When Minnesota passed the Assisted Living Licensure Law earlier this year, it created a framework to protect the health and safety of the state’s elderly and vulnerable adults living in such facilities. Implementing it requires writing the specific rules for the facilities to follow and establishing methods for evaluating how satisfied residents are with their care and living environment. For help with both projects, the State has turned to nationally-known long-term care quality researcher and School of Public Health (SPH) Associate Professor Tetyana Shippee. Shippee was recently appointed by state health commissioner Jan Malcolm to serve as a scientific expert on the law’s rulemaking advisory panel. Shippee is also leading the creation of assisted living resident and family surveys to measure how well the facilities are performing as well as a report card to communicate the results to consumers and policymakers.

“I am honored to be involved because it’s an opportunity for SPH and me as a faculty member to serve the citizens of our state in a critical way: working to improve care of the elderly,” says Shippee. “In developing the report card, I’m learning about quality areas that consumers say are important to them, which can then be addressed in writing the rules for the law.”

The rules of law  

Before the law was passed, Minnesota was the only state in the country that didn’t require assisted living communities to be licensed. The new law passed by the Minnesota Legislature sets priorities and objectives for regulating how assisted living facilities operate in the state. However, the law didn’t fully define and list what those rules and policies should be. The Minnesota Department of Health (MDH) is responsible for setting the regulations, such as describing what constitutes resident neglect and abuse, adequate facility staffing ratios, and emergency preparedness procedures.

When the then-bill was first being drafted, MDH convened the Assisted Living Licensure Rulemaking Advisory Committee to write it. The committee, which holds monthly public hearings, is made up of representatives from long-term care, elder law, and consumer advocacy organizations.

Now that the bill has become law, the health commissioner is required to publish the proposed rules by Dec. 31, 2019, and finalized rules by Dec. 31, 2020. 

Malcome added Shippee to the committee to ensure the inclusion of research expertise in writing the rules. 

“The goal of the committee is to operationalize the law, that is, to determine how it’s brought into practice,” says Shippee. “By serving on the committee, I aim to present scientific evidence and examples from other states that also inform the work of creating the Assisted Living Report Card.”

Shippee is also uniquely qualified to help make the law real because she once trained to be a lawyer.

“I have a law degree, so I understand how to work with legislative and political processes to establish effective policies,” says Shippee. “I’m excited to serve the process of fleshing out the law by, hopefully, acting as a neutral member on the committee that also has provider and consumer groups with potentially different interests.” 

Learning what matters most

As a complement to the new law, Minnesota’s Department of Human Services (DHS) is responsible for producing an Assisted Living Report Card and asked Shippee to help develop and test it. The report card aims to help consumers select and compare across facilities, and improve provider performance. Shippee previously worked with DHS on various iterations of its nursing home report card, including recent changes for short-stay nursing home residents which are based on her research into resident quality of life characteristics.

“Informing the development of Assisted Living Report Card is a tangible way that SPH is serving Minnesotans,” says Shippee. “The University of Minnesota is a land-grant institution, which means we’re here to benefit the state. By using research evidence to develop the report card and serving on the rule-making committee, we’re advancing  the well-being of older Minnesotans in a very meaningful way.”

The team developing the card includes Shippee, Professor Tim Beebe — a nationally known survey researcher — as well as two SPH graduate students. Odichinma Akosionu is a doctoral student in the school’s Health Services Research, Policy and Administration Program and also a former researcher with the Minnesota Department of Human Services. Emily Friedrich is a second year Master of Healthcare Administration student, who is a licensed nursing home administrator and currently holds a position in a senior care facility in Moorhead, MN. The team also contracts with the University of Minnesota Office of Measurement Services for the execution of the online surveys. 

The project began last winter when the researchers did a review of national studies, reports and expert interviews from across the country to figure out what others have previously said matters most in ensuring high quality of life in assisted living communities.

“Based on that research, we identified nine domains — broad categories of quality — that appear important nationwide,” says Shippee. “Now, we want to know which of these categories matter most to Minnesotans and hear from them if something is missing.”

To find out, Shippee and DHS launched a state-wide, online survey to residents, family members, providers, consumer advocates and other important stakeholders. The survey is designed to get feedback on the importance of different categories of quality — such as resident quality of life, safety and health outcomes, and staff quality — as well as other aspects of assisted living. It also asks survey-takers to identify if other important areas of quality are missing and what they think are key investments that need to happen to ensure high quality in assisted living. The survey is open through Nov. 30 and can be found online.

“The survey will be used to determine what domains of quality should be represented on the report card,” says Shippee. “It’s unlikely that all nine domains will be represented on the report card, but we will identify the priority domains that stakeholders say matter most. For example, if a majority of respondents identify staffing as the key domain, we will provide that recommendation for the state for potential inclusion in the report card.”

Shippee and her team will report the results of the survey to DHS by the end of December. After that, they’ll use the information along with other data to develop resident and family pilot surveys that will go out to a sample of assisted living sites in mid-2020. The pilot surveys will test how well residents and family members are able to answer the questions, how long it takes to complete the questionnaires and other aspects. The researchers will report their findings and make survey recommendations later that fall. DHS will then finalize and distribute the official report card surveys to assisted living residents and their families by Jan. 2021.

For more information on the new assisted living facility licensure law, read this PDF from the Minnesota Department of Health.