Recommended Changes to State's Oversight of Assisted Living Facilities

In 2021, the State of Minnesota enacted sweeping legislation to reform the state’s regulatory approach to senior care and create a new license for all assisted living facilities across the state. 

While the legislation was crafted over the course of several years and incorporated input from a wide range of stakeholders—including consumers, providers, regulators and others—largely absent from negotiations was a key group: smaller providers that serve Black, Indigenous, BIPOC, and other culturally specific communities. These providers, which typically serve 15 or fewer residents and often operate in smaller, homelike settings, compose a majority (62%) of licensed providers in Minnesota.

"There are thousands of smaller, culturally specific assisted living facilities across the US. While specific to Minnesota, these findings and recommendations could have implications for other states that are pursuing similar efforts.”

For a variety of reasons, ranging from lack of staffing capacity to language barriers to cultural differences in the care they provide, these smaller, culturally specific assisted living facilities have experienced challenges in conforming to the state’s new regulatory framework.

The Study

Now, two years after the new licensing and regulatory requirements were enacted, a study from the University of Minnesota uses newly available health inspection survey data to explore differences between these smaller, culturally specific providers and larger, majority providers.

Rajean Moone and Tetyana Shippee

The research team was led by Rajean Moone and Tetyana Shippee. Moone is the Faculty Director for Long Term Care Administration programs in the College of Continuing and Professional Studies and Shippee is a School of Public Health professor who has been partnering with the Department of Human Services (DHS) on the recently released Assisted Living Report Card. Both have published extensively on topics related to policy and aging. 

Megan Hakanson served as a student research assistant. Doctoral student Hawking Yam provided statistical analysis support.

The team first used the health inspection survey data to see if there were any significant differences between facilities with 15 and fewer residents and larger facilities. The researchers found few differences when applying statistical analyses to uncover deficiencies in the facilities’ care.

Researchers then interviewed directors of small, culturally specific assisted living facilities in order to better understand their experiences and capture recommendations for additional regulatory reform that may increase the quality of care for residents. 

Challenges and Solutions

The study identified four key challenges faced by smaller, culturally specific providers. For each challenge, the researchers also provided solutions.

  • Challenge 1: Lack of participation in the initial development of the licensing and regulations. Solutions: State agencies should ensure that all stakeholders are engaged in policy and systems development, further explore the requirements for obtaining the Licensed Assisted Living credential, collect relevant demographic data, and leverage the Residential Providers Association of Minnesota as an effective voice for small, culturally specific providers.
  • Challenge 2: Challenges confronted when implementing the licensing requirements. Solutions: Create an exemption in the state licensing requirements for small residential providers, and evaluate the Licensed Assisted Living Director credential for possible improvements to the licensing process.
  • Challenge 3: Inconsistencies in the state’s system of survey inspections of assisted living facilities. Solution: Provide comprehensive education and technical assistance to all facilities
  • Challenge 4: Inadequate reimbursement and funding issues. Solutions: Develop new rate setting methodology for Medicaid waivers, establish a cross-agency coordination team between the Department of Health and DHA, and evaluate the impact of Housing Support discrepancies.

"There are thousands of smaller, culturally specific assisted living facilities across the US," says Moone. "While specific to Minnesota, these findings and recommendations could have implications for other states that are pursuing similar efforts.”

Research synopsis provided by the School of Public Health. 

Funding for this research was provided by the Borchard Foundation Center on Law & Aging.