Assisted Living in Minnesota

Agency: Department of Health
Phone: (651) 201-4101
Website: http://www.health.state.mn.us/divs/fpc/profinfo/licensure.html

Legislation passed in 2006 (MN Statute 144G) restricts the use of the phrase "assisted living" to Housing with Services establishments that meet specific requirements which include, but are not limited to, offering or providing staff access to an oncall registered nurse, a system to check on each assisted living client daily, a means for assisted living clients to request assistance, staff to respond to health or safety needs 24 hours a day, seven days a week, two meals per day, weekly housekeeping and laundry, health services including assistance with medication administration or medication administration, assistance with at least three activities of daily living (ADLs), and health-related services from a Minnesota-licensed home care agency. Under the statute, "assisted living" means a service or package of services advertised, marketed, or otherwise described, offered, or promoted using the phrase "assisted living" either alone or in combination with other words, whether orally or in writing. Housing with Services establishments provide sleeping accommodations to one or more adult residents. These facilities offer or provide, for a fee, one or more regularly scheduled healthrelated services or two or more regularly scheduled supportive services.

Facility Scope of Care:
At a minimum, an establishment representing itself as assisted living must offer or arrange to provide assistance with selfadministration of medications or administration of medications and assistance with at least of three of the listed ADLs. (See MN Statute S144G.03 Subd. 2b for more detail.) Any services that are made available through a licensed home care agency may be provided in a Housing with Services establishment that uses the term "assisted living."

Move-In/Move-Out Requirements:
The federal Fair Housing Act, Americans with Disabilities Act, Minnesota Landlord-Tenant Law, and the Minnesota Human Rights Act apply to persons applying to lease a unit in a registered Housing with Services establishment. The assisted living establishment must offer a registered nurse (RN) assessment prior to move-in. (See Resident Assessment.) Health care services may be terminated without impacting the resident's housing status. Thirty day notice, with certain exceptions, must be given to terminate health care services and assistance must be offered in finding another health care provider. Requirements of what must be included in the termination notice are described in MN Statute S144A.442. Housing may be terminated if the conditions of the lease are violated. The 2006 legislation at MN S144G.03 describes what must be included in the termination notice of a Housing with Services contract.

Resident Assessment:
Assessments by an RN must be offered prior to move in or upon executing a contract, and assessments must be completed according to MN Rule 4668 in relationship to service plans, central storage of medications, and medication administration.

Medication Management:
At a minimum, an establishment representing itself as assisted living must offer to provide or arrange for assistance with selfadministration of medications or administration of medications. Home care licensure statutes and rules must be followed.

Physical Plant Requirements:
Establishments must comply with state and local building codes.

Residents Allowed Per Room:
Establishments must comply with state and local building codes.

Life Safety:
In Minnesota, assisted living is provided in a Housing with Services establishment. A Housing with Services establishment must comply with the state building code and the Minnesota Uniform Fire Code and applicable local building codes and requirements for the type of structure utilized for the housing component of assisted living. The Minnesota State Fire Code is comprised of the International Fire Code plus Minnesota amendments. In Minnesota, a Housing with Services establishment is registered with the Minnesota Department of Health. This registration has no requirements regarding the physical plant of the establishment.

Alzheimer's Unit Requirements:
Housing with Services establishments that secure, segregate, or provide a special program or special unit for residents with a diagnosis of probable Alzheimer's disease or a related disorder or that advertise, market, or otherwise promote the establishment as providing specialized care for individuals with Alzheimer's disease or a related disorder are considered "special care units." All special care units must provide a written disclosure to the following: (1) The commissioner of health, if requested; (2) The Office of Ombudsman for Older Minnesotans; and (3) Each person seeking placement within a residence or the person's authorized representative, before an agreement to provide care is entered into. Written disclosure must include, but is not limited to, the following: (1) A statement of the overall philosophy and how it reflects the special needs of residents with Alzheimer's disease or other dementias; (2) The criteria for determining who may reside in the special care unit; (3) The process used for assessment and establishment of the service plan or agreement, including how the plan is responsive to changes in the resident's condition; (4) Staffing credentials, job descriptions, and staff duties and availability, including any training specific to dementia; (5) Physical environment as well as design and security features that specifically address the needs of residents with Alzheimer's disease or other dementias; (6) Frequency and type of programs and activities for residents of the special care unit; (7) Involvement of families in resident care and availability of family support programs; (8) Fee schedules for additional services to the residents of the special care unit; and (9) A statement that residents will be given written notice 30 days prior to changes in the fee schedule.

Staff Training for Alzheimer's Care:
Supervisors and direct care staff must be trained in dementia care. Areas of required training include: 1) An explanation of Alzheimer's disease and related disorders; 2) Assistance with ADLs; 3) Problem solving with challenging behaviors; and 4) Communication skills.

Staffing Requirements:
In order to use the term assisted living, Housing with Services establishments are required to have a person available 24 hours a day, seven days a week, who is responsible for responding to the requests of assisted living clients for assistance with health or safety needs, unless they meet the criteria for exemption for awake-staff described in MN Statute 144G.03 Subdivision 3. In addition, the licensed home care agency providing the health care services must provide all services required by the client's current service agreement or service plan

Staff Education Training:
All persons who have contact with clients must complete an orientation to home care, which includes an overview of the home care statutes and rules as well as handling emergencies, reporting maltreatment, the home care bill of rights, handling client complaints, and the services of the ombudsman for older Minnesotans. Unlicensed personnel who perform delegated nursing services must successfully complete the core training and pass competency evaluations described in MN Rule 4668.

Medicaid Policy and Reimbursements:
Medicaid home and community-based waivers (elderly, traumatic brain injury, and community alternatives for disabled adults) pay for customized living services in assisted living and Housing with Services establishments.