Minnesota's top health regulator unveiled a plan Wednesday to intensify oversight of the state's rapidly growing assisted-living industry, amid growing concerns that an absence of basic care standards is putting thousands of seniors in harm's way.
At a legislative hearing Wednesday morning, state Health Commissioner Jan Malcolm proposed a system for licensing assisted-living homes, which now serve more than 60,000 Minnesotans but operate under less supervision than state-licensed nursing homes. Minnesota is the only state that does not license such facilities, making it difficult for the state to enforce minimum standards of care for an increasingly vulnerable population.
"We need to build on that system and create higher levels of regulation, including licensure, tied to the complexity of the services that are offered in those settings and the complexity of need," Malcolm said in her testimony.
The case for reform gained momentum early last year following a Star Tribune investigation detailing how such 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.
In March, the Legislative Auditor issued an in-depth report highlighting that Minnesota had fallen behind other states in its regulation of assisted-living facilities. Without licensing requirements, the auditor found, the state was hamstrung in its ability to hold facilities accountable for maltreatment. Even in severe cases, such as when a person wandered away from a facility and died, the state lacked basic standards for evaluating the facility and preventing further deaths.
Assisted-living facilities, which often resemble apartment buildings with services, were intended originally for older people who needed help to live independently, such as housekeeping and cooking, 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 catering to residents who are frail or have serious medical conditions. More than 40 percent of assisted-living residents, for example, have Alzheimer's disease or other forms of dementia; and nearly two-thirds are so frail they need assistance bathing, national studies have found.
"Assisted-living is the fastest-growing residential care option for elders in the United States, and regulations have not kept up with the realities on the ground," said Eilon Caspi, a gerontologist and research associate at the University of Minnesota School of Nursing.
However, when the state convened a working group last fall to explore licensing, it immediately faced a challenge: How to create a single licensing system for a highly diverse industry. Many of Minnesota's assisted-living facilities are little more than shared-housing communities that provide some personal care services, such as cooking or cleaning. Others have opened specialized "memory care" units for people with dementia, and provide skilled medical care similar to that in nursing homes.
