Work to design a “report card” for assisted-living facilities in Minnesota is entering its third phase with a target of having the online tool fully in place by the end of summer 2022.

Along the way, Minnesota is advancing from the back of the pack in its regulation of the facilities to at or near the top, says one of the report card’s designers.

“What we’re doing here in Minnesota, we jumped from the bottom of the line to the front of the line, because we are actually … (establishing) a precedent for how this work could be done,” said Tetyana Shippee, an associate professor in the University of Minnesota School of Public Health.

Tetyana Shippee
Tetyana Shippee

Assisted-living facilities provide a varying level of services to residents below the level of skilled-nursing facilities — traditionally known as nursing homes — in a more homelike atmosphere.

They can range from utilitarian to downright swanky.

“People thrive in the shared warmth of a community offering sunny outdoor patios, a garden room, cozy common areas and shoreline views,” says the website for The Shores, the assisted-living facility at Ecumen Lakeshore in Duluth. “Chef-prepared meals are served in The Shores’ beautiful lakeside dining area.”

That’s not what assisted living looks like everywhere, said Patti Cullen, president and CEO of the industry group Care Providers of Minnesota.

“You’re not going to get … assisted-living (facilities) that have the pool room and the library and the walk-in therapy pool and all those added features; you’re not going to see that in some of the communities where they just know their market is people who are poor,” Cullen said.

Below the surface, you might not know what you’re really getting, because Minnesota is the only state in the nation where assisted-living housing is unregulated. Prompted by media reports of abuse in some facilities, the Minnesota Legislature last year passed an elder care reform package.

One of the elements of the package is the development of the online report card, which will be intended to allow consumers to see who the places they’re considering for their loved ones have been evaluated by others according to certain criteria.

It’s something that consumers have come to expect, said Cheryl Hennen, ombudsman for the Minnesota Board on Aging.

“When we are purchasing a service, or we’re purchasing a product, as an example off of Amazon, we’ll see reviews,” Hennen said. “I feel that the American consumer needs to be much more aware of what other people are experiencing.”

An online report card already exists for the state’s nursing homes, but the version for assisted-living facilities won’t merely duplicate that, Shippee said.

“Assisted living is not — I will say with an underline and bold — nursing homes,” she said. “The history of assisted living is different. It serves, aims to serve, in a different way.”

So Shippee led a team formed last year that first looked at national sources and other states to see how they were evaluating assisted-living facilities. In late September, they shifted their sights to Minnesota, gaining input from focus groups, webinars and an online survey. By late November, they had input from more than a thousand people.

She was impressed, Shippee said, that 30% of survey respondents were residents or family members. Many took the time to write out thoughtful answers to open-ended questions.

The level of response showed her, she said, that this is an issue of importance to Minnesotans.

From providers and family members, via all means of gathering information, three concerns consistently rose to the top, Shippee said:

  • Residents’ quality of life.

  • Staff quality.

  • Safety.

Getty Images
Getty Images


Staffing issues

Residents’ quality of life will be a key element in the report card when it comes out, Shippee said. Safety issues are being addressed in some of the other measures in the elder care reform package. But based on the survey, she plans to advocate that more attention be paid to staff quality.

“Our items on staff quality were not just about staffing ratios,” she said. “Many people, in open-ended comments wrote about staff training, staff credentials, staff actually treating people with dignity and respect.”

That concern is linked to lack of numbers, said Maisie Blaine, Board of Aging ombudsman for the region that includes Duluth.

“Despite the fact that facilities are doing staff training and vulnerable adult education, they’re keeping sometimes substandard employees and just reprimanding and re-educating, because they don’t have anyone else that wants to come in and work,” Blaine said. “And then residents, of course, feel that. They can tell if someone doesn’t want to physically be there caring for them.”

She wants to see what the state will come up with for minimum staffing numbers at assisted-living facilities, because there’s currently no required staff-to-resident ratio, Blaine said. But in a season of relatively low unemployment, the needed people just aren’t available.

“I think every facility in the Northeast region and across the state will tell you we don’t have enough physical bodies to come in and do the job,” Blaine said.

Shippee is impatient with the argument, at least when it comes to assisted living, that facilities can’t afford to raise staffing and quality levels by paying more because their government reimbursements are too low.

“Let’s not forget that with assisted living, a tiny sliver of pay comes from Medicaid,” Shippee said. “This is all private pay. And these are high rates that folks are paying.”

Cullen acknowledged that the majority of assisted-living residents pay out of their own resources. But that’s not true in some parts of the state, she said.

“The northwestern side of Minnesota, the upper north sector of our state has a super high Medicaid population,” Cullen said. “We have assisted livings in that part of the state that are 80-90% people on Medicaid.”

Providers welcome the idea of a report card, and she’s mostly pleased with the process so far, Cullen said. She’s a little concerned, she added, about the possibility of going overboard on the side of safety at the expense of the resident independence that has been a hallmark of assisted living.

“There’s a tendency to go to the highest level of regulatory oversight, so safety at all costs,” Cullen said. “But yet these are individual seniors that have free will and free choice and freedom to make bad choices.”

Now that data collection is complete, the process continues. Peter Spuit, a Minnesota Department of Human Services official involved in the project, said a pilot program will be conducted in September and the online report card development will begin next January. The report card, containing multiple measures, including survey results, will be rolled out from September 2021 through August 2022.