas, and we needed to do something," said Mary Jo George of AARP Minnesota.

The case for reform was also fueled by a 2017 Star Tribune investigation chronicling how senior care facilities and state regulators 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 scathing report by Legislative Auditor Jim Nobles followed a few months later. The lengthy report raised concerns about Minnesota's confusing and outdated regulatory structure. For instance, state law classified assisted-living facilities as part of a broader group of "housing with services" establishments, which are not licensed by the state and not subject to the same level of oversight as nursing homes and other licensed providers, the auditor noted.

Minnesota's regulations date back to a time, in the 1980s, when assisted living was in its infancy and thought to need less regulation because residents were typically younger and required less care than people in nursing homes. Over the years, however, the distinctions have blurred. Assisted-living centers have expanded in size and opened specialized "memory care" units for people with dementia, which often resemble skilled nursing homes.

"With the population aging and growing, and more providers coming into the market, there was a real urgency toward creating a more comprehensive and clear framework," Malcolm said.

Even so, a deal to modernize the state's elder-care regulations was by no means certain.

Heading into the legislative session, the senior care industry resisted many of the consumer protection proposals pushed by advocates. Several sought-after measures, including a "private right of action" for lawsuits when seniors are abused, did not make it into the final agreement. Groups like AARP Minnesota also wanted protections for poorer seniors to ensure they could continue to live in a facility once they become eligible for Medicaid. The finalized deal lacks this protection, but does give facilities an incentive to care for Medicaid patients through discounts on licensing fees.

Yet most of the major protections sought by senior advocacy group survived the negotiating process, which consumed hundreds of hours and lasted well into the night over the weekend. For instance, vulnerable seniors can no longer be evicted from facilities without reason or released to unsafe locations.

Advocates acknowledged their success but said their work is not finished. "We will be back next year and the following year to fix what didn't get done," said Kristine Sundberg, president of Elder Voice Family Advocates.