In 2021, the State of Minnesota enacted sweeping legislation to reform its regulatory approach to senior care and create a new license for all assisted living facilities in 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: providers that serve Black, Indigenous and other diverse communities — often operating in smaller, home-like settings. While these providers typically serve 15 or fewer residents, they comprise 62% of licensed providers in Minnesota.

Small, culturally-specific assisted living facilities have experienced challenges in conforming to the state’s new regulatory framework for a variety of reasons, from lack of staffing capacity and language barriers to cultural differences in care. 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 providers in the state.

The study 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 care.

University of Minnesota School of Public Health (SPH) 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. The study identified four key challenges faced by smaller providers and policy recommendations for State agencies to address them:

• Lack of participation in the initial development of the licensing and regulations
  Ensure 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.
• Challenges confronted when implementing the licensing requirements
  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.
• Inconsistencies in the state’s system of survey inspections of assisted living facilities

Provide comprehensive education and technical assistance to all facilities.

• Inadequate reimbursement and funding issues

Develop a new methodology for setting rates for Medicaid waivers, establish a cross-agency coordination team between the Department of Health and Department of Human Services and evaluate the impact of Housing Support discrepancies.

The research team was led by principal investigator Rajean Moone, with co-investigator, Tetyana Shippee. Moone is the faculty director for Long Term Care Administration programs in the College of Continuing and Professional Studies and Shippee is an SPH professor who has been partnering with DHS on the recently released Assisted Living Report Card. Both have published extensively on topics related to policy and aging. Megan Hakanson was hired as a student research assistant. Doctoral student Hawking Yam provided statistical analysis support.

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

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

For more information on long term care administration programs at the UMN, go here.