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Minnesota Department of Health Releases Proposed Assisted Living Licensure Rules

The Minnesota Department of Health is proposing new rules governing assisted living facilities (Chapter 4659).

The draft rules were submitted to the Governor’s Office on Oct. 8, 2020. It is important to note that these rules are not yet final, and changes may be made through the rulemaking process. The release of these Proposed Rules is the next step in preparing for licensure that will take effect on August 1, 2021. The proposed rules are available online at Assisted Living Facilities Proposed Rules -- 10/8/20 (PDF).

A Notice of Hearing will be published later this year, which will start a 30-day public comment period. You do not need to wait until the formal comment period is opened to submit comments on these rules, and may submit comments using the following form: https://survey.vovici.com/se/56206EE31E37CEEC.

The Assisted Living Rulemaking Advisory Committee will be meeting on November 5 to discuss the proposed Assisted Living Licensure Rules as a committee.  Kari Thurlow from LeadingAge MN staff sits on this committee and represents our members. In addition to submitting comments to MDH, please feel free to share comments with Kari at kthurlow@leadingagemn.org.

The Proposed Rules cover many topics, and LeadingAge MN will be preparing a comprehensive summary of the rule. The following is a summary of some of the key components of the Proposed Rule. Please note this is not a complete summary:

Pre-Termination Procedures:

Before an assisted living setting can terminate the services and lease of a client, it must hold a pre-termination meeting with the resident and resident’s representative. A written notice must be provided at least 5 days before the meeting and must include (among other things) a proposed time, date, and location of the meeting; a detailed explanation of the reason(s) for the proposed termination; a list of facility individuals who will attend the meeting; an explanation that the resident may invite others; contact information for the Ombudsman; the name and contact information of an individual at the facility whom the resident may contact about the meeting or to request an accommodation; notice that attendees may request reasonable accommodations for a communication disability or if they speak a language other than English; and notice that if the resident’s housing or services are terminated, the resident has the right to appeal.

At the pre-termination meeting, the facility must collaborate with the resident and the resident’s representatives, case manager, and any other individual invited by the resident, to identify and offer any potential reasonable accommodations, modifications, interventions, or alternatives that can address the issues underlying the termination. Within 24 hours after the pre-termination meeting, the facility must provide the resident with a written summary of the meeting, including any agreements reached about any accommodation, modification, intervention, or alternative that will be used to avoid terminating the resident’s assisted living contract.

Resident Relocation Evaluation and Plan:

If a facility terminates a resident’s contract, or if the resident plans to move out because a facility-initiated a pre-termination procedure, the facility must prepare a written resident relocation evaluation and plan. The evaluation must include the following: the resident’s current service plan; a list of safe and appropriate housing and service providers that are in reasonably close geographic proximity to the facility and are able to accept a new resident; the resident’s needs and choices; and the right of the resident to tour the safe location and appropriate service provider, if applicable, prior to relocation.

The relocation plan is prepared during a planning conference that includes the resident, the resident’s representative and case manager, and other individuals invited by the resident. It incorporates the relocation evaluation and the date and time that the resident will move; the contact information of the receiving facility; how the resident, and the resident’s personal property including pets, will be transported to the new housing provider; how the facility will care for and store the resident’s belongings; recommendations to assist the resident to adjust to the new living environment; recommendations for addressing the stress that a resident with dementia may experience when moving to a new living environment, if applicable; recommendations for ensuring the safe and proper transfer of the resident’s medications and durable medical equipment; arrangements that have been made for the resident’s follow-up care and meals; a plan for transferring and reconnecting phone, internet services, and any electronic monitoring equipment; and who is responsible for paying moving expenses and how the expenses will be paid. There are expedited procedures proposed for emergency relocations.

Assessments

The Rule prohibits an assisted living facility from admitting or retaining a resident unless it can provide sufficient care and supervision to meet the resident’s needs, based on the resident’s known physical, mental, or behavioral condition. Prospective residents who are denied admission must be informed of the reason for the denial. A nursing assessment or reassessment must be conducted by an RN on a prospective resident or resident receiving any of the assisted living services. An assisted living facility must be able to conduct a nursing assessment during the weekend for a resident who is ready to be discharged from the hospital and return to the facility. The assessment must be done using a Uniform Assessment Tool described in the Rule.

Staffing

A clinical nurse supervisor must develop and implement a written staffing plan that provides an adequate number of qualified direct-care staff to meet the residents’ needs 24-hours a day, seven-days a week. When developing a direct-care staffing plan, the clinical nurse supervisor must ensure that staffing levels are adequate to address the following: each resident’s needs as identified by the service plan and assisted living contract; each resident’s acuity level, as determined by the most recent assessment or individualized review; the ability of staff to timely meet the residents’ scheduled and reasonably foreseeable unscheduled needs given the physical layout of the facility premises; whether the facility has a secured dementia care unit; and staff experience, training and competency.

The clinical nurse supervisor must develop a 24-hour daily staffing schedule. The

schedule must include direct-care staff work schedules for each direct-care staff member showing all work shifts, including days and hours worked; and identify the direct-care staff member’s resident assignments or work location. The daily work schedule must be posted at the beginning of each work shift in a central location on each floor of the facility, accessible to staff, residents, volunteers and the public.

A minimum of two direct-care staff must be scheduled and available at all times whenever a resident requires the assistance of two direct-care staff for scheduled and unscheduled needs. During the hours of 10:00 p.m. to 6:00 a.m., direct-care staff shall respond to a resident’s request for assistance with health or safety needs as soon as possible, but no later than 10 minutes after the request is made.

Staff Training

A facility must establish, implement, and keep current policies and procedures for staff orientation, training, and competency evaluation, and a process for evaluating staff performance as required under the assisted living licensure law. The facility’s training policy must identify the

requirements for retraining staff when the facility determines that a staff person is not demonstrating competency when performing assigned tasks. If retraining does not result in competency, the facility must identify the additional steps it will follow to ensure the staff person achieves competency, the time frame for completing the additional steps, and the actions the facility will take to protect resident rights until competency is achieved.

Settings operating under an assisted living facility with dementia care license are responsible for

ensuring and maintaining documentation that individuals providing or overseeing staff training relating to dementia and dementia care have the work experience and training required under the statute and have successfully passed a skills competency or knowledge test required by the commissioner before the individual provides or oversees staff training. The commissioner must publish and update, as needed, a list of acceptable skills competency or knowledge tests on the department’s website that are based on current best practice standards in the field of dementia care and meet requirements of the statute.

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